Inspection on 28/06/06 for Hollymere House General Nursing Home

This inspection was carried out on 28th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hollymere House General Nursing... 14/09/07

Hollymere House General Nursing... 24/10/05

Hollymere House General Nursing... 05/07/05

Hollymere House General Nursing... 11/10/04

Hollymere House General Nursing... 08/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hollymere House General Nursing Home Crewe Road Haslington Crewe Cheshire CW1 1QZ Lead Inspector Wendy Smith Key Unannounced Inspection 28th June 2006 8:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hollymere House General Nursing Home Address Crewe Road Haslington Crewe Cheshire CW1 1QZ 01270 501861 01270 585043 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Gillian Bratt Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (2) of places Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 service users to include:* Up to 48 service users in the category OP (old age not falling within any other category) * Up to 2 service users in the category PD (physical disability) aged between 60 and 64 years 24th October 2005 Date of last inspection Brief Description of the Service: Hollymere House is a modern two-storey property that was purpose built as a care home for older people. It is set in its own grounds, that are shared with the neighbouring Primrose House nursing home. The homes are in the Haslington area of Crewe close to local amenities and within reach of Crewe town centre. The homes are owned by Southern Cross Healthcare Ltd. Hollymere House has 48 single en-suite bedrooms and there are two lounges and a dining room on each floor. Bathing facilities are provided on both floors and a nurse call system is installed in all areas. There is ample parking space within the grounds. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out on 28th June 2006 as part of the Commission for Social Care Inspection’s inspection programme. The home had 48 residents, of whom two are under 65 years of age, 35 were receiving nursing care and 13 receiving personal care. Time was spent in conversation with the manager and other members of staff. Residents and visitors were also spoken with and, in general, they were satisfied with the care provided at the home, but had some complaints about catering. Comments cards were sent to GP’s, social workers, residents and relatives and some very positive comments were made. A sample of care plans and other records were looked at and the arrangements for medicines were reviewed. The home’s weekly fee for self-funding residents is £585.50 for those receiving nursing care and £479.50 for personal care. What the service does well: All residents are assessed by a social worker and by the home manager before admission to ensure that their needs can be met. Care plans are completed to a good standard and provide evidence that the health needs of residents are met. The arrangements for handling medicines meet the required standard. Residents and their relatives reported that staff are welcoming and caring. Complaints are responded to appropriately. Staff are provided to meet the needs of residents and 60 of care staff have an NVQ qualification. Good recruitment practices are followed. The home is well managed by an experienced manager and the views of stakeholders are listened to. Health and safety safeguards are in place. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have been assessed before admission and are appropriately placed at the home. EVIDENCE: The home manager said that she assesses all prospective residents prior to admission being arranged and the care plans looked at provided evidence that this was taking place. The care plans also contained assessments by a social worker. Two residents are under 65 years of age. Some residents have cognitive impairment due to dementia, however they also have health needs that require nursing care. There was no evidence to suggest that any residents were inappropriately placed at this home. Hollymere House does not provide intermediate care. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and care needs of residents are met to a good standard. EVIDENCE: A sample of three care plans was looked at and they had all been completed to a good standard. A resident admitted the previous week had a very helpful ‘pre-admission draft care plan’ written by the manager following assessment. For a resident admitted in October 2005 the care plan reflected improvements in her health and functioning. The third resident was very frail and being cared for in bed. She has lived at the home for two years and care plans have been re-written periodically to reflect changes. English is not her first language and a care plan has been written to address this. All care plans are reviewed monthly. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 10 The care plans recorded visits by GP, chiropodist, nurse assessor, social worker, speech therapist, dietician and wheelchair fitter. In addition to the social worker review, the home has its own review with relatives every six months, or three months if resident has pressure sore. These are recorded in the care plan. A night check sheet records two hourly checks during the night for each resident. Residents can choose not to have these checks and one has done so. A monthly sheet for each resident records assistance given with personal hygiene. A shift handover sheet records any incidents and changes and action taken One resident has a grade 4 pressure sore and progress is evaluated at each change of dressings. One of the home’s nurses has a tissue viability qualification and is able to provided advice and guidance. The tissue viability nurse is also consulted as required. A monthly dependency and pressure sore audit is recorded. Arrangements for ordering, storage, administration and disposal of medicines were looked at and found to be satisfactory. A monthly medicines audit is conducted and a new format for this, that is very comprehensive, has just been introduced. Comments received from relatives included ‘my husband is treated with dignity’, ‘all the carers here are very good’ and ‘the carers are approachable and welcoming’. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social needs of residents are provided for but the standard of catering needs to improve. EVIDENCE: The home has two part-time activities organisers working a total of 35 hours per week. On the day of the inspection two residents were enjoying a game of dominoes and others appreciated a visit by a small friendly dog. Other regular social events include crafts, music for health, stroke club and visits to the local pub. 24 visitors had signed in the visitors book between 10 am and 3:30 pm on the day of this visit. Some visitors were assisting their relatives with lunch. Over recent months there have been a number of complaints and concerns raised regarding the standard of meals provided. A new head chef had started working at the home on Monday 26th June 2006 and had excellent references from previous employment. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and allegations are responded to appropriately. EVIDENCE: Two complaints have been recorded since the last inspection. Records looked at showed that these had been fully investigated, responded to, and action taken. The standard of record-keeping was good. Three visitors completing comments cards indicated that they were not familiar with the home’s complaints procedure. This was discussed with the manager who confirmed that the complaints policy is displayed in the entrance area and a copy is given to all new residents and their families. An allegation of abuse was reported to social services and responded to. Southern Cross have robust adult protection procedures, but not all staff have received adult protection training. Requirement made Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and well-maintained but requirements made for the improvement of bathrooms and ventilation have not been actioned. EVIDENCE: A housekeeper has been appointed and has made great improvements to the cleanliness of the home. There is also a new maintenance person, who said that he is enjoying the job and is working closely with the maintenance person from Primrose House. The gardens were well tended and fences had been painted. The refuse area was clean and tidy. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 14 Overall the building is maintained in good condition however some improvements are needed. A number of double-glazed window panels are blown and have been for several years. Exterior woodwork at the rear of the property needs to be re-painted. The chairs in two lounges are uncomfortable and unsuitable which may partly account for the fact that no residents use these lounges. There are two bathrooms on each floor of the home. All of these have a low level bath. One has been out of use for several months. Two bathrooms have a bath seat but none of the baths can be accessed using a hoist. A carer described that she has to put a towel on the floor and kneel down in order to assist residents with bathing. Bath panels are of poor quality. A requirement for the improvement of bathrooms was made in 2004 and since then a shower room has been added, but the remaining bathrooms have not been improved. The manager said that she has to wait a long time for any improvements of this scale to be authorized. The home’s maintenance person has started redecoration of the first floor corridor because of the time delay for the authorization of contract decorators. There are continuing problems with the building becoming very hot in summer, particularly on the first floor. Staff were advised to keep a daily temperature record to demonstrate the extent of the problem. Requirements and recommendations made. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably trained and qualified staff are provided to meet the needs of residents. EVIDENCE: The home employs six registered nurses, of whom four are overseas nurses and have a good command of English. There are two senior carers and 27 care assistants. The manager said that she is working towards having a senior carer on duty every night. There is minimal use of agency staff. 60 of care staff have an NVQ qualification and six more are working towards this. The recruitment records of the last three staff to be employed were looked at. These provided evidence that good recruitment practices had been followed. A three monthly training plan is in place and a training matrix showed what training each member of staff had received. The home has two moving and handling trainers and all staff were up to date in moving and handling. Some staff have not yet had adult protection training, although the manager said that this is included in the induction training for new staff. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. EVIDENCE: The home has an experienced manager who is a registered nurse. She is working towards a management qualification. A comments card received from a GP said ‘The current home manager has given stability to the changing management structure and has helped the trained staff to grow professionally’. A comments card from a relative described the home as ‘A very supportive and caring environment where our comments are listened to’. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 17 Since the last inspection the manager provided management cover for another home in the area for several weeks but is now back full-time at Hollymere. The home also has a Care Manager. Some difficult staff issues have been addressed in recent months. Within the last three months meetings have been held for nurses, care staff, and residents and relatives. Monthly auditing tools are in place for care plans, medicines and accidents. Visits required by regulation 26 of the Care Homes Regulations are carried out by the area manager. All policies and procedures have been reviewed in 2006. The home has an administrator who deals with day to day finances. The home does not handle any residents’ finances, however most residents have small amounts of personal spending money in the safe. Receipts are provided for all money received and paid out. Residents money is kept in individual envelopes. Written and electronic records are kept. The pre-inspection questionnaire completed by the home manager provided dates when all equipment was tested and serviced. The maintenance person carries out weekly tests of the fire alarm and emergency lighting. Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 Requirement The home’s bathrooms must be improved so that they are suitable to meet the needs of residents who require assistance with bathing. This requirement has been made in previous inspection reports and the last timescale of 31/12/05 has not been met. The registered provider is to be contacted so that a timescale can be agreed with the Commission for Social Care Inspection. The ventilation of the home and in particular the bathrooms must be improved. Time scale of 31/12/05 not met. Ensure that all staff receive POVA training. Timescale for action 28/06/06 2. OP25 23 31/10/06 3 OP18 13, 18 31/08/06 Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP15 OP19 OP19 OP19 Good Practice Recommendations The standard and variety of meals should be improved. Window panels should be replaced as needed. Some exterior woodwork needs re-painting. Provide comfortable chairs in all lounges Hollymere House General Nursing Home DS0000018737.V294723.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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