Inspection on 05/07/05 for Hollymere House General Nursing Home

This inspection was carried out on 5th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

Hollymere House General Nursing... 28/06/06

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

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 Crewe Road Haslington Crewe Cheshire, CW1 1QZ Lead Inspector Wendy Smith Announced Inspection 5th July 2005 09:30 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 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 F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hollymere House Address Crewe Road Haslington Crewe Cheshire CW1 1QZ 01270 501861 Telephone number Fax number Email 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 Ltd Gillian Bratt (proposed) Care Home 48 Category(ies) of OP - Old Age (48) registration, with number PD - Physical Disability (2) of places Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 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 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 11th October 2004 Brief Description of the Service: Hollymere House is a modern two-storey property that was purpose built as a nursing home for older people. It is situated in its own grounds which 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 the town centre by public transport. Both homes are owned by Southern Cross Healthcare Ltd.The home 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 F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by two inspectors on 5th July 2005 over a period of six and a half hours. 48 residents were living at the home, of whom 25 were receiving nursing care and 13 receiving personal care. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. Staff records were inspected. A tour of the building, including communal areas and some bedrooms, was completed. Information was also taken from the pre-inspection questionnaire completed by the manager. Time was spent in conversation with the home manager, and several staff on duty were spoken with. Comments cards were received from nine residents and from 17 relatives/visitors. A letter was received from a relative and another three relatives and a member of staff made comments by telephone. Residents were mainly positive about the care they received at the home, however their comments indicated that meals and activities could be improved. Most relatives/visitors also made mainly positive responses and one described the staff as ‘very pleasant and helpful’. One relative commented that his mother would like a bath or shower more often, three had concerns regarding cleaning and maintenance, and another relative was concerned about a difficulty with a hoist. Three relatives expressed their concerns regarding a general lack of attention to individual needs and preferences that would make a great difference to the quality of life experienced by residents living at the home. Issues raised by two members of staff were discussed with the home manager. What the service does well: Care plans had been completed and maintained to a good standard. Medicines are well managed. Hollymere House provides accommodation that is spacious and well planned for residents who need to use a wheelchair. The bedrooms are of a good size and have en-suite facilities; some rooms have been very well personalised by the residents. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 6 Staff recruitment policies are in place and are followed to a good standard. The home’s laundry provides a good service for residents. What has improved since the last inspection? What they could do better: The home should demonstrate that residents are able to exercise choice in daily living routines, specifically times of getting up and going to bed, and that their individual needs are considered when personal care is delivered. The standard of catering should be improved. The range of activities should be improved, particularly for residents who are not able, or do not wish, to participate in group activities. Bathrooms need to be improved to provide a more sympathetic environment for residents and equipment that is less difficult for the staff to use. Ventilation of the building, in particular the bathrooms, needs to be improved. Window panels should be replaced as identified. An appropriate place should be provided for hairdressing to be carried out. The skill mix of staff working on night duty should be reviewed. Staffing levels should be maintained to meet the needs of residents at all times. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 7 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 F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 3. Standard 6 is not applicable. Residents are assessed before admission is agreed to ensure that the home can meet their needs. EVIDENCE: The manager said that she goes out to assess all prospective residents before admission to the home is arranged. Southern Cross Healthcare has a preadmission assessment pro-forma and completed copies of this were seen in residents’ care plans. There were also assessments by social services and health professionals. On the day of the inspection there were no residents who appeared to be inappropriately placed at the home. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7, 8, 9 and 10. Residents’ care needs, and how they should be met, are recorded in their care plans. Residents’ health care needs are fully met. Medicines are well managed. Personal care practices were not always considerate of the dignity of residents. EVIDENCE: A sample of four care plans was inspected. These had been completed to a good standard and a full review of the plan had been recorded each month. A local GP visits the home on a regular weekly basis. The manager said that the doctor will speak with relatives and will review medicines as requested. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 11 Three residents had pressure sores. Their care plans recorded wound care and demonstrated that appropriate treatment was being provided to promote healing. One of the nurses has expressed a particular interest in tissue viability and hopes to have the opportunity to attend advanced training in the near future. A relative highlighted a problem with a hoist that had been out of use awaiting repair for a considerable length of time. A complaint had been made about this and the manager had taken action following this complaint. Additional moving and handling equipment had been bought so that there were two different types of hoist on each floor of the home. There were no terminally ill residents at this time. A relative spoken with said that her mother had received excellent care during a recent illness. The home has a medication room which is of adequate size and was found to be tidy and orderly. Medication policies and procedures are in place. Registered nurses are responsible for medication for residents receiving nursing care, and three senior care assistants, who have received appropriate training, are responsible for medication for residents receiving personal care. Two separate systems are in place. A Nomad cassette system is used for residents receiving personal care and a monitored dosage system for nursing residents. Storage and administration, including controlled drugs, were seen to be satisfactory. The manager audits medication monthly and had addressed a recent problem identified with administration of warfarin. A number of personal care issues were raised with the inspectors and these included commodes not kept clean, baths not being carried out regularly, a resident being washed and dressed whilst sitting on the toilet, a resident with only a sheet on the bed and the relative went to get a blanket because staff were too busy, incontinence pads not changed for long periods, appropriate cups and spoons not always available. In general, the relatives spoken with considered that there were no major issues, but that there was a lack of sensitivity and attention to detail in the way in which care was provided to individual residents. See requirement. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 14 and 15. Residents did not always find that the lifestyle experienced in the home met their expectations and preferences. Friends and relatives may visit at any reasonable time. Residents did not always feel able to exercise choice and control over their lives. The standard of meals was acceptable but could be improved. EVIDENCE: Comments received from relatives, a resident and a member of staff indicated that residents may be got up early in the morning and put to bed early in the evening in order to assist the staff manage their workload rather than due to the personal choice of the resident. This was discussed with the manager who did not agree that this was the case, and said that residents who got up early in the morning only did so by choice. See recommendation. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 13 The home has a part-time activities organiser and on the day of the inspection a number of residents were joining in activities in the lounge. An activities programme was displayed in the entrance area, and residents have enjoyed several trips out recently. Activities appear to be orientated towards the more able residents who are able to join in group sessions. Five of the residents who completed comments cards considered that suitable activities were provided ‘sometimes’. The manager said that she hoped to recruit an additional activities organiser in order to provide a broader range of service. See recommendation. Hairdressing was taking place in the staff room, which was not ideal for staff trying to have their break time. See recommendation. Most residents used the dining rooms for their meals. In general, residents felt that their meals could be improved. One relative said that there had been only sandwiches for tea for the last month. The manager explained that the head chef had left the home and there was also a vacancy for a kitchen assistant. A new chef had been recruited and would be starting work at the home on 25th July. Whilst the current situation is not satisfactory, the inspectors appreciated the present difficulties and expect that the situation will improve when new staff are in post therefore a requirement has not been made at this time. This will be monitored at future inspections. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16. Complaints are dealt with appropriately. EVIDENCE: The home has a complaints procedure that meets the required standard. This is displayed in the home and included in the Statement of Purpose and Service User Guide. Three complaints had been recorded since the last inspection and records showed that these had been dealt with appropriately. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The home is generally safe and well-maintained, however some window panels are in need of replacement. Communal areas are provided to meet the required standard. Bathrooms in the home need to be improved. Specialist equipment was provided, however there had been some difficulty with maintenance of a hoist. All of the bedrooms meet the National Minimum Standards and many had been personalised by residents. There was some difficulty with over-heating, particularly in bathrooms. Hygiene standards had improved. The home provides good laundry and sluicing facilities, however laundry hours need to be reviewed. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 16 EVIDENCE: A tour of the home showed that it was generally well-maintained and was decorated and furnished to a good standard. Some of the window panels contained condensation and had been identified as needing replacement. See recommendation The home has four bathrooms and a shower room. All four baths are very low level and are therefore difficult for staff as they involve a great deal of bending in order to assist residents. Two of the baths do not have any bathing aids. Bath panels are damaged. Bathroom 56 has a bathing aid that is badly stained. See requirement Bathrooms have no natural ventilation and there was a problem with bathrooms becoming over-heated during recent hot weather. This had resulted in residents being unable to have a bath as it was too hot. Ventilation in other areas of the home had also presented problems during hot weather and high level windows had to be opened by the maintenance person by means of a ladder. This meant that staff could not close the windows when the weather became cooler. See requirement All bedrooms are single and have en-suite facilities. Bedrooms were seen to be appropriately decorated and furnished and some were personalised with residents’ own belongings. All areas of the home are spacious and accessible to wheelchair users. Equipment was seen to be in use to meet individual needs. The laundry was found to be clean and orderly. The laundry assistant has worked at the home for several years and has always taken great pride in providing a quality service for the residents. Due to the home now being fully occupied this was proving difficult to maintain, and the allocation of laundry hours needs to be reviewed. See recommendation. There had also been some difficulty with the ordering of cleaning products for the laundry. The home was cleaner and tidier than at previous inspections, however several relatives commented that this was not always the case. There was a vacancy for a cleaner. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The numbers and skill mix of staff rota’d to work during the day was satisfactory, however the levels had not always been maintained due to sickness. The skill mix at night must be reviewed. Recruitment policies and practices were satisfactory. EVIDENCE: The staffing rotas showed two nurses and seven care staff on duty between 8am and 8pm, however the inspectors were informed that due to sickness these levels could not always be maintained. A member of staff told the inspector that they were able to manage with lower staff numbers provided the staff ‘worked together’, however some of the relatives spoken, and another member of staff considered that the care of the residents was sometimes compromised by shortage of staff. The manager said that she is able to cover shortfalls with Agency staff. Some staff were working long hours, up to 72 hours a week on a regular basis, however their contract was only for 44 hours. This was discussed with the manager who said that this was by choice and that no one was pressurised into working long hours. Staff spoken with said that they were willing to work long hours in order to provide cover for the home. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 18 At night there is one nurse and four care assistants on duty. This means that the nurse has to give out medicines to 48 people and supervise the care on the two floors of the home. See requirement Staff files relating to four members of staff were inspected. These were found to be all in order with the exception of one Criminal Records Bureau disclosure, where it appeared that a POVA check had not been requested. The manager is aware of the need for a POVA check and said that she would check that this was always done in future. Staff have had appraisals and supervision sessions that highlighted the role of the key-worker. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33. The home is managed by a suitably qualified and experienced person. Quality monitoring systems are in place, however these do not appear to have addressed issues that are causing concerns to relatives. EVIDENCE: The manager has been in post since November 2004. She has previous experience as a home manager and has almost completed a Registered Manager Award. There is no deputy manager. Administration support is provided 25 hours per week. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 20 There are a number of quality monitoring systems in place. Satisfaction surveys have been carried out by Southern Cross Healthcare and the results are published and displayed in the home. There is a suggestions box in the entrance area. A residents meeting is planned for July 19th and a relatives meeting for 27th July. Monthly visits to comply with regulation 26 of the Care Homes Regulations are carried out by the area manager. Unfortunately the quality monitoring systems had not addressed all of the issues that were raised by residents, visitors and staff. See requirement made in relation to standard 8. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 2 3 3 3 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 2 x x x x x Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? 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 OP8 and OP33 OP21 OP25 OP27 Regulation 24 Requirement The registered person must review the quality of the care provided and make improvements where necessary. Bathrooms must be improved to meet the needs of residents requiring assistance. The ventilation of the home and in particular the bathrooms must be improved. The registered person must ensure that the numbers and skill mix of staff is appropriate to the needs of residents at all times. Timescale for action 30/9/05 2. 3. 4. 23 23 18 31/12/05 31/12/05 30/9/05 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. Refer to Standard OP12 OP12 Good Practice Recommendations The registered person should ensure that routines of the home do not take precedence over the individual needs and preferences of residents. Activities should be provided to cater for the differing needs of individual residents. F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 23 Hollymere House 3. 4. 5. OP12 OP19 OP26 The registered person should provide a suitable place for hairdressing to be carried out. Window panels should be replaced as needed. Staff hours allocated to laundry duties should be reviewed. Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, 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. Extracts may not be used or reproduced without the express permission of CSCI Hollymere House F51 F01 S18737 Hollymere House V228931 050705 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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