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Inspection on 10/05/05 for Holmesley Nursing Home

Also see our care home review for Holmesley Nursing Home for more information

This inspection was carried out on 10th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Holmesley is a relaxed and comfortable home providing high quality accommodation in a beautiful setting. The residents benefit from a well trained team led by a manager with good leadership skills. Staff have a good understanding of their roles and limitations, asking for advice as needed. Care planning is good and staff have a good knowledge of the residents needs and preferences. Residents all said that Holmesley is a happy place to live.

What has improved since the last inspection?

Since the last inspection a new conservatory with a decking area has been added to the home. A little used bathroom has been replaced with a shower room. Formal reviews of care plans, involving the resident, relatives and health and social care staff, where appropriate, have been introduced and are proving successful.

What the care home could do better:

The manager could improve her practice in relation to recruitment and the handling of allegations of abuse. The majority of hot surface temperature radiators have been covered. It is anticipated that all will be covered as part of the on going maintenance and decoration. The manager has been asked to consult with Devon Fire and Rescue Service in relation to the holding open of doors and has been asked to keep all receipts for service users monies.

CARE HOMES FOR OLDER PEOPLE Holmesley Nursing Home Fortescue Road Sidmouth Devon EX10 9QG Lead Inspector Teresa Anderson Announced 10 May 2005 10:00 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. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holmesley Nursing Home Address Fortescue Road Sidmouth Devon EX10 9QG 01395 513961 01395 519549 holmesley@tiscali.co.uk Mr Stephen Robert Barber, Mr Trevor Gosling 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) Mrs Margaret Anne Mantle Care Home 34 Category(ies) of OP Old age (34) registration, with number of places Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Notice of Proposal to grant for staffing/environmental conditions of registration issued 20/07/2000 2 The new extension will not be brought into use until the National Care Standards Commission has received written confirmation that Building Control, Environmental Health Department and Devon Fire and Rescue Service requirements have been met 3 The new extension will not be brought into use until an inspector has visited to confirm that the extension is ready for occupation and has been built according to plans which have been agreed with the Commission Date of last inspection 27 January 2005 Brief Description of the Service: Holmesley provides accomodation and personal care and nursing care for up to 34 residents with needs related to old age. The home is privately owned and is situated half a mile from the town and seaside resort of Sidmouth. The house is set in over 2 acres of grounds and gardens with views over the Sid Valley and down to the sea. The home has two lounges, a dining room and a newly constructed conservatory. Bedrooms are on the ground and first floors and are linked by a 13 person passenger lift and a stair lift. There are two double/twin rooms and the majority of rooms have ensuite facilities. Some rooms have a patio door directly onto a terrace and others have coastal views. The home has ample parking. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and was arranged with the owners and manager as part of the normal inspection programme. It took place between 10.00am and 5.00pm. The manager and owners had completed a preinspection questionnaire and one comment card from a relative was received by CSCI. The inspector spoke with approximately 18 of the 34 residents, with 2 relatives, with the manager, owner, deputy manager and 4 members of staff. She looked around the majority of the home and looked at paperwork in relation to care planning, staff recruitment, training and safe working practices. What the service does well: What has improved since the last inspection? What they could do better: The manager could improve her practice in relation to recruitment and the handling of allegations of abuse. The majority of hot surface temperature radiators have been covered. It is anticipated that all will be covered as part of the on going maintenance and decoration. The manager has been asked to consult with Devon Fire and Rescue Service in relation to the holding open of doors and has been asked to keep all receipts for service users monies. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 6 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. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 standard(s) 3. Comprehensive pre-admission assessments ensure, as far as is possible, that the home can meet the needs of potential residents. EVIDENCE: Prior to admission, the home manager assesses all prospective residents. These assessments are comprehensive to ensure that the home and staff can meet the needs of the resident. They include information from health and social care professionals where appropriate. Recently admitted residents said that their needs are being well met and that they were ‘very happy’ with the choice they had made. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. The health and personal care needs of residents are identified and met. The homes arrangements for the management of medicines are robust. Residents have their privacy and respect protected and promoted. EVIDENCE: All aspects of residents’ health, personal and social care needs are identified and planned for in easy to read care plans. Staff have a sound knowledge of the individual needs and preferences of residents. Plans are kept up to date and are reviewed by staff frequently. Daily routine preferences are kept in the residents bedroom for staff to refer to and to communicate new information. At the last inspection, the manager planned to introduce formal reviews, involving the family and health care professionals where appropriate. Where this has taken place, it has proved to be successful in ensuring the care received is the care the resident wishes for. Health care needs are monitored and well met. Comments from residents included ‘they look after me so well’ and ‘if I need the doctor, they always call for one’. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 10 All staff who administer medications are registered nurses and receive appropriate training updates. Systems and records in relation to medication are sound. Discussions with staff, residents and observation of interactions between staff and residents demonstrated that the privacy, dignity and respect for residents is given a high priority. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 standard(s) Not inspected on this occasion. EVIDENCE: Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 standard(s) 16 and 18 The home has a robust complaints procedure and residents are confident that all complaints and suggestions will be taken seriously and acted upon. Residents are not fully protected by the adult protection procedures in place. EVIDENCE: The manager at Holmesley welcomes complaints and comments as part of the quality improvement procedures. Since the last inspection in January one complaint has been received by the home. Residents told the inspector that if they weren’t happy with something, they just have to say and it is dealt with. They say they feel safe and well looked after. Holmesley has copies of the appropriate procedures to be followed if an allegation of abuse is made. Whilst staff do receive training there is evidence that they do not all have a sound understanding of these procedures. On one occasion this has resulted in the complaints procedure being inappropriately followed when the Protection of Vulnerable Adults procedure should have been followed. It is recommended that the manager receive training from Devon County Council in the Protection of Vulnerable Adults. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 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 standard(s) 19 and 26. Residents live in a safe, comfortable and clean environment that is well maintained. EVIDENCE: Holmesley has a number of communal areas where residents can choose to spend their time. These include their own well-furnished bedrooms, a lounge, dining room and newly constructed conservatory. In addition, the lounge can be partitioned off for residents to receive their visitors in private. All areas of the home are maintained and furnished to a high standard. There are a number of seating areas outside where residents told the inspector they enjoy the sunshine and views. Some of the residents had been counting the number of bird varieties and some were trying to identify the many trees in the surrounding land. The home and residents benefit from numerous housekeeping staff, laundry staff and a full time maintenance man. The latter undertakes routine maintenance and helps residents to, for example, put up pictures, adjusts banging doors and changes mattresses at resident’s requests. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 14 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, 29 and 30. Residents confirm that their needs are met by staffing numbers and skills. Staff are well trained, supervised and are competent. Residents are not fully protected by the homes recruitment policies and procedures. EVIDENCE: As a nursing home, Holmesley has a registered nurse on duty 24 hours a day. In addition the manager, also a registered nurse, works office hours. Staffing numbers are flexible according to the dependency needs of residents. Residents say that staff are busy but always respond to them and are always kind and helpful. Comments included ‘this is such a happy place’, ‘ the staff are wonderful’ and ‘they have warm smiles’. Housekeeping, laundry and kitchen staff support care staff. In addition the home employs two activities coordinators. Whilst the recruitment policies are sound, the manager should ensure that references are appropriately taken up, for example, from the last employer. Staff receive varied and appropriate training which equips them to care for people with diverse needs. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 15 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, 32, 33, 35 and 38. There is clear leadership and guidance to staff to ensure residents receive consistent care. Some elements of the environment are potentially not safe. EVIDENCE: Holmesley has an experienced nurse manager who is well respected and supported by the owners, deputy manager and nursing and care staff. The staff team are committed and understand the ethos of the home and work hard to ensure that the home is run for the benefit of service users. Good quality monitoring and improvement systems are in place. When asked what the home might improve one resident said she would like more broad beans and others said ‘nothing’. Some safe working practices are followed which include mandatory training, maintenance and checks. During the inspection the fire alarm sounded. All staff followed the correct procedures, the fault was found and this was dealt with appropriately. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 16 Some hot surface radiators are not yet covered posing potential risk to residents and it is planned this will be completed as part of the risk assessment and refurbishment programme. Holmesley is undergoing continual refurbishment. Part of this includes the replacement of all bedrooms doors with fire doors which can be held open by magnetic holders. Whilst this is ongoing the manager has not yet consulted with Devon and Fire Rescue Service to ensure that the procedures and practices being used in relation to the holding open of bedroom doors are safe. Systems for storing and managing resident’s monies are good. However, more detailed records of monies spent should be kept to ensure clear audit trails. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 17 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 x 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 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 4 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 4 3 x 2 x x 2 Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 18 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 25 Regulation 13(4) Requirement The registered person must ensure that all parts of the home to which service users have access are as far as reasonably practicable free from hazards to their safety. (This relates to the need to ensure all hot surface radiators are covered). The registered person must consult with the fire authority to ensure that adequate arrangements are being made for containing fires. (This relates to bedroom doors being held open). Timescale for action 31/12/06 2. 38 23 (4) 24/05/05 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 18 29 Good Practice Recommendations The registered person should ensure that all allegations of abuse are followed up using the procedure laid down in the Alerters Guide. The registered person should ensure that two appropriate references are obtained before appointing a member of staff. D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 19 Holmesley Nursing Home 3. 4. 30 35 The registered person should arrange to undertake training in the Protection of Vulnerable Adults with Devon Social Services. The registered person should ensure that appropriate recepts are kept when handling service users monies. Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Holmesley Nursing Home D54 D06_s26664_holmesley_v217172_100505 stage 4.doc Version 1.30 Page 21 - 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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