CARE HOMES FOR OLDER PEOPLE
Holmesley Nursing Home Fortescue Road Sidmouth Devon EX10 9QG Lead Inspector
Teresa Anderson Unannounced Inspection 10:30 18 December 2005
th 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 Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holmesley Nursing Home Address Fortescue Road Sidmouth Devon EX10 9QG 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) 01395 513961 01395 519549 holmesley.nursing@virgin.net Mr Stephen Robert Barber Mr Trevor John Gosling Mrs Margaret Anne Mantle Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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 Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 20/7/2000 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. 10th May 2005 2. 3. Date of last inspection Brief Description of the Service: Holmesley provides accommodation and personal 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 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 DS0000026664.V259404.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. It is the second inspection of this financial year, so this report should be read in conjunction with the report of May 2005. The inspection took place between 10.30am and 14.30pm. The inspector spoke with approximately 19 residents, 2 visitors, 4 members of staff and the manager. She saw the majority of the home including the laundry and many of the bedrooms. What the service does well: What has improved since the last inspection?
Since the last inspection the manager and her deputy have received further training in the protection of vulnerable adults. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 6 The manager has ensured that she receives two references for all staff before offering employment. Systems for managing residents’ monies include receipts for all monies spent. Some radiators have been covered to prevent accidental scalding. Fire regulations are being complied with. 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. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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 Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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): These standards were inspected and met during the inspection in May. EVIDENCE: Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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): These standards were inspected and met during the inspection in May. EVIDENCE: Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 10 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. Residents enjoy a varied lifestyle that suits them and they have good contact with the community and with family and friends as they prefer. Residents benefit from an ethos which promotes choice and control but which could be further enhanced for those with limited communication. Residents enjoy a varied and nutritional diet. Some residents would benefit from more detailed recording in relation to fluid intake to ensure they are adequately hydrated. EVIDENCE: Residents at Holmesley are offered a number of different activities. These include quizzes, word games and outings to local facilities such as the garden centre. Those who wish to join in are assisted and the wishes of those who choose not to join in are respected. Residents said they really enjoy these activities. Others said they prefer not to join in but like to watch TV, listen to their music and/or read. Those residents who are not able to join in due to frailty receive one to one attention from staff. Residents said that those who are frail and less able are treated as well as those who are able and vocal. Many residents talked of the local schoolchildren that had recently visited and of the carols they had sung. Many residents complimented the abilities of the residents’ liaison manager (who, amongst other things, organises activities) and those who offer her support. Visitors said they were free to come and go
Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 11 as the resident pleased and that they are always warmly welcomed and offered refreshments. One visitor eats lunch with his wife everyday. The food at Holmesley is described as ‘excellent’ and ‘good’. Some residents commented that the chef had changed and some had noticed a difference in cooking. Others had not. One said she preferred more salt and pepper in her meals but went on to say that this was always available to her to add herself. Residents said they choose what they like to eat and that there is always an alternative if they did not like something. Residents can choose where they eat their meals. One resident commented that if she did not feel like going to the dining room that she could have her meal on a tray in her bedroom. Residents said they can have hot and cold drinks when they like, and all residents had jugs of juice in their bedrooms and/or close by. Not all frailer residents have their fluid intake recorded. This would be good practice to ensure that these residents do not become dehydrated. Residents talked of how they choose what they do with their days. For example where they spend their time, what time they get up and go to bed and what they wear. One resident commented ‘if I have to be away from my home, then I want to be here which feels like home’. The inspector did notice that some residents who have difficulty communicating were not offered the same degree of choices as others. For example, vocal residents were offered the biscuit box. Non-verbal residents were given biscuits. Whilst the inspector has no doubt that these are the preferred biscuits of those residents, the rights of all residents to make choices should be promoted. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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): 18. Residents are well protected by the home’s policies and procedures in relation to the protection of vulnerable adults. EVIDENCE: All staff receive training in the protection of vulnerable adults and demonstrated a sound understanding of what abuse is. They were clear that there is a zero tolerance policy to abusive behaviour and knew that any suspicions or events should be immediately reported. Since the last inspection the manager and her deputy have received further training. Residents said they feel safe and well cared for. They said they had no complaints or concerns but that if they did they would tell a member of staff or the manager who they said would ‘fix it’. The more able residents said that the frailer residents are treated very well, with real care and gentleness. One visitor commented that the residents are all treated with respect. One complaint received by CSCI is currently being investigated. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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): 25 and 26. Residents’ safety could be further enhanced if all radiators were covered or had guaranteed low temperature surfaces. Residents’ benefit from a committed laundress and a system that ensures that clothes are well cared for. EVIDENCE: The majority of radiators at Holmesley are already covered to prevent accidental scalding. The few remaining uncovered radiators are to be covered in the near future. Many residents commented on how well their clothes are cared for. They say they are always ‘beautifully laundered’, ironed and stored. The laundress obviously takes a great pride in her work and is commended for this. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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 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): 29 Residents’ safety could be further improved by following the guidance in relation to recruitment issued by the Commission for Social Care Inspection. EVIDENCE: Since the last inspection the manager has ensured that she receives two references for all staff before offering employment. However, due to problems with internet access (which the manager normally uses to stay in touch with updated information) she was not aware of new guidance on the portability of Criminal Record Bureau Checks (CRB). This has resulted in one member of staff being employed without a new CRB being undertaken. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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 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, 32 and 35. There is clear leadership and guidance to staff to ensure residents receive consistent care and that the home is run in their best interests. Procedures for dealing with residents’ finances ensure these are handled safely. 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 residents. Staff told the inspector they enjoy working at Holmesley. Residents said that the staff are ‘kindly’, ‘helpful’ and that the manager is ‘approachable’ and can be relied upon to ‘sort things out’. They talked of Holmesley as a second home and of how the staff supported them to live independently. Many residents commented on the ‘good atmosphere’, saying ‘we can have a laugh’, ‘I moved here because of the happy, laughing staff’ and that ‘nothing is too much trouble’.
Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 16 Systems for managing monies on behalf of residents are sound. Residents say the system suits them. Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X 2 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X X Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No 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 OP25 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 not employ a person to work at the home unless he has obtained all the information and documents specified in Schedule 2. Timescale for action 31/12/06 2. OP29 19 (1) (b) 31/01/06 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. Refer to Standard OP14 Good Practice Recommendations The registered person should ensure that residents’ capacity to exercise personal choice and autonomy is maximised (this relates to those residents who have communication problems and therefore cannot verbalise their choices).
DS0000026664.V259404.R01.S.doc Version 5.0 Page 19 Holmesley Nursing Home 2. OP15 The registered person should ensure that frailer residents have adequate fluid intake (this should be ensured through the use of fluid intake records). Holmesley Nursing Home DS0000026664.V259404.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Exeter 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
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