Inspection on 19/07/07 for Holmesley Nursing Home

This inspection was carried out on 19th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Holmesley Nursing Home 19/11/08

Holmesley Nursing Home 29/11/07

Holmesley Nursing Home 07/09/06

Holmesley Nursing Home 18/12/05

Holmesley Nursing Home 10/05/05

Holmesley Nursing Home 27/01/05

Holmesley Nursing Home 20/07/04

Holmesley Nursing Home 20/02/04

Holmesley Nursing Home 30/12/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Holmesley Nursing Home Fortescue Road Sidmouth Devon EX10 9QG Lead Inspector Teresa Anderson Unannounced Inspection 10:30 19 and 24th July 2007 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.V338404.R01.S.doc Version 5.2 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.V338404.R01.S.doc Version 5.2 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@btconnect.com Mr Stephen Robert Barber Mr Trevor John Gosling Mrs Margaret Anne Mantle Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection September 7th 2006 Brief Description of the Service: Holmesley is a privately owned home that provides accommodation and care (including nursing care) for up to 38 people with needs related to old age. The home is situated approximately half a mile from the town and seaside resort of Sidmouth, and is set in approximately 2 acres of grounds and gardens with views over the Sid Valley and down to the sea. The home has a communal lounge with an area that can be partitioned off to create a second small lounge area, 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. Access to the town centre is via private transport. The fees charged range from £490.00 to £675.00 per week. There is one room that can accommodate a couple and this is available at £980.00 per week. Information about this home, including reports, is available from the home direct. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 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. The site visit started at 10.30am and finished at 6.00pm. During that time we looked closely at the care and services offered to 4 people as a way of judging the standard of care and services generally. Where possible we spoke with these people in depth, and tried to contact their relatives and any health or social care professionals involved in their care. We looked at their care assessments and care plans closely, and spoke with staff about their knowledge and understanding of these plans. We looked at their bedrooms and we looked at the overall environment from their perspective. We also spoke with approximately 10 other people who live here, with 2 visitors, with the manager, with nurses, carers, the activities co-ordinator and with the kitchen staff. We looked around the building at all communal areas and saw some of the bedrooms. We looked at other records including medication, staffing, accident and incident reports, training, fire safety and recruitment. Prior to the visit to the home we sent surveys to various people asking for feedback and comments. We sent 10 surveys to people who live here and 8 were returned completed; 6 to relatives of the people who live here and 5 were returned; 10 to staff and 2 were returned; 6 to health and social care professionals who attend people living here and 4 were returned. Their feedback and comments are included in the report. Other information given to the commission throughout the year has been taken into account. In addition, and before we visited, the manager provided information about the management of the home and an assessment of what they do well and what they plan to improve upon. We went back to the home on a second day to speak with the provider and to look at some records which were not available on the first day. What the service does well: People who consider coming to live here have enough information on which to base their decision. They, and/or their supporters, are shown around the home and shown the bedroom which will be theirs. When they move in they are helped to settle in by staff who are described as ‘really helpful’. Each person who lives here has their healthcare needs planned and well met. Staff ensure that any risks relating to nutrition or skin damage for example are identified and appropriate actions taken to keep people healthy. People are Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 6 helped to see their GP, optician, chiropodist and specialist health care professionals as needed. One person’s family say that their relative’s health and well being has improved considerably since coming to live here. People’s visitors are made to feel really welcome and are kept up to date with their relatives care and with any developments. People living here enjoy a varied and nutritious diet using fresh vegetables and fruit. The cook is aware it is difficult to please the diversity of tastes of the people living here, but really tries hard to achieve this. She tries new recipes and uses the feedback she gets to inform menu planning. There are hot and cold drinks available throughout the day and night and the cooks shortbread and cakes are real favourites. Holmesley is furnished and maintained to a high standard. Any minor repairs that are needed are addressed quickly. Staff follow infection control procedures and the home is clean and odour free throughout. The manager recently carried out a self audit as recommended by the Department of Health and scored very highly showing that the home has high standards in relation to infection control. Contracts are in place for the maintenance of systems, and fire procedures and checks are robust. Staff are described as lovely and helpful. Some staff were repeatedly mentioned for their kindness and thoughtfulness. There is enough staff on duty to meet people’s needs including a Registered Nurse on each shift, 6 carers in the morning, 4 in the afternoon and 2 at night. In addition there are support staff such as kitchen assistants, cleaners and an activities co-ordinator. People whose monies are managed by the home on their behalf are kept safe and securely. What has improved since the last inspection? What they could do better: Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 7 As a result of this inspection a number of requirements and recommendations were made. It was found that: People who come to live here have their needs assessed but the level of detail does not help staff to meet their needs when they are first admitted. In addition information gained from other sources, such as social services, is not used to inform care planning. Although some work has been done to improve care planning, these are not person centred and lack important details. For example care plans do not detail how people might be helped to remain continent or to achieve continence. In particular more detail is needed to help meet the needs of those people with communication or memory/mental health disabilities. The management of medications is not sufficiently robust. The records kept of the fridge temperature show that it is not always running at the correct temperature. No drugs require refrigeration at this time. In addition staff are not keeping accurate records relating to the medications received into and kept in the home, the prescribing and disposal of medications are not always being checked by two people and records are not always signed or dated. People’s privacy and dignity is not consistently respected such as staff forgetting to knock on doors before entering. Not all the people who live here are supported to make decisions about their daily lives. For example they are not offered opportunities to practice their religion in a way that suits them and not all people are consulted about what time they would like to go to bed or get up. Although some people have their social needs well met, less able people do not have their needs met satisfactorily. Some people are receiving medications to lower their cholesterol. The cooks list of these people is not up to date. Therefore not all these people are receiving a lot fat diet. Procedures in relation to safeguarding adults have not been used appropriately. Complaints about staff conduct and allegations/disclosures have not been recorded appropriately, meaning that people cannot be assured that they will be heard, that appropriate actions will be taken or that they will be kept safe. Some people are assessed as needing bed rails. The risk assessments to determine this are not comprehensive and there is no recorded evidence that alternative measures have been used to keep people safe from falling out of bed. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 8 Not all people living here have access to a call bell and cannot therefore always call for help when they need it. 36 of care staff hold a National Vocational Qualification (NVQ) in care. This is below the 50 , which is recommended, although there is clearly a strong commitment to reaching this target. Staff have not received training in how to meet people’s social needs or in communicating with people with communication disabilities. The recruitment procedures of people who come to work here is not sufficiently robust to fully protect the people who live here. The management arrangements are not currently ensuring that sufficient care is being taken to keep people safe. Where monies are held on behalf of the people who live here, two members of staff are not always checking the monies received and/or are not making a record of this. The manger is not taking appropriate actions to supervise staff especially where concerns have been raised. Record keeping does not provide enough detail. This means that it is not always clear that decisions made on behalf of the people who live here are the best decisions. 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. The summary of this inspection report can be made available in other formats on request. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 9 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.V338404.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 was not inspected, as this home does not provide intermediate care. Quality in this outcome area is good. People who consider coming to live here have enough information about the home so that they can make an informed decision. Improvements in the information collected during their initial assessment would help to ensure that their needs can be met when they first come to live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home was randomly selected to undergo a themed inspection in March 2007 that related to ‘Choice’. A number of requirements and recommendations were made at that inspection and the majority of these have been addressed. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 11 In surveys people say they have a contract and had enough information about the home on which to make a decision about where to live. People living here and visitors confirm that they had been given written and verbal information and had been shown around the home. One person said that staff were really helpful with the information they had supplied. Before coming to live here people undergo an assessment of their needs. At the themed inspection it was recommended that these assessments be more comprehensive and detailed. The manager reports that very few people have been admitted since that inspection but did provide one assessment. This person has complex moving and handling and communication needs, and is at risk of damage to their skin because they cannot move themselves. The assessment did not include information relating to these needs or about family involvement, sleep patterns, or their food preferences. The home did obtain a copy of the assessment carried out by social services. However, they have not incorporated the information in this into the overall assessment or the plan of care. People who come to live here say they were helped to settle in by being shown for example where the lounge and dining room are and being helped to personalise their rooms. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. People who live here can be confident that their healthcare needs will be well met. However, they cannot be assured that care will be planned or delivered in a way that is person centred and they cannot be assured that their privacy and dignity will be consistently protected. Improvements in the way that medicines are managed will reduce the risks currently posed to the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people who live here say they receive the care, support and medical care they need. Relatives, in surveys, say that the home meets the needs of their relative and that they receive the support and care they expected or that was agreed. Healthcare professionals say that staff seek and put advice into action. We looked at 4 care plans and found that peoples’ core needs are assessed by the Registered Nurses and that actions are taken to meet these needs. For Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 13 example each person is assessed to see if they are at risk of falling, developing pressure sores or if they might be prone to dehydration or malnutrition. These assessments form the basis of an action plan which staff follow to keep each person healthy. Care plans show that people see the doctor and specialists when they need to and are also supported to see the chiropodist and the optician. No one living here has a pressure sore, there are few incidents of falling, and these are mostly related to people wanting to be independent and staff supporting this wish. Staff say they ensure that people who are at risk of dehydration are supported to drink and that those at risk of malnutrition are helped to eat and/or given supplementary high calorie drinks. In addition, care plans are easily accessible, well ordered and easy to read. Staff demonstrate a good knowledge of plans of care, and how to meet the needs identified. One person commented that their relative’s health has improved considerably since moving into this home. They say they are now much happier, are eating much better and are more mobile. They also say that this person has been accompanied to hospital appointments by staff who were really helpful. People spoken with are generally happy with the care given. However, we did identify some areas that need improvement. The care plans seen lack important details about how needs should be met in a person centred way. For example one person has profound communication and mobility disabilities. Whilst the care plan informs staff of what mood some words indicate, and staff were knowledgeable about this, there was not a plan in place to make communication easier for this person or to help to develop a communication system. This person is doubly incontinent but the plan of care does not include plans on how incontinence might be avoided. When spoken with, staff said that people are taken to the toilet before lunch and before supper and that they know when this person is wet because they become agitated. This person spent all day sitting in a wheelchair. They like to sit in a wheelchair because it means being moving around the home is easier. Whilst a pressure cushion is provided to prevent pressure sores, sitting in a wheelchair that is not designed to be used in this way is very uncomfortable. When we checked with this person if they were comfortable they indicated they were not. Staff report this person becomes fidgety but do not always know why. The deputy manager has agreed to find out if this person can have a wheelchair that is designed for sitting in for long periods. The care plan did not include information about things such as this person’s preferred daily routine although the assessment from social services did say that this person can become upset if their daily routine is not followed. There was no information about their favourite foods or drinks, their favourite Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 14 pastimes or how they might be helped to be occupied. As this person has a profound communication disability, this type of information is very important if a consistently high standard of care is to be delivered. Another care plan records that a person was admitted to this home because they could no longer cope at home. The care plan did not provide details of what they could not cope with so that staff could provide support in these areas whilst allowing this person to retain their abilities in other areas. This person has a mental health disability. Although recordings in the care plan made by staff demonstrate a lack of understanding of this disability, when observed staff were seen to be really caring and kind. We looked at how the medications are managed in the home generally and in relation to the 4 people we case tracked. We found that some people had more tablets than records indicate that they should have. A member of staff reports that they keep extra medicines so that they do not run out. No record is kept of this. We also found that staff were not always signing hand written medication records and these were not always checked by a second person to ensure that mistakes are not made. We found that when a controlled drug had been disposed of, the person who had done this had not signed to say they had done it or when they had done it. Records do not demonstrate that the medicines destroyed are checked by a second person, as they should be. In addition at the last inspection in September 2006 we noted that the fridge where medications are kept was too warm. This has not been satisfactorily addressed. Staff have been recording for some weeks that the fridge was sometimes running at a high temperature. No action has been taken. In addition, some medications being stored in the fridge should be stored at room temperature. Storing them in a fridge might alter their effectiveness. The deputy manager agreed to address these issues as soon as possible. We also looked at how well this home ensures that the privacy and dignity of the people who live here is protected. We found variable practices. We saw some staff always knocking on bedroom and bathroom doors before entering and some staff sometimes doing this. The manager reports that she has had cause to remind some staff about this at the last staff meeting. Care plans demonstrate that people who live here are asked if they would prefer to have their personal care given by a carer of the same gender. This was confirmed by people who live here. However, the care plan of one person we case tracked, who has a profound communication disability, states that this person does not mind about staff gender. Staff were not sure how they had obtained this information or if this person understood the question. Another person who was case tracked told us she enjoys being bathed by a male carer. However, other issues identified by staff should have been taken into account when this decision was made. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 15 Another person living here said that staff were very good at not making her feel shy when they bathed her. For example by talking to her but not looking directly at her and always making sure she had a towel to cover herself. At the last inspection we told the manager about an incident where a carer had not been respectful to a person who lives here. Since then we have received two further reports of disrespectful behaviour by a member of staff. This is detailed in the section ‘Complaints and Protection’. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. Some people living here benefit from a varied and interesting social life. However, the diverse range of social needs and abilities of individuals living here have yet to be addressed satisfactorily. In the same way, some people are not being supported to make choices or have control over their daily lives. People benefit from a diet which is varied and nutritious and which they enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of people who completed surveys say that they always enjoy the activities arranged by the home. However, 7 of the 8 forms returned had been completed with the help of the activities co-ordinator, and 2 had been returned not completed because the staff report that the people they were sent to ‘could not respond’. Comments from people about the activities arranged include ‘I prefer not to join in’ and ‘I prefer to stay in my own room with my own things’. Another person commented that they thought that their relative living at the home Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 17 does not get enough attention socially. Some people spoken with say they get bored and they wish there was more to do. Care staff say that they do not have the responsibility for meeting the social needs of the people who live here. Instead the home employs an activities coordinator who works Monday to Friday. There is also a person who helps out between 2pm and 4pm. However, when we talked to the co-ordinator about their routine they say they carry out administrative duties in the morning, they then go into town to carry out any shopping for residents that is needed. At 2pm they pick up the second activities person and return to the home at approximately 2.15pm, leaving again at 4pm. This means that the time allocated to meeting people’s social needs is limited to approximately 1.75 hours during the week. Activities that have been arranged are posted up on the notice board in the hall and include quizzes, exercise to music, word games and carpet bowls. This does mean that people have to be mobile to get to this notice to made a decision about what they might like to join in with and many of the people living here have mobility problems. In addition to these activities the home usually arranges for an outside entertainer to come in once a month and they say they are trying to increase this to twice monthly. People say they really enjoy the outside entertainers and singing along. The home recently held a garden party which staff report went very well. On the day of this site visit there were no activities arranged for that day. During the majority of the morning about 8 people were sitting in the lounge. We sat in the lounge from approximately 11am until 12.30pm and then from 1.00pm until 1.30pm. During this time the television was turned on. None of the people sitting in the lounge were watching this. Some people were chatting and some people were reading books. One person commented on how loud the television was and one person said they had turned their hearing aid off because the television was on. In the early afternoon one person asked that it be turned off. A member of staff said they could not do this because they thought that some people were watching. They did however turn the volume down. In the afternoon some people were playing cards with some visitors. Staff sat one person that we case tracked who has a communication disability, closest to the television. They were not asked if they would like to watch the television. They could not see the screen as they had been sat sideways on to the television. Their care plan relating to social activities and their life story were not completed. Staff report this person used to like to paint. Activities do not include painting. Another person who was case tracked spends all their time in their room. They have a visitor every day and this visitor reports when they are not there staff Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 18 make sure that the radio or talking books are put on for them to listen to. The care plan of another person who is severely disabled and spends their time in bed does not detail how their social needs might be met. Staff say that they chat with her when they carry out care tasks. Another person case tracked says they join in when they feel like it and that they never get bored. This person has been offered trips out but has so far declined. We looked at care plans to see if staff were finding out about people’s interests and planning social interactions based on these interests. There was little information in the care plans seen about people’s previous lives or their interests. In addition, the activities co-ordinator has not had training in meeting social needs or in how to engage with people with memory, mental health or communication disabilities. In addition care plans do not contain information that would help less able people to make choices and have more control over their daily lives. For example the care plans seen did not contain information about what time people like to get up or go to bed or what they like to eat. When asked staff were knowledgeable about some people’s preferences. One person who was in bed at 5.30pm said this was not a choice but because they were bored. However, staff report that another person likes to stay up late and this always happens. One person asked for a second cup of tea, and although they were given it, the member of staff who bought it rolled their eyes and tutted. One person asked to go to bed three times and was ignored. In the questionnaire provided by the manager it is reported that all the people who live here (except one who has no religion) are Christian. However, people’s preferences in relation to how they practice their religion are not recorded in the care plans seen. Church services are held at Christmas and Easter and communion is available once a month. Visitors to the home say they are always made welcome, that they are offered refreshments and that they are kept up to date with information about their relatives. They can visit when they like (within reason) and their relative can choose to receive their visitors in the communal areas or in their bedroom. Staff and visitors were seen to be really friendly and helpful with visitors. People say they always or usually like the meals at the home. The chef works hard to cater for different tastes and continues to try out new dishes. On the day of this site visit she had cooked a curry and the majority of people spoken with said they had enjoyed this. One person said it was ‘very authentic’. There are hot and cold drinks available throughout the day. There are home made cakes and biscuits which are highly praised for their lightness and for being delicious. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 19 The cook keeps a list of those people who need a special diet and reports that liquidised foods are no longer liquidised together so that people who need food served in this way can taste the different flavours. However, the list of people requiring a low fat diet because they are on cholesterol reducing medicines was not up to date. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. Some people are potentially being put at risk of harm because their complaints are not always properly investigated, because allegations are not being taken seriously enough and because record keeping is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home say that staff are kind and helpful. In surveys they say that they always or usually know who to speak with if they are not happy. Relatives say that the home have always or usually responded appropriately if concerns have been raised. The home reports that they have not received any complaints, and neither have the commission. However, two people have raised concerns with us which include concerns that a member of staff is not respectful and can be rude. At the last inspection we had cause to bring this same issue to the attention of the manager. When spoken with during this inspection the manager and a Registered Nurse report that they have had cause to speak to a member of staff about them being rude. When we discussed these issues with the manager she reports that she has dealt with this issue informally, has not recorded the incidents, the discussions with staff, the actions taken nor if the residents concerned are happy with the Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 21 outcome. Staff say that this is still happening but that they do not report it any more because nothing is being done. Records show that staff have received training in safeguarding adults and they demonstrate an understanding of what abuse is. However, the above examples show that procedures laid down to protect vulnerable adults are not being following. In addition, one care plan records an incident that should have prompted staff to take advice from the adult protection team. Although they spoke with this persons GP, they did not do this. This incident and the actions taken to address this issue have been referred to the adult protection team by the commission. Risk assessments in relation to the use of bed rails are not comprehensive enough. They do not give consideration to whether the bed rail was designed for the bed it is to be used upon and does not consider ways of reducing risk that do not involve this form of restraint. In the questionnaire returned to the commission prior to the site visit, the manager did not include information about how the home deals with protecting people who live here. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. People who live here benefit from a home that is homely and well adapted for older people with physical disabilities. Some minor improvements would help the people who live here to always get help when it is needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live here say that the home is always clean, fresh and odour free. Carpets are steam cleaned 6 monthly and staff work really hard to keep the home clean and tidy, yet homely. This has consistently been the case at successive inspections. The home is decorated in a homely fashion which people who live here appreciate. There are lots of homely touches such as plants, flowers and pictures and the décor and furnishings are of a high quality. It is maintained to Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 23 a high standard and people report that any repairs needed are carried out quickly and that the handy man is always helpful if for example pictures need putting up. One person commented that it was good that he had fixed their television to the wall freeing up more space on a chest of drawers. The majority of rooms are for single occupancy and many have hand washing and toilet facilities, and some have a full ensuite shower room. Staff demonstrate a good knowledge of how to prevent the spread of infection and washing machines have a very hot cycle to deal with heavily soiled linen. The manager has recently carried out a self-assessment of the home in relation to cross infection designed by the Department of Health. The home has scored very highly indicated good control of infection. The home has adapted baths for people with mobility problems together with numerous aids throughout the home to help people move around more independently. At the last inspection it was recommended that the manager ensure that people had access to call bells. These are available in all bedrooms and many people in their bedrooms had these to hand. However, one person in the lounge showed us that they could not reach the call bell and said that if they wanted assistance they waited until a member of staff came by. Another person, with a communication disability, could not call for help and did not have a call bell. This was discussed with the deputy manager who is going to see if remote call bells could be made available. There are a number of communal areas for people to sit in and these have some chairs that are higher so that people can get in and out of them more easily. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. People who live here are supported by staff who are employed in sufficient numbers and who would benefit from further training. Recruitment processes continue to lack robustness potentially placing people who live here at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota shows that there is always a Registered Nurse on duty and that in the morning there are 6 carers, 4 in the afternoon and 2 at night. In addition, there is ancillary staff including a cook, kitchen assistant, housekeeper, activities co-ordinator and a handy man. The manager is supernumerary. Staff say they are never asked to care for anyone outside their expertise and that they know what to do in an emergency. They say they are kept up to date with each persons needs and that they are given clear instructions about the care to be given. Staff say they enjoy working here. The owners report that some of the carers are registered nurses who choose to work as carers and that 5 of the other 14 carers hold a National Vocational Qualification in care to level 2 or above. This equates to 36 of the staff which Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 25 is below the national target of 50 , although the home continue to work hard to meet this target. The manager reports that staff induction training meets ‘Skills for Care’ requirements, although records were not available for us to see. The questionnaire identifies that a significant number of people have hearing, sight and communication disabilities. Training in these areas of care has not been provided. We saw some staff explaining very carefully what they were about to do and being really sensitive towards people. We also saw one member of staff speaking about a person in front of that person without addressing them. This same member of staff did not know this persons name. People who live here say that staff are kind and helpful. Some staff were repeatedly mentioned as being particularly good. People say staff are available when they need them and that they listen and act on what they say. One person said that they rarely called for assistance at night but when they once did, staff came very quickly, made this person a cup of tea and stayed with them for a while. Whilst we were talking with one person in their bedroom a member of staff came to check that this person was alright as she had not seen her since coming on duty. The resident said ‘she’s just lovely’. We looked at three staff recruitment files. These did not all contain all the necessary checks that help to fully protect people from being cared for by unsuitable people. One of the files did not contain a police check although a POVA check had been carried out. This is acceptable as long as staff work supervised. During this inspection we saw a carer without a police check working unsupervised. One file contained one reference where there should be two. The manager said she had obtained another reference, and reminded us that this had been discussed with the commission. However, she did not know where she had filed it. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. People who live here are potentially being placed at potential risk due to inadequate management arrangements in the absence of the Registered Manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this site visit the manager provided comprehensive information in a questionnaire that we sent asking for information about the management of the home. In general, this demonstrates an understanding of what this service does well and what might need improving. However, the information provided regarding meeting Health and Personal Care needs did not identify the need to Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 27 improve person centred care planning and delivery. It described care planning as being of ‘exceptional quality’. Some improvements have been made in care planning but further improvements would help to address the shortcomings identified in relation to meeting the diversity of needs of the people who live here particularly in relation to their social care needs and rights to make individual choices. The questionnaire completed by the manager did identify that more time could be dedicated to meeting the social needs of the people who live here and that more staff should have management training. The manager says that ‘the last year has not been a good one’ due to her absence through ill health. For that reason, she says, she has not been as up to date with things as she should be. For example, supervision meetings with staff have not been documented; complaint/concerns raised by some people have not been documented, and it would appear they have not been appropriately investigated; induction training records could not be located and some staff recruitment information is not being obtained. Although the manager has attended training in safeguarding adults, the procedures relating to this have not been followed and records relating to an alleged incident are poor. The manager explained that she was on leave from the home at the time this occurred. This means that staff who are responsible in the mangers absence do not have the skills needed to cover her absence. The manager is again due to be absent from the home. These issues were discussed the owners of this service. They demonstrate a real commitment to addressing any shortcomings identified. The questionnaire provided demonstrates that all policies and procedures are up to date and that the home has contracts for ensuring the maintenance of equipment. All staff receive fire training and frequent drills take place. The manager says that the provision of mandatory training has been bought up to date since the last inspection. The kitchen is clean and the kitchen equipment is in good working order. The cook reports that fridge and freezer temperatures are recorded and are within the recommended temperature limits. Since the last inspection a screen has been added to the back door allowing for ventilation in the kitchen whilst continuing to control for pests such as flies. The questionnaire states that the home does not have an annual development plan for quality assurance. However, this service carries out annual quality assurance surveys that are made available to people in the guide to the home. The manager reports that there are no themes emerging that need addressing. We checked monies held by the home on behalf of the people who live here. These are kept safely and were in order. Receipts are kept and a record kept of monies received. Staff were reminded that monies received in on behalf of people should always be checked and signed by two people. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 28 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 1 3 Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14 (1) Requirement All people who come to live here should undergo a detailed assessment prior to coming to live here so that their needs can be met. This, and any other assessments, should form the basis of the plan of care. All the people who live here should have a care plan that details how their health and welfare needs are to be met. They must be supported to contribute to this plan so that care can be delivered in a person centred way. This particularly relates to those people with communication and/or mental health needs. Previous timescale of 28/02/07 partially met. 3. OP9 13 (2) The risk to the people who come to live here posed by the handling of medications by staff must be reduced. This includes: • Ensuring that medication records are accurate and up to date. Version 5.2 Page 30 Timescale for action 31/10/07 2. OP7 15 (1) 31/01/08 31/08/07 Holmesley Nursing Home DS0000026664.V338404.R01.S.doc • • • Ensuring that any medications disposed of are checked by two people who sign and date when they did this. Ensuring that any hand written entries on medication charts are checked, signed and dated by two people. Ensuring that the medication fridge runs at an appropriate temperature (previous timescale of 10/02/07 not met). 31/08/07 31/01/08 4. OP10 12 (4) (a) 5. OP12 16 (2) (m) People who live here must be assured that their rights to privacy and dignity will always be respected. People who live here must be consulted about their social preferences and they should be supported to have their social needs met in a way that suits them. (Previous timescale of 10/02/07 not met). People who live here must be protected from the risk of potential harm/abuse. This includes ensuring that correct procedures are followed if an allegation or disclosure is made. The people who live here must be assured that their safety is protected through robust recruitment procedures. This includes references and police checks. Where a POVA is obtained whilst awaiting the return of a full police check, staff should always work under the supervision of another member of staff. Whilst the manager is on sick DS0000026664.V338404.R01.S.doc 6. OP18 13 (6) 31/08/07 7. OP29 19 31/08/07 8. OP31 26 31/08/07 Page 31 Holmesley Nursing Home Version 5.2 9. OP37 17 leave or whilst she is working from home or part time, the registered person (owner) must visit the home (or make arrangements for someone to visit) on a monthly unannounced basis. This should result in them making a decision about the quality of care provided and in taking appropriate actions where necessary. Records made in relation to people who live here should be accurate and kept up to date. 31/08/07 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 OP8 Good Practice Recommendations People who come to live here, through appropriate care planning and interventions, should be supported to remain continent and be supported to become continent where possible. People who wish to sit in a wheelchair for long periods of time should be assessed by a person qualified to do this, so that they can be supported to do this safely and with regard to their comfort. People of all abilities should be supported to make choices in their lives. This includes for example ensuring that people have opportunities to practice their religion and make choices about what time they go to bed and get up. People who are prescribed medication to lower their cholesterol should be supported to this by receiving an appropriate diet. Where staff are considering using bed rails to help keep people safe, they must ensure that risk assessments are comprehensive and that they record what other options have been considered and discounted, giving the reasons why. People should have access to a call bell that they can reach easily. DS0000026664.V338404.R01.S.doc Version 5.2 Page 32 2. OP8 2. OP14 3. 4. OP15 OP18 5. OP22 Holmesley Nursing Home 6. OP28 7. OP30 8. 9. OP35 OP36 The manager should continue to work towards ensuring that 50 of care staff hold a National Vocational Qualification (NVQ) in care to level 2 or above to ensure that the people who live here will have their needs met. The manager should ensure that staff receive training that helps them to meet all the needs of the people who live here. This might include training in caring for people who are visually or hearing challenged, helping to meet people’s social needs and supported people with communication problems to communicate more easily. Any monies received on behalf of the people who live here should be checked by two people who should sign to say they have done this. The manager should ensure that appropriate measures are taken to supervise staff especially where concerns have been raised about their behaviour. Supervision records should be kept up to date. Holmesley Nursing Home DS0000026664.V338404.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000026664.V338404.R01.S.doc Version 5.2 Page 34 - 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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