Inspection on 07/09/06 for Holmesley Nursing Home

This inspection was carried out on 7th September 2006.

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

Other inspections for this house

Holmesley Nursing Home 19/11/08

Holmesley Nursing Home 29/11/07

Holmesley Nursing Home 19/07/07

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 Key Unannounced Inspection 7th September 2006 09.30 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.V305394.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.V305394.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@tiscali.co.uk 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.V305394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th December 2005 Brief Description of the Service: Holmesley provides accommodation and personal and nursing care for up to 38 residents with needs related to old age. The home is privately owned. It 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 (in September 2006) range from £460.00 to £650.00 per week. Information about this home, including reports, is available from the home direct. Holmesley Nursing Home DS0000026664.V305394.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. It started at 09.30 and finished at 4.30pm. Because the manager and owners were not available on the day on inspection, the inspector did not have access to certain records. She returned at a later date to inspect these. Prior to the site visit the inspector sent surveys (asking for comments) to 16 residents and 8 were returned; to 13 care staff and 4 were returned. Surveys were also sent to local health and social care professionals and 6 were received. The manager provided information in a pre-inspection questionnaire sent to the home by the Commission. During the site visits the inspector looked at and spoke or observed in depth the care and services received by 4 residents. Approximately 12 other residents were spoken with, together with 2 visitors, 5 care staff, the manager, owner, liaison manager and the cook. Records in relation to care planning, training, recruitment and health and safety were inspected. All communal areas were seen by the inspector together with the majority of service areas and some bedrooms. What the service does well: Prior to being admitted to Holmesley each resident is given comprehensive information about the home. One resident said they were ‘very pleased’ with this and others said it helped them to make their choice. One visitor said they had visited 12 homes and this one was ‘marvellous’. Each prospective resident is assessed by a Registered Nurse who passes this information on to care staff to ensure that residents needs can be met from the moment they are admitted to the home. Residents’ healthcare needs are met with appropriate referrals being made to the wider multi-disciplinary team and to healthcare specialists when needed. Residents say they always or usually get the care and medical support they need. Health care professionals say that the home communicates clearly with them and that staff demonstrate a clear understanding of the care needs of residents. One resident said staff always ‘go that extra mile’, another said ‘the staff are lovely’. Holmesley has good links with the local community and some residents are assisted to visit local amenities and attractions. Visitors come and go as they please. One visitor said how they were always made welcome and that staff always kept them updated on their relative’s condition. The cook is currently reviewing the menus as she reports there have been considerable changes to the residents living at Holmesley. She is trying new Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 6 dishes and asking for feedback. Residents say the food is mostly good, although one commented it could be ‘bland’ and another said the quality was variable. Holmesley provides accommodation in a clean, homely and well-kept environment. Residents say it is always clean and odour free and that there are plenty of cleaners. One resident said how lovely it was that their bedroom was kept so clean and tidy. There are a number of communal areas for residents to sit in which are maintained to a high standard. Access throughout the home for people with disabilities is good and includes wide corridors, the addition of ramps and handrails and a stair and a passenger lift. Staffing levels are appropriate to the numbers and needs of the residents. There is always a Registered Nurse on duty that is usually supported by six carers in the morning, four in the afternoon and evening and two at night. Staff are described as ‘lovely’ and ‘kind’. One visitor said ‘they have got time for you and tell you what is going on’. Another said ‘there is a good male carer to male resident ratio’. The home is well managed. What has improved since the last inspection? What they could do better: The system for identifying residents strengths and support needs and for planning the care required must be improved to ensure that all needs are identified and met. Residents should have the opportunity to undertake exercise and/or physical activity. Staff should ensure that appropriate actions are taken to prevent malnutrition and to identify the actions that need to be taken to prevent falls. The fridge that stores medication must be maintained at an appropriate temperature to ensure safe storage. Residents must be asked about their social interests and preferences and arrangements must be made to enable them to engage in activities of their choice and preference. All residents should be given the opportunity to exercise personal choice and autonomy. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 7 Liquidised food should be presented in a way that is attractive and appealing and not liquidised together, in order to help the resident’s appetite. Call bells should be accessible to residents so that they can call staff when needed. Recruitment procedures should be robust. This includes (where appropriate) checking the accuracy of information given, the reasons for leaving previous employment and getting a reference from the last employer where applicable. Quality assurance should be undertaken to check residents’ satisfaction with the services offered. All staff must receive training that is appropriate to the work they are to perform including mandatory training such as food hygiene, manual handling refresher courses and infection control. Records relating to accidents and incidents must be kept up to date and properly investigated. 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.V305394.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents receive the information they need to make an informed choice about where they live. Residents can be assured that the home can meet their needs when they are admitted and that staff have an understanding of those needs. Holmesley does not provide intermediate care. EVIDENCE: All eight residents who responded to surveys said they had received enough information about the service before moving in. One commented they were ‘very pleased’. Some residents spoken with said they, or a relative had visited the home prior to moving in. This information includes the homes purpose, a directory of services, the most recent results of quality assessments, a price list, the latest inspection report and a sample contract. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 10 The majority of residents remembered receiving a personal contract, although some thought their family might have dealt with this. One person stated they had signed a contract but had not yet received a copy. Prior to admission all residents are assessed by a Registered Nurse. This assessment provides details about the resident’s needs, which is relayed to staff. Staff spoken with, said that they mostly received good information about each resident before they moved in including a moving and handling plan and about equipment required to prevent pressure damage for less able residents. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some more dependent residents are potentially at risk because their care is not being planned and reviewed adequately. Residents’ healthcare needs are generally well met with the involvement of the wider multi-disciplinary team and healthcare specialists. The systems for the administration of medication are generally good and safe. Personal support is offered in a way that promotes and protects residents’ privacy and dignity. EVIDENCE: Holmesley cares for people with a wide range of needs and with different levels of dependency. Some people rely heavily on the nurses and carers with some being cared for in bed, whilst others are mobile and live relatively independent lives. In order to meet this diverse range of needs Holmesley has developed a care planning system that staff are familiar with. The inspector looked at the care plans of four residents in depth. Each had been assessed to determine their risk of falling, the risk of them developing Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 12 pressures sores and for any risk of malnutrition. Each had a plan of care. However the assessments and plans seen were not all comprehensive or detailed enough to ensure that needs are anticipated and/or met. The assessment that identifies resident’s risk of falling requires that the resident have their blood pressure taken when they are both standing and sitting. This had not been done for any of the four residents case tracked. Three of the four residents were also identified as being at risk of falling. Although the assessment stated that the resident should be ‘targeted for intervention’ no intervention was recorded and staff spoken with did not know what intervention should take place. Whilst records show that the number of falls is low, the inspector was told by residents of falls they had had which had not all been recorded. Three of the four care plans seen showed that these residents are at risk of developing pressures sores. Records of the actions to be taken were not specific, for example they did not identify the pressure relieving equipment to be used only stating that ‘appropriate’ equipment should be used. The assessment regarding the risk of malnutrition for one resident did not include important information about their swallowing. The care plan states that this resident should be weighed regularly. This has not happened. No alternative arrangements have been put in place to monitor this person’s nutritional state. This person has liquidised food to enable them to swallow. Staff report that the whole meal is liquidised together, and not as separate foods which is more likely to be appealing and aid appetite. Records are not kept of this persons food preferences. Care plans are not always meaningfully reviewed. For example one care plan gave clear instructions regarding the management of one resident’s bowel actions. When the inspector and nurse reviewed the records it was not clear that care staff had taken these actions. Nurses had not identified this. In addition important information regarding the comfort and dignity of this resident was not recorded. It is therefore unclear what actions had not been taken to overcome these issues. Another resident’s needs had increased and they are much frailer and less able to communicate. During the inspection it was observed that this person appeared uncomfortable in their chair in a slouched position. They called out throughout the day asking to lie down on the bed. Staff report this has become the norm. They also report that the resident shouts and becomes distressed when touched ‘as if in pain’. Paracetamol is given once daily, although this has been given more often in the past and can be given more frequently as prescribed by the GP. The care plan contains no detail regarding this person’s behaviour – what brings on the shouting or what provides relief or comfort. The only recorded intervention made to address these issues was a request for the GP to visit. The manager has since reported that staff have changed the Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 13 position of this persons chair so that they can look into the corridor where there is something to see. Although the above issues pose potential risks to residents, records show that this home has a low incidence of pressure sores and the number of falls and incidents recorded is low. However, during the inspection the inspector was made aware of one fall and an incident, which had not been recorded appropriately. The majority of residents, in surveys, say they always or usually get the care and support they need and the majority say that get the medical support they need. Of the six surveys returned by health professionals, all said that the home communicates clearly with the GP practice, that there is always a senior member of staff available to confer with and that staff demonstrate a clear understanding of the care needs of residents. Staff state that they know who to contact in an emergency or if the resident is unwell. Records show that referrals are made to dentists, chiropody and other allied health professionals as needed. Medications are generally well managed. They are stored securely and safely, although staff had been recording that the temperature of the fridge in which some medications are stored is consistently high at 12C. No action has been taken to address this. Administration records were checked and found to be up to date and in order. Residents spoken with said that staff treat them with respect and that staff listen to what they say. Staff report they make sure that residents dignity is promoted by for example ensuring that care is provided in private. With one exception staff were observed being patient with and respectful to residents. Information regarding the exception was passed to the nurse in charge during the inspection. GP’s report that they are always able to see residents in private. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Whilst links with the community and visitors are good some residents are not experiencing a lifestyle that suits them. Support is offered in a way that does not always promote choice and flexibility for all residents. The meals offered provide choice, variety and meet nutritional needs. EVIDENCE: The information given to residents regarding activities states that these are available on a daily basis and that the type of activities will vary according to the requirements of the residents. It also states that residents who have particular interests will be encouraged, as far as practicable, to pursue their hobbies. However, the four care plans seen do not contain information regarding the resident’s previous interests or information about what might meet their social needs during their stay at Holmesley. One said ‘happy to socialise’ and another ‘likes to watch TV’. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 15 Staff and residents said that whilst outings are arranged and musicians are bought into the home, there is not a programme of activities. On the day of inspection there was much excitement because a musical group were visiting. Staff worked really hard to get all residents ready for this and to accommodate them in the lounge so they could join in. One member of staff thought that a very dependent resident would enjoy this (based on her knowledge of the resident’s past interests) and ensured she had a good seat and was comfortable. Residents told the inspector how much they had enjoyed the ‘old time music’ that had been arranged a few weeks previously. Responses in surveys received from residents in relation to activities were mixed. Three stated that the activities arranged always meet their needs, two said usually and one said never. One said they were unable to join in because of their disability; another said there had been few activities the resident could join in with. However, another stated that they go out on trips. During the inspection some residents said they really enjoyed their lifestyle and others said they were bored. Residents told the inspector that they would like some activities that are prearranged. One suggested quizzes and another said they would like to do some cooking. One resident said that the liaison manager had suggested that she might have a meeting with residents. The resident thought this might be a good time to ask about preferences and for residents to make suggestions particularly as there were so many new residents. One member of staff thought residents might benefit from a gentle exercise class, some residents agreed with this. Residents said they mostly choose how to spend their days. They said they choose what to wear, what to eat, where to eat it and what time they get up and go to bed. Staff describe how they help residents with communication difficulties to exercise choice. For example, showing them clothes and asking them which they would like to wear. One resident with profound communication difficulties indicated that some staff work hard to offer choices and to find out what the resident wanted. When the musicians were visiting one resident told staff that they might want to come out quite soon. Staff made sure they kept an eye on this resident and as soon as the resident indicated, took them back to their bedroom. However, one resident who is described by staff as getting tired spends alternate days in their bedroom and in the lounge. It would be better practice to agree with this resident short times that she would prefer to be out of bed, in the lounge and in bed. This would better support her right to make choices and would help to better meet her social needs. Another resident was not allowed to have her lunch later than the time it was scheduled to be served. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 16 Another resident asked for strawberries because another resident was having them and was told she couldn’t have them. Another resident who is very dependent and nursed in bed had the radio on in his bedroom switched to a local popular station. When the inspector spoke with their relative they reported that the resident prefers classical music. Visitors say they can come and go as they please and that staff always welcome them and keep them up to date. The majority of residents who sent in surveys said they always or usually enjoy the food. The cook said that there had been considerable change in the clients recently and that she was reviewing the menu accordingly. One person said the food could be bland. When the inspector checked if condiments are available to all residents, staff reported that they are not. The home offers a four-week rotating menu. Choices are not routinely offered for the main meal of the day but can be arranged if requested. Some residents who require a liquidised diet are not having each food liquidised separately. This is not good practice and does not encourage a good appetite. The cook keeps a record of all food served and of the fridge temperatures. Records are also kept of resident’s food likes and dislikes. These do require some updating. Food is covered and stored appropriately. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents can be assured that their views will be listened to and acted upon and that they will be safe from abuse. EVIDENCE: In surveys the majority of residents said that staff listen and act on what they say and that they know who to speak with if they are not happy or wish to make a complaint. One person commented ‘there is always someone to talk to’. The complaints procedure is contained in the guide to the home. Residents told the inspector they feel safe and that staff are kind and thoughtful. Staff demonstrate a good understanding of what abuse is and know who to report allegations to. The manager reports that all staff receive training in the protection of vulnerable adults. Staff stated in surveys that they are familiar with Adult Protection procedures. Since the last inspection the commission has received one complaint about this home. Elements of this complaint were upheld or partially upheld. Medication was not being given by a Registered Nurse as is required in a Nursing Home (upheld); not all staff were receiving sufficient training (partially upheld); one resident was not always allowed to have a meal in a preferred place or at a preferred time (partially upheld). Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from living in a home that is well maintained, clean, safe and homely. Resident’s capacity to be safely independent is compromised by a lack of accessible call bells. EVIDENCE: Residents told the inspector that the home is always clean and fresh. One said ‘there are plenty of cleaners’ and another said ‘they really take care to keep your room nice’. A carer described how they prevent the spread of infection in the home and was observed taking great care with hand hygiene. Staff carry alcohol gel to further prevent the spread of infection. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 19 Holmesley is well maintained and furnished. The furniture is homely with much of it being suitable for those who may have difficulties standing or sitting. Each bedroom is personalised to the taste of the occupant. The drive leading to the home and care park have recently been levelled and tarmaced and some bedrooms have been redecorated. The building of an extension has been completed adding a further four bedrooms with ensuite facilities to the home. When asked what might improve the home, four residents said they would like a call bell in the dining room that they could easily reach. One resident described how she had fallen and had not been able to reach a call bell to call for help and thought this could be improved. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from a staff team who are skilled, trained and employed in sufficient numbers to meet needs. Recruitment procedures have improved but do require further improvement to ensure the safety of residents. EVIDENCE: A Registered Nurse is on duty at all times at Holmesley Nursing Home. In addition there are 6 carers in the morning, 4 in the afternoon and evening and 2 at night. Carers are supported by kitchen staff, a full time manager/matron, a full time liaison officer, a part time activities co-ordinator, cleaners and a handy man. Residents say that staff are kept busy but that they usually come to answer the call bell quickly. In surveys three residents said that staff are always available when needed, four said they are usually available one said sometimes. The manager reported that there had been some problems with some staff not answering bells quickly enough but thought this had been dealt with. One resident said they had recently waited a very long time for their call bell to be answered. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 21 The manager reports that Holmesley has experienced some changes to the staff team recently. The number of staff has not been reduced throughout this period but this has inevitably placed some extra burden on the staff who remain and who help to induct new carers to the home. One resident commented that there could be some communication difficulties with those employees for whom English is not their first language. The manager reports that this has been a minor problem and has been dealt with in supervision of those staff. She also reports that one employee is taking English lessons. Another resident said that staff could sometimes be noisy. One resident said they were pleased that staff checked on them at night. Another said they too were pleased but wished they would do this more quietly by not ‘banging doors and talking’. Staff were also described as ‘lovely’ and ‘helpful’. Although records were not seen on this occasion the manager reports that all staff receive an induction before working alone. The home has a large proportion of staff that are undertaking the ‘Overseas Nursing Programme’. These carers undergo a three month induction. This is followed by a training programme including mentorship which, when completed, will entitle them to be Registered Nurses with the Nurses and Midwifery Council. Of the remainder of the care staff the manager reports that approximately 50 are trained to NVQ level 2 or above. Four staff recruitment files were seen. All had proof of identity, Criminal Record Bureau checks, an application form and a statement regarding their mental and physical fitness. The manager was however reminded that references must, where possible, be taken from the previous employer. Where this is not possible robust checks must be made relating to the relationship of the referee to the prospective employer. She was also reminded that where a ‘to whom it may concern’ reference is accepted that other checks as to the integrity and good character of the applicant should be robust. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are potentially at risk because the management systems designed to ensure residents live in a safe environment where they and their interests are protected are not being applied consistently. EVIDENCE: Holmesley has an experienced manager/matron who is also a Registered Nurse. She is respected by the owners, deputy manager and staff. She has successfully created an atmosphere which is described by residents as ‘friendly’, ‘fun’ and where ‘staff go the extra mile’. At inspections she always demonstrates an openness and willingness to listen and is consistently hospitable and helpful. She keeps up to date with current good practice and is currently investigating a course of training to meet an identified learning need. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 23 Quality assurance systems at Holmesley have been running for some time. However, the manager reports that staff and residents meetings have not been held recently due to other commitments. Some residents thought a meeting would be a good idea, especially as there had been a number of changes to residents and staff recently. The manager and owner also show a strong commitment to canvassing the views of those who do not tend to come to meetings or to speak out openly. Questionnaires are frequently undertaken, the results of which are published and added to the guide to the home. The last time this was carried out was in June 2006. As part of this inspection residents’ surveys identified a number of issues that would improve the individual lives of residents. These included one resident who wants onions with their liver and another who feels the bed is not as comfortable as it might be. As the surveys received are anonymous, the inspector has not been able to ask for the changes requested. The manager and owner have agreed that this might indicate that it is time for them to gain the views of residents for themselves. The management of three residents personal allowances were checked. Monies are stored safely and access to this is limited. The accounts checked were in order and the system is easily auditable. Records are not being kept up to date. This includes care planning, risk assessments for falls, nutritional needs, and equipment required to prevent skin pressure damage and recruitment. Due to the problems with recruitment the manager reports that not all staff have received the required mandatory training. For example some staff have not received training in food hygiene or infection control. Some staff have not received refresher training including manual handling. The pre-inspection questionnaire indicated that maintenance and safety contracts are in place. Cleaning materials are stored safely. The fire log and training are up to date. Not all accidents/incidents are recorded or investigated appropriately. Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 24 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 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 3 17 x 18 3 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x 1 2 Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 (1) (2) Requirement You must ensure that, after consultation with the resident, a care plan is drawn up for each resident detailing how the residents needs in respect of health and welfare are to be met. You must ensure that all medication is stored safely. (This refers to medication stored in the fridge). You must consult with residents about their social interests and make arrangements to enable them to engage in activities. You must ensure that you record any injury to a service user. You must ensure that all staff receive training that is appropriate to the work they are to perform. (This relates to ensuring that all mandatory training is up to date). You must ensure that you maintain in respect of each resident a record that includes information relating to Schedule 3 (3) (j) – a record of any DS0000026664.V305394.R01.S.doc Timescale for action 28/02/07 2 OP9 13 (2) 31/10/06 31/12/06 3 OP12 16 (2) (m) 17 Schedule 4 (12) (c) 18 (1) (c) 4. 5. OP37 OP38 31/10/06 28/02/07 6. OP38 17 (1) (a) Schedule 3. 31/10/06 Holmesley Nursing Home Version 5.2 Page 26 accident or incident affecting the service user. 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 You should ensure that opportunities are given to residents to take appropriate exercise and physical activity. And you should ensure that appropriate interventions are taken for those who are at risk of falling. You should ensure that you keep a record of nutrition, including weight gain or loss, for those at risk and that appropriate actions are taken. You should ensure that residents’ are encouraged to exercise personal choice and autonomy. You should ensure that liquidised food is presented in a way that is attractive and appealing in terms of texture, flavour and appearance and that the food preferences of residents are known in order to maintain residents’ appetites. You should ensure that all call bells are accessible to residents. You should ensure that you carry out robust recruitment procedures where necessary checking the accuracy of information and getting a reference from the last employer where applicable. 2. 3. 4. OP8 OP14 OP15 5. 6. OP22 OP29 Holmesley Nursing Home DS0000026664.V305394.R01.S.doc Version 5.2 Page 27 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 © 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.V305394.R01.S.doc Version 5.2 Page 28 - 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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