Inspection on 13/03/09 for Holmfield Nursing Home

This inspection was carried out on 13th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmfield Nursing Home 07/02/08

Holmfield Nursing Home 31/07/06

Holmfield Nursing Home 15/11/05

Holmfield Nursing Home 19/07/05

Holmfield Nursing Home 03/02/05

Holmfield Nursing Home 24/08/04

Holmfield Nursing Home 20/01/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmfield Nursing Home 291 Watling Street Nuneaton Warwickshire CV11 6BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Holmfield Nursing Home 291 Watling Street Nuneaton Warwickshire CV11 6BQ 02476345502 02476329664 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Haydn-Barlow Care Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 22 Physical Disability (PD) 1 Date of last inspection Brief description of the care home Holmfield is situated on the A5 in between the towns of Hinckley and Nuneaton. The home is registered to provide nursing care for up to 22 elderly service users. Service user accommodation is provided on two floors, access to the first floor is by stair lift for those who are unable to manage stairs. The home has garden areas to the front and rear of the building. Ample parking is provided to the front of the property. The current Care Homes for Older People Page 4 of 30 Over 65 22 0 0 1 Brief description of the care home owner Haydn-Barlow Care Ltd has owned the home since end of September 2003. The current scale of charges is not shown in the Service User Guide but additional charges are made for chiropody, hairdressing, toiletries and newspapers/magazines. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Holmefield Nursing Home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment, (AQAA), which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within the AQAA, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Care Homes for Older People Page 6 of 30 Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, some policies and procedures, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between What the care home does well: What has improved since the last inspection? The care files looked at of residents with pressure sores, or at risk of developing them, had appropriate care plans in place in order to instruct staff of the care required to assist in the improvement of sores or to assist in the prevention of them. Care Homes for Older People Page 8 of 30 The manager told us that they now included a care plan to meet temporary needs, such as short term illness, and this was evidenced in one of the care plans looked at. What they could do better: A risk assessment and consultation with relevant people should be carried out before providing a resident with bed rails and any necessary action identified put in place. This will minimise the risks. There was no evidence that care staff had attended training related to the prevention or treatment of pressure sores. It is recommended that this is provided in order to minimise the risk of their occurence. An audit of six of the medications that were not supplied in blister packs showed that three of them had fewer than we calculated from the MAR sheets. This indicated that either tablets had been given and not signed for or that tablets had gone missing. The manager should ensure that the quality assurance and staff competence audit that she plans to implement is used to identify the staff who are making the errors and any necessary action is taken to prevent these errors. The manager should demonstrate to us how medication is to be safely transported around the home once the bedrooms on the first floor are occupied. Although the home was able to show us that special occasions are celebrated there was insufficient evidence to show that residents are offered stimulating activity and occupation, of their choice and preference, on a daily basis. The notice in the reception area showing our details needs to be updated to the current address and telephone number. Internal and external window frames and sills need to be repaired and/or repainted. Disposable towels should be stored in appropriate dispensers in order to maintain infection control. A hoist being used by staff to transfer a resident to her armchair was seen to have a very dirty and dusty frame. All equipment should be kept clean in order to maintain infection control. Whilst many of the staff have attended training related to safeguarding residents from abuse this should extend to all staff. The doors of the shared bathrooms should be lockable on both the bathroom and bedroom sides in order to maintain the privacy and dignity of the occupants of the bedrooms. The registered person should demonstrate that the Fire Service has been consulted regarding the door between the dining room and the reception being held open, being unable to fully close and of its suitability in the event of a fire. Care Homes for Older People Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: Three care files were looked at as part of the case tracking process. All three residents care files included a pre-admission needs assessment. These included all the required headings, including past social history and current interests. Medical conditions and needs were also identified. These were covered in sufficient detail for the home to make a decision about whether they could meet the persons needs or not and prior to offering them a place at the home. They included the need for pressure sore care and pressure relieving equipment for a person who had pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). A care plan had been devised from each of these assessments to enable care staff to have the information required to meet the needs of the residents. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place that provide appropriate information. There were shortfalls in bedrail risk assessements and decision making. Residents have access to health care professionals and are cared for in a respectful manner. Medication systems generally safeguard the residents health and welfare. Evidence: Care plans were included in all care files looked at and covered the areas of need identified in the assessments, including their current interests. One service user with pressure sores had appropriate care plans in place and had been provided with the appropriate pressure relieving equipment to minimise the risk of further pressure sores and to assist in the improvement of the current sores. Another resident with a high risk of developing pressure sores also had an appropriate care plan and equipment to minimise the risk. However training records showed no evidenence that care staff had attended training related to pressure sore prevention or treatment, which would assist in minimising the risk of these occuring. Care Homes for Older People Page 13 of 30 Evidence: Two of the care plans included the care required when using bedrails but did not include risk assessments. Whilst care plans can cover the risks it is recommended that a risk assessment is carried out prior to the provision of bedrails to ensure that this is appropriate and to minimise risks. One care file had a consent form for the use of bedrails, signed by the son of the resident. Residents on going health needs were being met with evidence of visits to, or visits by, the GP, opticians, chiropodist and hospital outpatients or other health care professionals as necessary. One care plan included a short term care plan for a chest infection. Discussion with staff told us that short term care plans are now always put in place so that temporary needs are met. Weight records were found in all care files looked at and each resident had been weighed monthly in order to monitor that they were taking adequate nutrition. There were records of nutritional screening for each resident and risk assessments were in place for moving and handling, falls and individual or personal risks. The medication system was assessed. A medication policy was in place and accessible to the nurses. The medication is provided by the pharmacist in multi dose system (MDS) blister packs, although some tablets are unable to be packaged in this way and are dispensed in original bottles or packets. Storage of medication was in good order. The manager had just purchased a minimum/maximum thermometer to use in the store room for medication to monitor that the correct temperature of less than 25 degrees centigrade was maintained. The temperature of the medication fridge was checked and records showed that medication requiring refrigeration were stored at appropriate temperatures. Internal and external medicines were stored in separate parts of the same cupboard and medication in us was stored in the trolley kept on the ground floor. As there is no passenger (shaft) lift this cannot be taken upstairs. The first floor was not occupied at the time of the visit but the manager needs to ensure that medication is transported safely around the home and can be made secure if the person responsible is called away or in an emergency. Only nurses administer medication. The Medication Administration Record (MAR) Sheets were looked at and were in good order with no unexplained gaps and appropriate codes used to explain the reasons if medication was not given. Care Homes for Older People Page 14 of 30 Evidence: An audit of medication not in the blister packs was carried out and all those checked indicated that they had not all been administered correctly. Three of the six medicines checked had fewer tablets than was calculated from the MAR sheets. The manager said that she was planning to use a quality audit system for the medication administration that would monitor the competence of staff and identify those who were making errors. A sample of signatures of staff able to administer medication was available and kept with the MAR sheets. Copies of the prescriptions provided by the GP were maintained and cross checked with medication received in order to ensure that what is received is what was ordered. Medication was disposed of appropriately and safely. Controlled drugs were recorded, stored, administered and disposed of appropriately and safely. The evidence seen showed that the medication generally safeguards the health and welfare of the people living at the home but with shortfalls in the accuracy of administration. The AQAA told us that all of the homes quality assurance surveys showed that the people living at the home were treated with respect and that their rights to privacy is upheld. All observation made of staff with residents and discussion with them confirmed this. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Special occasions are celebrated but there is limited activity that stimulates and occupies the people living at the home on a daily basis. Visitors are made welcome. Residents had some control over their daily lives. The varied meal choices were enjoyed by them. Evidence: Although the Service User Guide told us that the home employs an activity organiser this is not now the case and relies on care staff to provide appropriate occupation for the residents. Activities were recorded in the daily records but these were sparse and did not demonstrate that there was sufficient activity provided. The records showed that there had been several things happening at Christmas, such as Brownies carol singing, a sing a long and an entertainer but not a great deal had been recorded since then. However group activity was taking place in the lounge during the visit. Visiting is at any time, according to the manager and the Service User Guide. Visitors spoken with said that they were made welcome and a comment made by relatives to the home included, we feel we spent a lovely day with her and that again was thanks to everyone who Care Homes for Older People Page 16 of 30 Evidence: kept us supplied with drinks and making sure we were OK, and being so friendly. Other comments made by relatives were, Your care has been second to none. We have always found the staff to be caring and considerate to (relative) and to us when visiting. Discussion with residents and staff, observations made by us and the AQAA showed that residents had choice in their daily lives such as when they get up and when they go to bed, what they eat, whether they join in with activities or not and where they spend their day. The bedrooms looked at were personalised with their belongings such as ornaments, plants and photos. The Service User Guide says that the residents may bring with them some items of furniture and belongings to personalise their room following discussion with the manager. Meals are taken in a bright and pleasant dining room. Door from/to dining room continues not to close properly due to a bulge in the flooring by the doorway and was tied open during our visit. The door would therefore not be able to delay the passage of smoke or flames in the event of a fire. The home has a varied and nutritious menu that offers choice The AQAA told us that a review of the menus is planned for the near future. The registered provider said in discussion and in the AQAA that residents are free to request other meals and such requests are normally catered for. Residents who were spoken with on the subject confirmed that this was the case and that they enjoyed the meals at Holmefield. Records of the meals taken by residents are kept in the home for inspection. The kitchen is linked to the dining room by a serving hatch. When viewed it was clean, looked organised and in very good order. It was noted that fresh vegetables were provided in preference to tinned or frozen and other good quality food items were seen in the storage areas. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies, procedures and training to safeguard residents Evidence: The complaints policy was displayed in the reception area and was accessible to the residents and to visitors. A complaints log is kept and was made available to us. These records showed that complaints are addressed appropriately, that they are taken seriously and are acted upon. One complaint/safeguarding allegation related to the development of pressure sores was referred to social services with an outcome that the home dealt with the persons care appropriately. A further complaint sent to us regarding several issues about the services provided including rotting window frames and lack of equipment for the resident. The home had dealt with most of these issues prior to the complaint being sent to us and had satisfactorily addressed the remainder before the inspection. However there was still a rotting external window sill at the front of the home that needed attention. The AQAA and the manager told us that all staff attend training related to safeguarding and this was confirmed by staff spoken with but records showed that there were several staff who had not yet undertaken this. It is recommended that all staff are provided with this training in order that they are able to identify abuse and are aware of what to do if they suspect or witness it occurring. The appropriate policies and procedures are in place related to safeguarding although Care Homes for Older People Page 18 of 30 Evidence: the organisations policy does not make it fully clear that the manager does not begin investigating any allegations before having had discussion with the social services safeguarding team. Recruitment procedures and practices safguard resd and financial practices safeguard their financial interests. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there generally comfortable surroundings, which are clean, free of offensive odour but with some maintenance and safety shortfalls. Evidence: The home accommodates twenty two residents over two floors. The communal space consisting of a large lounge, a dining room, a conservatory, a large assisted toilet and two assisted bathrooms are on the ground floor. There are also bedrooms on this floor with the medical room, office and further bedrooms on the first floor. The reception area is a small but welcoming hallway. Alcohol gel was provided for visitors to assist in maintaining infection control. Compliments and thank you cards were available for people to look at in a folder and the complaints procedure was displayed for residents and vistors to be able to understand how to make a complaint if needed. Our address was displayed in the reception to inform residents and visitors but this showed a previous name (NCSC) and location. This should be updated so that people have our correct details. The large lounge is divided into sections by pillars and therefore enables smaller social grouping of armchairs for the people using the lounge. Windows in the lounge and to the front of the premises provide ample natural light. This room is pleasantly decorated, carpeted and furnished, although the provider said that new armchairs Care Homes for Older People Page 20 of 30 Evidence: were to be provided in the near future, thereby offering comfortable surrounding for the residents. Two televisions are provided in this room to cater for all groups of residents but have to be on the same channel at all times as they can both be heard in all areas of the lounge. Neither of the televisions are large screen to assist people with impaired vision. The conservatory provides a further sitting area for residents and is well furnished. It offers views of the front garden and of the comings and goings of the road at the front of the home. The carpet in the corridor adjacent to the corridor was faded and looked unattractive. A portable unguarded heater was in the conservatory and another in the adjacent corridor. The registered provider removed these promptly but was reminded that these should be fixed and must be guarded or of a low surface temperature in order to avoid accidental burning. Other concerns regarding storage heaters in the corridors had been addressed and these appliances were in working order. As previously mentioned the dining room is pleasant and bright, also having large windows that provide ample natural light. The kitchen is linked to the dining room by means of a doorway and a serving hatch. The door from the dining room to the reception was tied back during the time of the visit and as before would not close properly because of the bulge in the dining room floor. This created a possible risk, in the event of a fire, to people living and working in the home. The first floor is reached by the front staircase and a stair lift on the rear staircase. There is one shared room on the first floor which has an ensuite bathroom. None of the bedrooms on the first floor were occupied at the time of the visit and most of them were in need of improvement. The registered provider said that these were all to be brought up to a good standard and it was seen that some were currently in the process of refurbishment. Carpet on the corridor outside the office was badly stained and looked unsightly. Bedrooms looked at had been personalised with the occupants belongings and those that were occupied were clean and looked comfortable. The bedrooms varied in standard of decor with two that had been refurbished to a very good standard including the ensuite facilities. We were told by the registered provider that all bedrooms were to be brought up to the same standard. The bedroom doors continued to need varnishing and the owner said that this was planned. One shared ensuite bathroom did not have any means of locking the doors to the bedrooms, either on the bedroom or bathroom side. It is recommended that these are Care Homes for Older People Page 21 of 30 Evidence: provided and that they can be unlocked in the event of an emergency. Not all ensuite bathrooms had a disposable towel dispenser so that the towels had to be stored on the window sill. In order to maintain infection control appropriate dispensers should be fitted. One of the assisted communal bathrooms did not have any hand washing facilities. This could create a risk of cross infection if staff and residents using this area are unable to wash their hands when necessary. Gardens were well maintained and accessible to residents providing pleasant areas for residents use. An outside window frame was rotting and whilst not creating any hazards was unsightly and gave a poor first impression to visitors and the public. Some internal window frames also needed repainting or repair. Staff were observed when using a hoist. The hoist was very dirty and posed a hazard to the maintenance of infection control. Staff had ready access to protective clothing in order to maintain infection control. The laundry area is in an outbuilding and was clean and well organised. The washing machine did not show that it had a sluicing cycle but is industrial and has appropriate temperatures to disinfect laundry. A copy of the cleaning schedule aimed at maintaining infection control was displayed in each bedroom. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient care staff available to meet the needs of the current residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The staffing levels for the current number of residents (13) was one nurse, either Registered General Nurse or a Registered Mental Nurse, and two care assistants during the day and one nurse and one care assistant during the night. This would be sufficient for the reduced number of residents but needs to be monitored and adjusted as and when the numbers increase with permanent or respite service users. There was one nurse and two care staff on duty when we arrived and the manager and registered provider came in afterwards to be part of the inspection. In addition to nurses and care staff there are two cooks who work 7.30am to 12.30pm alternately and a newly recruited housekeeper who works 7am to 1pm. The registered provider manages any administration and therefore there are no administrative staff. We were told that the home rarely needs to rely on agency staff as the have good attendance levels and staff are willing to cover absences for each other. Training records were looked at and following discussion with the registered provider it Care Homes for Older People Page 23 of 30 Evidence: was seen that 80 of the care staff have the National Vocational Qualification (NVQ) Level 2 in Care with three care staff currently undertaking this training. This qualification shows that the person has been assessed as competent in their care role. The number of people having this qualification exceeds the required 50 . 3 staff files were looked at. All three contained the appropriate Criminal Records Bureau and Protection of Vulnerable Adults checks, two written references, a full employment history and two of the three contained a copy of their contract. One did not but the registered provider forwarded a copy of this after the visit. The home asks recruits for a full Curriculum Vitae (CV) as well as to complete an application form and the applicant is asked to explain any employment gaps. All staff files of nurses included their current PIN number showing that they were registered to work as a nurse. These procedures and practices help to safeguard residents from the employment of unsuitable people. Evidence of training was seen in each of the staff files looked at and training records were made available for inspection. Staff had undertaken mandatory training in Moving and Handling, Fire Awareness, Food Hygiene and Infection Control but the records showed that only one person had completed a First Aid course. It is recommended that staff undertake first aid training that enables them to have the knowledge and awareness to be able to deal with accidents and health emergencies. According to the records training related to specialist needs undertaken by care staff included, continence management, basic stoma care and food and nutrition; one care assistant had undertaken training related to dementia and another had taken training related to Parkinsons disease. Some care staff had had bereavement, palliative care training and wound care. There was no evidence that care staff had received training related to care of the skin or pressure sore prevention. It is recommended that they are provided with this training to assist in the prevention of pressure sores and skin damage. Other training had been undertaken by nursing staff related to their role and the needs of the people living at the home. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualifications and experience and who has applied for registration with us, manages the home. There is monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. Apart from shortfalls identified health and safety practices protect residents and staff at the home. Evidence: The acting manager has had previous experience of managing nursing homes, has completed the NVQ level 4 in Management, is a Registered Nurse and other recent training to update her skills and knowledge includes Dementia Care, Infection Control, The National Framework Gold Standards Award, Tissue Viability, The Mental Health Capacity Act and Deprivation of Liberty Safeguards. She had been the acting manager at Holmefield for almost a year. She is responsible for the management and supervision of the care and nursing staff and the registered provider is responsible for non-clinical aspects of the home. Application for registration has been submitted to us for the acting manager. Care Homes for Older People Page 25 of 30 Evidence: A Quality Assurance Programme is in place. Surveys had been distributed to residents and their relatives in order to have feedback on the services provided by the home. This is maintained by the registered provider at monthly, six monthly and annual audits of the services, depending on the area of service. Records seen were up to date. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. A limited amount of money is held by the home for each resident. There were appropriate records of transactions, and cash that balanced against these records for this money. Receipts were available for inspection for all transactions made. This safeguarded the financial interests of the people living at the home. Staff had undertaken mandatory training related to health and safety issues, although apart from one person they had not attended any first aid training. Two concerns related to health and safety were identified; the ill fitting dining room door was tied open thereby not preventing any passage of smoke or flames in the event of a fire and the portable and unguarded heaters in and by the conservatory, which could cause accidental burns. The heaters were removed promptly. The registered provider should provide evidence that the fire service has been consulted with regard to the dining room door, and any recommendations actioned. A random check of records showed that equipment had been regularly serviced and maintained and that in-house checks on the fire system were up to date. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 13 Heating must be provided in all areas that is free from hazards to the people living at the home. This will minimise the risk of accidental burning. 26/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 8 8 Care staff should attend training related to the prevention and treatment of pressure sores. Risk assesments should be devised and relevant people consulted before a person is provided with bedrails, to ensure that this is safe and appropriate. Audits should be carried out to ensure the competence of staff administering medication and appropriate action taken if errors are found. The manager should be able to show that medication can be safely transported to all parts of te home. The home should be able to demonstrate that residents are offered stimulating and regular activity that meets their wishes and preferences. Page 28 of 30 3 9 4 5 9 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 18 All staff should attend safeguarding training in order to give them the knowledge and skill to identify abuse and to know what to do about it. The internal and external windows should be maintained to a satisfactory standard. The bedroom doors should be varnished or painted to improve their appearance. The doors to the shared ensuites should be lockable on both the bathroom and bedroom sides. Staff numbers should be monitored and adjusted so that there are always sufficient staff in number and skill mix to meet the needs of the people that are living in the home. The registered person should demonstrate that the Fire Service has been consulted regarding the door between the dining room and the reception being held open, being unable to fully close and of its suitability in the event of a fire. The registered person should ensure that residents are safeguarded from accidental burning from heating appliances. 7 8 9 10 19 19 21 27 11 38 12 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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