Inspection on 15/11/05 for Holmfield Nursing Home

This inspection was carried out on 15th November 2005.

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

Holmfield Nursing Home 13/03/09

Holmfield Nursing Home 07/02/08

Holmfield Nursing Home 31/07/06

Holmfield Nursing Home 19/07/05

Holmfield Nursing Home 03/02/05

Holmfield Nursing Home 24/08/04

Holmfield Nursing Home 20/01/04

Similar services:

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmfield Nursing Home 291 Watling Street Nuneaton Warwickshire CV11 6QB Lead Inspector Yvette Delaney Unannounced Inspection 15th November 2005 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 Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holmfield Nursing Home Address 291 Watling Street Nuneaton Warwickshire CV11 6QB 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) 02476 345502 02476 329664 Haydn-Barlow Care Ltd Mrs Fiona Cooper-Woods Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Physical disability (1) of places Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Manager completes the NVQ level 4 and the Registered Managers Award by the end of 2005. 19th July 2005 Date of last inspection Brief Description of the Service: 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 owner Haydn-Barlow Care Ltd has owned the home since end of September 2003. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection for this inspection year, an unannounced inspection, carried out on a Friday during the hours of 15.00 pm and 22.00 pm. A tour of the premises was undertaken. Records were examined, which include care plans, risk assessments, staff files and maintenance records. Conversations were held with six members of staff and formal and informal conversations with a number of residents. The inspection focused on the progress made on the requirements and recommendations made at the last inspection. The home provides facilities and services for up to twenty-two older people requiring long term care. The deputy manager was present during the inspection and the owner of the home arrived later that evening to carry out a pre-arranged interview and was able to take part in the inspection. Staff were receptive and positive throughout the inspection with a good level of knowledge about residents in their care. What the service does well: What has improved since the last inspection? What they could do better: In the absence of the registered manager the registered owner must ensure that action is taken to address all requirements made following inspections. All sections in the report require some element of improvement. Areas identified include ensuring that the Statement of Purpose accurately reflects the services and facilities offered by the home. The completion of preadmission procedures and ensuring that care plans identify the current needs Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 6 of residents. Systems must be in place, which ensure that appropriate checks are made when recruiting staff. When taking up references the manager must ensure that references are requested from suitable referees. The main area where improvements are needed is in the state of the premises. Overall the home was observed to need of a lot of maintenance work, decoration and refurbishment both internally and externally if a safe and comfortable environment is to be provided for the residents who live there. A number of the areas identified at the last inspection remain in need of attention. Some windows in the home need replacement, due to the poor and deteriorating condition of window frames and damaged windowsills. 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. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 The Statement of Purpose and Service User Guide do not accurately reflect the services and facilities currently available to residents living in the home Pre-admission assessments are incomplete and do not provide comprehensive information from which to ensure that potential residents care needs are identified prior to admission. As a result staff in the home cannot be sure that they are able to meet residents needs. Potential residents and/or their family are able to visit the home prior to admission offering them the opportunity to make a choice about moving into the home. EVIDENCE: A Statement of Purpose and Service User Guide were examined both provide details on the aims and objectives of the home and the range of facilities and services it offers to residents. Information in the documents needs to be reviewed so as to accurately reflect the services and facilities the home currently offers. Areas for review in respect of accuracy of information include the section on ‘Facilities provided in the home’ which states that: Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 9 The home, en-suite facilities and communal toilets are accessible by wheelchair. A rolling programme of routine maintenance and redecoration is implemented to ensure the home remains comfortable and homely. Evidence following a tour of the home demonstrates that the above information is inaccurate. A copy of the Statement of Purpose is available to residents, relatives and other visitors and a copy of the Service User Guide has been issued to all residents. Contracts of residency were also available outlining the terms and conditions under which facilities and services are offered to residents. Discussions with two relatives confirmed that they had the opportunity to visit the home before making a decision to move in. Three care plans examined evidenced that the deputy manager assesses potential residents assessment information obtained was lacking in specific detail to accurately identify all of the health, personal and social care needs of residents. Summaries identifying the care needs of residents referred by the different care management teams namely Social Services or the Primary Care Trust were available on file. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 10 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 and 10 The residents’ health personal and social care needs were not consistently described in care plans, which could result in the oversight of care and possible harm to residents. EVIDENCE: The home accommodates a high percentage of service users with a high level of dependency. Access is available to health professionals outside of the home, which includes the Chiropodist, GP, District nurses and the Dentist. Care profiles examined contained evidence related to these visits. Three care plans were examined these did not describe all the assessed needs of individual residents, for example a plan of care was not available for a resident with sticky eyes to demonstrate the care and treatment to be given. Information related to care was insufficient in some cases or lacked specific detail from which to ensure appropriate care would be given by staff. Information recorded was not always consistent, did not reflect current needs and whether care needs had been met. Care plans examined had not been updated to ensure that they identify the current needs of residents to whom they relate and there was no evidence Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 11 documented to confirm that relatives and residents are involved in a review of individual care. There was evidence of completed risk assessments in care plans examined, although one plan of care lacked a moving and handling assessment. Other risk assessments examined include determining the risk of a resident falling and the potential risk to residents in using bed rails to maintain their safety whilst in bed. Equipment necessary for the promotion of tissue viability and the prevention and treatment of pressure sores is available in the home. Generally staff were observed to be respectful towards residents when delivering care and when speaking to residents. A note placed on a bedroom door stated, “ Carpet sprayed with urine neutraliser may be slippery.” This practice does not ensure that the privacy and dignity of residents are respected at all times. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 12 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): 13 and 15 Residents are encouraged and supported to maintain contact with their family, friends and local community resulting in supporting their social skills and increase in their mental well being. Menus did not demonstrate that residents receive suitable meals three times per day, which are wholesome and provide residents with a nutritious and balanced diet. EVIDENCE: Relatives, friends and other visitors are encouraged to visit throughout the day and maintain contact and involvement in the care of their relative. Visitors were observed to visit the home at the time of inspection, two of which were spoken with. Visits took place in the lounge areas or the residents own bedrooms. Times of visiting were varied throughout the day and there were no restrictions. Two relatives spoken with were happy with the home and expressed that they were free to visit their relative at any time and were able to take them out if they wished. Meals were not fully assessed at this inspection. Menus available were examined these demonstrate that one main meal is offered at lunchtime with a choice of a snack meal as the alternative, which is similar to that of the choices offered at teatime. Choices lack variety and do not offer the opportunity of an Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 13 alternative main meal which is nutritionally balanced if the meal being offered is not suitable. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Policies, practices, procedures and the staff team’s knowledge of the recognition of the signs of abuse, ensure that residents are protected from abuse. EVIDENCE: Staff on duty were able to confirm having attended training related to Adult Protection. Discussions with two care staff on duty demonstrate that they have a good knowledge base and understanding of issues related to preventing and handling concerns related to protection of adults. Staff are aware of ‘whistle blowing’ and would not hesitate to report any concerns to the manager. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 15 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, 20, 21, 22, 23, 24, 25 and 26 The home is in need of improvements to provide a well-maintained environment with sufficient and suitable equipment and facilities, which ensure safe and comfortable surroundings, are provided for all residents. EVIDENCE: Some areas of the home have been redecorated and a few bedrooms were well presented, however overall the home was observed to need of a lot of maintenance work, decoration and refurbishment both internally and externally if a safe and comfortable environment is to be provided for the residents who live there. A number of the areas identified at the last inspection remain in need of attention. Some of the windows in the home need replacement, due to the poor and deteriorating condition of the window frames and in some cases windowsills. Those needing replacing include the dining room window to the front aspect of the home, bedroom windows and the kitchen window. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 16 The laundry was inspected and it was noted that the washing machine, tumble driers and facilities do not meet the current standards. There is no sluicing facility and care staff sluice dirty laundry in a sink situated in the laundry. The laundry area was organised and clear of clothing and linen. The Inspector was informed that care staff carry out laundering of residents personal clothing at the home and all other laundry is undertaken by an external company. The laundry is returned un-ironed and unfolded, which then has to be completed by care staff. The completion of these housekeeping duties by care staff reduces the number of care hours available to residents. It was not evident from duty rotas that staffing levels take these duties into account. The home provides shared bathing/showering facilities between two bedrooms. The layout, size of the room and the equipment and facilities provided are not suitable for use by residents currently accommodated in the home. The Inspector was informed that the majority of en-suites are not used as they are not easily accessible. A number of the en-suite rooms are small and could not be used by those residents who are disabled and require aids to assist them. There is only one assisted bath, which is accessible and suitable for use by all residents. A further assisted bath is available in one en-suite area dividing two bedrooms. The bath can only be accessed through doors in each bedroom and therefore not accessible to other residents without intruding on the privacy of the current occupants. Due to poor accessibility the residents occupying the adjacent bedrooms do not currently use the bath. One of the en-suites was being used for storage and contained a hoist, several washbowls and a urine catheter overnight bag, which was temporarily stored and reused at night. The tubing was left exposed, if reconnected presents a risk of cross-infection, which could leave to harm for the resident. The bathroom facilities still require work to bring them to acceptable standard and provide suitable and accessible bathing and showering facilities for all residents. The tiles required in the shower room (lower floor) have not been replaced and remains in a poor state of repair. In one en-suite there was no toilet seat. Hot water temperatures at a number of baths remain unregulated and water leaving the tap is too hot. Action required as a result of the outcome of a Legionella risk assessment has not been completed. There is a small communal toilet area situated off the main corridor of the ground floor. Two toilets are provided but due to the positioning and floor space available only one of the toilets is used. Commodes were stored in the corridor and clean clothing by radiators in the same area. Bedrooms doors were propped open and one door was kept open by a wardrobe door. The amount of natural light in one of the bedrooms situated on the first floor is poor and the level of lighting and colours chosen to decorate the room does not help to improve the situation. The call bell system Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 17 remains in need of checking one of the call bells was not working and the inspector informed that this had been reported to the engineer and was awaiting repair. One of the bedrooms on the first floor of the home is used for storage. Items stored include televisions, mattresses and chairs. The room is not locked and would be easily accessible to residents who wander. Packs of pads were stored on the floor of bedrooms in some cases this limited the amount of useable space available to residents. The home was not free from offensive odours on the day of inspection. There is a large garden area to the rear of the home, which is slightly raised. Access is available steps and the inspector was advised that wheelchair users and residents with poor mobility can access the garden via a ramp. The dining room floor is not safe for use by residents. The floor is not level at the entrance to the dining room. The flooring used is slippery and is coming away from the floor. The inspector was advised that the flooring is will be replaced as part of the major refurbishment plans. The home does not have a passenger lift, but provides a stair lift, which is currently used by one resident. The room, which is known as the treatment room on the first floor of the home is a small room used for the storing medicines. The room was not organised on the day of inspection and presents as a hazardous area. Hazards could occur due to a lack of storage space, the carpet is raised presenting a trip hazard, the ceiling is water damaged due to a leak. Containers block the cupboard door providing access to the water boiler. The owner of the home was present on the evening of the inspection and stated that a programme of re-decoration and refurbishment of the home has been discussed and planned. The owner was asked to provide details of his plans for improving and renewing both the internal and external condition of the premises. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 18 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 The number of qualified staff employed is insufficient to cover all shifts, which will allow for the deputy manager to undertake management responsibilities and registered nurses to ensure that nursing care and appropriate supervision of care staff is carried out. The deployment of additional non-care duties for all staff does not provide sufficient care hours to meet the needs of residents. Generally recruitment practices offer protection to those living in the home. Staff training lacks planning and is poorly recorded. Responsibilities for the management of staff training are unclear. EVIDENCE: The duty rota for September/October 2005 was examined, the rota does not demonstrate clearly the time allocated to the deputy manager to undertake management duties. The rota identified three shifts over a period of 4 weeks when there were 2 registered nurses on duty. Information in the Statement of Purpose and as demonstrated on duty rotas in respect of staffing levels indicate that the Registered Nurse is included in the care assistant numbers. There was information available to demonstrate the time allocated to undertake nursing care duties. Nursing and care staff also undertake housekeeping duties, which include laundry, cleaning and catering, which reduces the number of care hours available to residents. It was not evident from duty rotas that staffing levels take these duties into account. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 19 Contracted hours worked by staff are identified in their contract of employment. Duty rotas examined show that staff work long stretches of up to 12 days without a break. Conversations with care staff indicate that they have chosen to work in this way. There is no information to demonstrate that supervision and auditing of shift patterns have been carried out to monitor and confirm that staff are safe to work and undertake their duties effectively at all times. There is a total of two care staff with an NVQ level 2 qualification giving a total of 18 . The inspector was advised that remaining care staff are at different stages of completing the qualification to ensure that 50 of care staff are qualified have at least an NVQ level 2 qualification in care. Staff have received in-house training on the prevention and management of abuse, fire and infection control. The owner is actively recruiting staff, residents and relatives were unable to confirm that they had seen an improvement in staffing. The owner carried out an interview for a nurse on the evening of the inspection. Three staff files examined demonstrated that procedures for recruiting and appointing new staff members, which would support the protection of residents living in the home are not followed at all times. Examination of one file showed that although there were two references on file, references had not been requested from the most recent employers for a nurse employed in the home. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 and 38 The home has not got an effective management structure in place, which has resulted in ineffective leadership an unclear ethos and the introduction of poor practices and care planning records which do not safeguard the rights of residents and ensure that their welfare and interests are protected at all times. Supervision of staff is inconsistent, procedures implemented focuses on monitoring care practices delivered by staff, which if consistently carried will support ensuring that residents’ health, safety and welfare is maintained at all times. EVIDENCE: Management arrangements in the home are unclear, the home is currently being run and managed by the deputy manager. The indication is that suitable and sufficient time has not been allocated to ensure a safe and structured approach to managing the home. The duty rota for mid September to mid October demonstrates that 3 supernumerary days had been allocated during Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 21 the period of 1 month. Conversations with the deputy manager indicate that she has concerns about the time available to effectively manage the home. The owner of the home arrived at the home on the evening of inspection to carry out an interview indicating the type of support being provided by the line management structure outside of the home. Minutes were available dated July 2005 evidence the outcome of a meeting held between staff and the management team. Conversations with two care staff and evidence in written records demonstrate that staff are receiving supervision. Records examined demonstrate that supervision is carried out but not consistently. Certificates for the service and maintenance for major systems were available. Areas identified for action following a Legionella risk assessment has not been completed. At the last inspection the owner stated that the required work would be included in the planned refurbishment programme. As discussed under the section titled ‘Environment’ the home was observed to need a lot of maintenance work, decoration and refurbishment both internally and externally if a safe and comfortable environment is to be provided for the residents who live there. Records examined include the visitor’s book, which is available in the reception area and had been completed. Accident and incident details, which demonstrate that appropriate and informative audit, had been carried out. Fire alarms and emergency lighting have been checked. Fire drills have been carried out during the day. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 22 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 2 3 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 2 1 2 X X 2 1 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X 2 3 2 Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 23 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 OP1 Regulation 4, Sch1 Requirement The registered provider must ensure that the Statement of Purpose accurately reflects the facilities and services available in the home. The registered provider must ensure that the Service User Guide accurately reflects the services and facilities available in the home. All residents must be issued with a copy of the Service User Guide. Timescale for action 31/03/05 2 OP1 5 31/03/05 3 OP3 14 4 OP7 15 The deputy manager must 31/01/05 ensure that a comprehensive pre admission assessment is completed for all prospective residents to ensure that their needs can be met. (Outstanding from Inspection of 19 July 2005) The deputy manager in the 31/01/05 absence of the registered manager must ensure that care plans are current and accurately record residents health, personal and social care needs. (Outstanding from Inspection of 19 July 2005) DS0000052950.V266272.R01.S.doc Version 5.0 Page 24 Holmfield Nursing Home 5 OP7 15 6 OP8 14 , 17 Sch 3 7 OP9 13 8 OP10 12, 16 Residents and their relatives must be given the opportunity to be involved in care planning and reviews. Records of their involvement should be maintained. (Outstanding from Inspection of 19 July 2005) The registered person must provide a suitable set of scales to accurately record any changes in weight and ensure adequate monitoring of nutritional status of residents. (Outstanding from Inspection of 19 July 2005) The deputy manager in the absence of the registered manager must address the following: • Establish a suitable system for the receipt of medications into the home. • Review arrangements for the disposal of medications in accordance with legislative requirements. • Ensure that MAR sheets specify indications for administration of as required medications. • Review the systems for the safe storage of oxygen. • Ensure that medications transcribed by hand are accurate. (This requirement was not assessed at this inspection) The deputy manager in the absence of the registered manager must ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users at all times. • A review must be carried out on all notices/instructions displayed on the door of DS0000052950.V266272.R01.S.doc 31/03/05 31/03/05 31/03/05 31/03/05 Holmfield Nursing Home Version 5.0 Page 25 9 OP12 16 10 OP15 16 11 OP19OP38 13, 23 12 OP19 23 13 OP20 23 residents’ private accommodation. The deputy manager in the absence of the registered manager must review the range of group and individual social and leisure opportunities available. Activities available must be based on residents’ abilities and interests. (This requirement was not assessed at this inspection) The registered provider must review the menus and ensure that meals offered are varied and offer nutritious wholesome meals three times a day. The registered provider must provide the Commission with a detailed and timed action plan for the maintenance and refurbishment of the home. The plan must include action to be taken on the areas identified in the main body of the report in Standards 19, 20, 21, 22, 25 and 26 and referred to in Standard 38. (Outstanding from Inspection of 19 July 2005) The registered provider must ensure that the treatment room on the first floor is assessed and reviewed to ensure that the room is safe to use. The communal dining room must be made safe for use. The state of the flooring must be reviewed and replaced or other appropriate action taken to make the area safe for use by residents. The grounds to the rear of the home need to be safe and accessible to residents at all times. The garden area must also be accessible to residents DS0000052950.V266272.R01.S.doc 31/03/05 31/03/05 31/03/05 31/03/05 31/03/05 14 OP20OP22 23 31/03/05 Holmfield Nursing Home Version 5.0 Page 26 31/0 3/05 15 OP21OP22 23 16 OP21 13, 23 17 OP22 23 18 OP23 23 19 OP24 12(1)(a) 13(4) b,c 20 OP25 13, 23 21 OP25 23 22 OP25 23 who have mobility problems and use walking aids or a wheelchair. The plans for ensuring that sufficient and suitable lavatories and washing facilities are available to all residents accommodated in the home must be included in the refurbishment plan requested. The tiling to the shower room (lower floor) must be replaced and the room redecorated. (Outstanding from Inspection of 19 July 2005) Call systems provided in each room must be serviced to determine the reason for their continuous dysfunction and repaired or replaced as required. The Registered Manager must ensure that suitable provision is made for the storage of equipment to be used by residents, which does not minimise their available living space. A review must be made on the storage of peg feed equipment and incontinence pads. The Manager must ensure that all bedrooms accommodated by service users resident in the home are safe and free from offensive odours. The registered person must ensure that work identified in the Legionella report (June 2005) is completed. (Outstanding from Inspection of 19 July 2005) The level of lighting provided in bedrooms and the corridor of the first floor of the home must be reviewed and action taken to improve. Hot water temperatures must be maintained within a legally accepted safe range of 38ºC DS0000052950.V266272.R01.S.doc 31/03/05 31/03/05 31/03/05 31/03/05 31/03/05 31/03/05 31/03/05 31/01/05 Holmfield Nursing Home Version 5.0 Page 27 23 OP26 16 24 25 OP26 OP27 13,16,23 18(1)(a) (3)(a)(b) 43ºC unless a resident requests a different temperature and a risk assessment has been completed to demonstrate that it is safe to do so. Safe infection control measures must be practised at all times. The deputy manager must ensure that overnight urine bags can be re-used. Catheter bags when not in use must be appropriately stored or discarded. The registered person must provide suitable laundry facilities. The numbers and skill mix of staff must be appropriate to meet the health and welfare needs of service users. Any extra non-care duties must be clearly identified on duty rotas and separate to care hours provided. 31/01/05 31/03/05 31/01/05 26 OP27OP31 18 27 OP27 13(4)(c) The Registered Provider is requested to provide the figures for staff hours allocated to Personal and Nursing care in relation to the assessed needs of the service users. The deputy manager must be 31/01/05 given sufficient supernumerary time to fulfil the management responsibilities. The registered provider must clarify her roles and responsibilities during the registered managers maternity leave. (Outstanding from Inspection of 19 July 2005 for, which an immediate requirement was issued.) The registered manager must 31/03/05 risk assess the amount of days being worked by staff without a day off to ensure there are no DS0000052950.V266272.R01.S.doc Version 5.0 Page 28 Holmfield Nursing Home 28 OP28OP30 18 29 OP29 7, 9, 19 Sch 2(5) 30 OP32 12, 21 31 OP33 26 32 OP36 18 risks to the health and safety of the residents or staff. The Registered Provider must forward his plans for ensuring that a minimum of 50 of care staff are qualified to NVQ level 2. The registered provider must implement an ongoing training programme for all staff, which is appropriate to their needs and supports staff in providing safe care that meets the needs of residents in their care. The Registered Manager must ensure staff files contain evidence that appropriate references have been sourced and obtained prior to employing someone to work in the home. Evidence must be available, which confirms that the service users and staff are involved in the day-to-day running of the home and their views are taken into consideration. The registered provider must provide a written report in accordance with Regulation 26. A copy of this must be forwarded to the Commission. (Outstanding from Inspection of 01 March 2005 for) The deputy manager in the absence of the registered manager must that staff receive a minimum of six supervisions each year and appropriate records maintained. 31/03/05 28/02/05 31/03/05 31/03/05 31/03/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 29 No. Refer to Standard Good Practice Recommendations Holmfield Nursing Home DS0000052950.V266272.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. 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