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Inspection on 19/07/05 for Holmfield Nursing Home

Also see our care home review for Holmfield Nursing Home for more information

This inspection was carried out on 19th July 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff working in the home were observed to be caring towards residents and were aware of residents likes, dislikes and needs. Residents said that their relationships with the staff were good and staff were caring and hard working. Visitors said that they felt welcomed by the staff and could visit at any time.

What has improved since the last inspection?

Since the last inspection a new roof has been fitted to one area of the building. Garden areas to the rear and side of the home have been improved and replanted. Carpets have been cleaned. Care staff have commenced NVQ training and resident care plans continue to improve. Two residents and one relative said that there had been noticeable improvements in the home and that they were very happy with this.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Holmfield Nursing Home 291 Watling Street Nuneaton Warwickshire CV11 6QB Lead Inspector Louise Thompson Unannounced 19 and 20 July 2005 09:15 am 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 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 E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holmfield Nursing Home Address 291 Watling Street Nuneaton Warwickshire CV11 6QB 02476 345502 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hadyn-Barlow Care Ltd Ms Fiona Cooper- Woods Care Home 23 Category(ies) of Old Age (22) registration, with number Physical Disability (1) of places Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3 February 2005 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. The gardens are easily accessible to the service user. 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 E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over two days between the hours of 9.10 am and 4pm. This was the first visit for this inspection year. Staff co operated fully with the inspection. The deputy manager was present during the inspection. The owner was present on day two of the inspection. The inspection process involved a tour of the home, talking with the manager, examining records and care plans, observation of care practices along with discussions with residents, staff and two relatives who were visiting during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Assessment and care planning must improve so that the staff are able to know what to do for each resident. The arrangements for management of medicines need review to ensure that medicines are stored and given correctly. The refurbishment of current bathing facilities and improvements in décor throughout parts of the home are necessary to ensure a safe and comfortable environment for people living in the home. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 6 The most serious concern from this inspection was the arrangements for the management of the home whilst the manager is on maternity leave. The roles and responsibilities need to be clear and the deputy must be given sufficient time to enable her to fulfil the management roles and responsibilities. This is necessary so that the home continues to be well managed and residents’ needs met. A letter was left at the home to inform the owner and deputy manager that these should be put right immediately. 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 E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 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 standard(s) 3 The assessment process prior to admission of residents is inadequate. Without suitable assessments there can be no assurance that care needs of residents will be met. EVIDENCE: Whilst the manager is on maternity leave assessments of prospective residents is the responsibility of the deputy manager. Due to unforeseen qualified staffing issues recently it has been difficult for the deputy to identify suitable time to undertake these assessments. Individual records are kept for each resident inspection of the records of three previously admitted resident files showed that full pre admission assessment information had not been completed/ recorded. Assessment information obtained was lacking in specific detail to accurately identify all of the health, personal and social care needs of residents. Information was available on each file of assessment made by other health and social care professionals. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10 Progress has been made on improving care plans and arrangements to ensure that the health,personal and social care needs of residents are identified and planned for. Systems for the management and administration of medication are poor in some areas. These shortfalls have the potential to place residents at risk. Staff practice in maintaning privacy and dignity are good. EVIDENCE: Individual care plans are available and those examined identified residents’ health care needs and the actions staff needed to take to ensure that these were met. The personal and social care needs of residents were not fully assessed and lacked suitable care plans. Good evidence was seen on all four files viewed of suitable risk assessments and appropriate care plans. All plans had evidence of monthly review. One of the files viewed had evidence of resident/relative involvement in care planning/reviews within the last year. Residents and three relatives spoken to during the inspection said that they were happy with the care. One gentleman said it was” the best you can get.” Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 10 Access is available to health professionals outside of the home, which includes the Chiropodist, GP, District nurses and the Dentist. Systems for the assessment and management of wounds are satisfactory with evidence of involvement of the Tissue viability nurse. The home does not currently have a suitable set of scales to weigh residents; therefore it is not possible to accurately monitor the nutritional wellbeing of residents. Systems for the management and administration of medications were observed and the following issues of concern were discussed with the deputy manager. • • • • • There was no record of receipt of medications into the home. The policy for disposal of medications needs review in accordance with legislative changes. MAR sheets for some medications state give as directed, and medication prescribed to be given when required did not spcify reasons for their adminsitration. Medication transcribed by hand had been written incorrectly. Current systems for storage of oxygen are unsatisfactory. Staff were observed treating the service users with dignity and respect during the inspection. Five residents said that the staff were very caring and that they enjoyed living in the home. Two relatives spoken to said that the staff met residents care needs. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 15 Meals are nutritious but menus are lacking in choice and variety. EVIDENCE: The inspector observed lunchtime during the first day of inspection. The meal was attractively served and tasty. There were no alternative choices at lunchtimes and an inspection of records demonstrated that menus lacked sufficient variety and choices. A number of people living in the home said that they enjoyed the meals, that these were well cooked and portion sizes were good. One resident said that she had requested that faggots be put on the menu and this request was met by the home. Tea time is usually a choice of sandwiches/cakes, staff can provide snacks should these be requested. The kitchen area was observed to be clean and tidy. A sink in the washing up area was observed to be leaking from the pipe. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Systems for the management of complaints are satisfactory residents can be confident that their concerns are listened to, taken seriously and acted up on. EVIDENCE: A copy of the complaints procedure is located in reception and this is also included in the Service User Guide. Records are maintained of concerns raised details of any investigation undertaken and action taken as a result. Records show that there are no complaints recorded since the last inspection. The Commission has received one complaint since the last inspection with regards to the level of heating. This was upheld and suitable action was taken by the home. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 , 21 and 26 The home is in need of some improvements to provide a well-maintained environment with sufficient, suitable equipment and facilities, which ensures safe and comfortable surroundings are provided for residents. EVIDENCE: Since the last inspection the flat roofing has been replaced and work has commenced on improving areas of the garden to the rear and side of the building. A number of areas throughout the building still require redecoration and refurbishment to ensure a safe and comfortable environment for those who live there. In particular: The dining room window to the front aspect of the home is in need of replacement. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 14 On the first floor carpeting in the corridors is old, stained and worn in parts. Plastering and redecoration requires finishing and the lighting needs to be improved as this could present a trip hazard. A number of resident bedrooms require redecorating and the call bell system in some rooms requires repair/replacement. Bathroom and shower facilities require refurbishment. One shower room (lower floor) had a number of tiles missing and was in a poor state of repair. One assisted bathroom was being used to store furniture and was not accessible to residents. Although the home has a large number of bath/shower facilities not all of these are accessible to the current residents. Hot water temperatures at a number of baths are currently unregulated and water leaving the tap is too hot. Records seen of regular hot water checks confirm this. A bathing policy is implemented until suitable restrictors are fitted. A Legionella risk assessment has been undertaken recently and the owner said that this work will be completed shortly. Laundry was observed in baskets and stacked on the floor awaiting collection by an external laundry provider. Since the last inspection staff have recommenced laundering personal clothing at the home. The laundry requires refurbishment as the machines and facilities do not meet the current standards. The owner said that he was planning a refurbishment programme to address these and other issues identified within the next 6 months. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The number of qualified staff employed is insufficient to cover all shifts and allow for the deputy manager to undertake management responsibilities. 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 registered manager is currently on maternity leave. The deputy manager and a senior qualified staff member are sharing management responsibilities until she returns. Duty rotas for June/July 2005 demonstrated that the deputy manager was doing additional shifts and long days to provide suitable qualified cover. She said this was mostly due to one qualified staff member leaving and a further qualified staff member off sick. Agency staff had been requested but the agency was unable to provide cover. As a result she has had insufficient time to attend to management responsibilities. One relative and resident spoken to said that staffing levels had been reduced recently but the situation was improving and that the newly appointed staff were very good. The owner said two additional qualified staff have been appointed and will commence duty when pre employment checks have been completed. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 16 An immediate requirement was made at the time of the inspection that the deputy manager was given sufficient time to fulfil her management responsibilities and that the roles and responsibilities were made clear. Care assistant numbers were being maintained within agreed levels. Records of staff training demonstrated that staff have attended training in fire, dementia and protection of vulnerable adults in January 2005. NVQ training has been arranged with care staff having completed or currently undertaking an NVQ. Responsibilities for the planning and management of staff training whilst the manager is on maternity leave were unclear. Three staff files examined demonstrated that procedures for recruiting and appointing staff members are followed and protect residents living in the home. One of the files contained evidence of verbal references whilst the home was awaiting the return of the written reference. This was due to the qualified staffing situation within the home. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, 36 and 38 Residents’ financial interests are safeguarded. Issues surrounding health and safety and staff supervision need attention to safeguard the health, safety and well being of the residents. EVIDENCE: Procedures for the management of residents’ pocket money accounts and any valuables handed in for safe keeping are satisfactory. Records for two residents money were checked and were found to be correct. The home provides suitable insurance. Auditing and financial procedures are satisfactory; details of audited accounts for September 2004 were available at inspection. A system for staff supervision has been partially implemented. Records observed demonstrated that formal supervision has not been maintained during the manager’s maternity leave. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 18 Certificates for the service and maintenance for major systems were available the manager said that these were done by appropriately qualified personnel. Since the last inspection a Legionella risk assessment has been completed. Areas identified by this report are to be actioned in the planned refurbishment. The management of clinical waste disposal is currently under review. Training records showed 11 staff attended that manual handling training in November 2004. There were no arrangements for newly appointed staff members to attend manual handling training. As several of the residents need assistance with moving and handling this potentially places residents and staff at risk of injury. There were no records of COSHH training available. Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x 2 x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x 3 3 2 x 2 Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? 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 OP 3 Regulation 14 Requirement The manager must ensure that a comprehensive pre admission assessment is completed for all prospective residents to ensure that their needs can be met. The manager must ensure that care plans are current and accurately record residents personal and social care needs. Residents and their relatives should be given the opportunity to be involved in care planning and reviews. Records of their involvement should be maintained. 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. The manager must attend to 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 Timescale for action 30/09/05 2. OP 7 15 30/09/05 3. OP 8 14 , 17 Schedule 3 31/08/05 4. OP 9 13 30/08/05 Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 21 5. OP 12 16 6. OP 15 16 7. OP 19 13, 23 8. 9. OP 21 OP 25 13, 23 13,23 10. OP 26 13,16,23 indications for administration of prn medications. Review the systems for the safe storage of oxygen. Ensure that medications transcibed by hand are accurate. The manager must review the range of group and individual social and leisure opportunities available. These should be based on residents abilities and interests. (It was not possible to assess this at this inspection due to annual leave of the activity organiser.) The registered person must review the menus and ensure that choices are made available. Clear information is to be provided about the choices available at meal times. The carpeting to corridors on the first floor and resident rooms must be replaced and the plastering to the first floor must be completed. Lighting must be improved. The call bell system must be repaired/replaced in rooms where this does not work adequately. The registered person must provide the Commission with a timed action plan for the refurbishment of the home. This should include attention to areas identified in the main body of the report in standards 19, 21, 26 and 38. The tiling to the shower room (lower floor) must be replaced and the room redecorated. The registered person must ensure that work identified in the Legionella report (June 2005) is completed. The registered person must review and refurbish the laundry facilities. 30/09/05 30/09/05 31/12/05 30/08/05 31/12/05 31/12/05 Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 22 11. Op 27 18 12. OP 36 18 13. OP 37 26 14. OP 38 13,23 The deputy manager must be given sufficeient supernumerary time to fulfil the management responsibilities. The registered person must clarify the roles and responsibilities during the registered managers maternity leave.(An immediate requirement was made at the time of the inspection) The registered person must clarify the responsibilities for the supervision of care staff members. Staff should receive a minimum of six supervisions each year with records maintained. The registered provider must provide a written report in accordance with Regulation 26. A copy of this must be forwarded to the Commission( Old timescale of 01/03/05 not met) The manager must ensure that arrangements are made for staff to attend manual handling and COSHH training in accordance with legislative requirements. 21/07/05 30/09/05 31/08/05 31/08/05 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. 2. Refer to Standard OP 26 OP 30 Good Practice Recommendations The inspector recommends that additional baskets are provided to prevent laundry being stacked on the floor. The inspector recommends that the responsibilities for the management of staff training is made clear. The training records should be developed further and include details of the date of the training, details of the training provider and content of course along with the staff signature of attendance.A written staff training plan should be provided. E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 23 Holmfield Nursing Home Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Holmfield Nursing Home E53 S52950 Holmfield Nursing Home V239978 190705 Stage 4.doc Version 1.40 Page 24 - 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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