Inspection on 31/07/06 for Holmfield Nursing Home

This inspection was carried out on 31st July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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

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 Michelle O`Brien Key Unannounced Inspection 31st July 2006 09:00 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.V306771.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 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.V306771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15th November 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. 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. The current scale of charges is £338.18 - £472.09 per week. Additional charges are made for chiropody, hairdressing, toiletries and newspapers/magazines. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced fieldwork visit to this service as part of a key inspection process involving looking at a range of information. This included the service history for the home and inspection activity, notifications made by the home and information shared from other agencies and the general public. This visit took place between 08.50am and 4.10pm. On the day of the visit 16 service users were accommodated in the home including one service user who was in hospital. The inspector had the opportunity to meet most of the service users and chatted to two of them at length about their experience of the home. Other service users passed the time of day with the inspector in brief and polite conversation. Some of the service users found it difficult to engage in conversation due to their medical condition but were able to express some of their feelings with verbal and non-verbal communication. The inspector joined service users in the dining room for their midday meal. Four service users were ‘case tracked’. This involves investigating an individual’s experience of living in the care home by meeting with them, talking to them and their families (where possible) about their experiences, looking at their care files and focusing on outcomes. The manager was on annual leave but called into the home briefly to allow the inspector access to staff files. The inspector also talked to two of the care staff, two nurses, the maintenance person, the cook and activities co-ordinator. Documentation maintained in the home was examined including policies and procedures and records maintaining safe working practices. The inspector would like to thank staff and residents for their co-operation and hospitality during this visit. What the service does well: Staff were observed to be kind and caring towards service users and were aware of their needs and abilities and their likes and dislikes. It was evident through discussion with staff that they were knowledgeable about the people they were caring for. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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.V306771.R01.S.doc Version 5.2 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.V306771.R01.S.doc Version 5.2 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): Standard 3 was assessed Quality in this outcome area is adequate. There is a risk of the home being unable to meet the needs of a service user if needs are not fully identified during assessment. EVIDENCE: Four service users were identified for ‘case tracking’; two of these were admitted after the last inspection, one was admitted just before the last inspection and one was admitted several years ago. Records demonstrate that service users are visited by a member of staff to make an assessment of their needs before they are admitted to the home. An assessment form is used to record the abilities and needs of service users but the form is not always fully completed and the information gathered is not always recorded in sufficient detail to enable staff to develop care plans or identify the resources needed for an individual prior to their admission. Two out of three pre admission forms examined were not fully completed. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 9 Service users’ files contained information from social workers and hospital staff detailing needs. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 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): Standards 7, 8, 9 and 10 were assessed Quality in this outcome area is adequate. Service user’s needs were not consistently described in care plans which could result in an oversight of care. EVIDENCE: Staff were observed to be kind and caring towards service users and were aware of their needs and abilities and their likes and dislikes. It was evident through discussion with staff that they were knowledgeable about the people they were caring for. Four service users were case tracked. Their care files contained care plans to meet most of their basic needs but the care planning system needs to be further developed so that care plans are developed to meet all the physical, social and psychological needs of service users. Information in one service user’s care file indicated psychological needs but a care plan was not developed to address the need. Risk assessments are completed for nutrition, the risk of pressure sores and falls. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 11 The risk assessment tool used for monitoring the risk of developing pressure sores does not indicate the degree of risk; it has only two grades – ‘at risk’ or ‘not at risk’. For example, a bedbound person with no ability to move or change their position has the same degree of identified risk as a person who has sufficient ability to move with a little assistance. The manager should consider implementing a tool which gives a better indication of whether the risk is low, moderate or high which might be of more assistance to staff during care planning to decide upon resources or action needed for pressure relief. The care plan of one service user prescribes the use of an ‘airwave cushion’ provide pressure relief but a foam cushion was observed to be in use. There was conflicting information about the feeding regime for one service user who was being fed with a tube directly into the stomach (PEG). The care plan contains details of one type of feed while the medicine administration record indicated that a different type of feed was delivered to the home and administered. There was evidence that care plans are developed for service users who have wounds such as pressure sores or skin ulceration. These could be improved by the use of wound ‘mapping’ or photography to chart the progress of the wound. Care plans are not consistently reviewed and evaluated each month to ensure that the care prescribed is current and appropriate. There is evidence of some consultation with relatives about the care planned. One care file contained a consent from relatives about the use of cot sides to reduce the risk of falls. The inspector was concerned about some of the moving and handling practices observed in the home. Four out of eight service users sitting in the lounge in the morning did not have any footwear on other than socks but were standing to transfer from chair to wheelchair. This increases the risk of slipping during transfer. If service users are unable to wear appropriate footwear due to a medical problem then this should be included in their care plans within a risk management framework. Every wheelchair that was used to transfer or mobilise a service user was used without footplates. This increases the risk of entrapment of a person’s feet or legs if they are unable to hold them up while the wheelchair is moved. A row of wheelchairs were stored in a corridor between the main lounge and a bedroom annexe and all had the footplates removed. Footplates were seen stored all together in a box in this corridor. A set of weighing scales has been purchased by the home in response to a requirement made during the last inspection. Service users have their weight recorded each month. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 12 There was evidence of service users having access to GP, optician, and dietician. The management of medicines in the home was reviewed. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys and a medicines fridge is available. The following concerns were identified in relation to medicine safety and discussed with the nurse in charge during the inspection: Prescriptions are not seen prior to dispensing and there is no system to check the dispensed medicine and Medicine Administration Records (MAR) against the original prescription. There is no evidence that staff practice and competency is audited ‘Out of date’ eye drops were found in the medicines fridge. Of a random audit of medicines supplied in original packaging 1 out of 2 were accurate. The number of lansoprazole sachets remaining for one service user did not correspond with the number of times the medicine was signed as administered suggesting it was signed for but not given. An oxygen bottle was observed stored unsafely in a corridor outside a service user’s room. Excess and unused medicines are collected by the pharmacy. This must be reviewed to ensure that the arrangements for the disposal of medicines comply with legislative requirements. Staff were observed to address service users by their preferred names and were respectful of their rights to privacy and dignity when attending to their care needs. However, there were notices pinned on the walls of the downstairs communal toilet area naming individual service users and the size of incontinence pads that they should wear. This practice does not uphold the dignity of people living in the home. Two service users commented that they felt that they were ‘well looked after’ saying that they ‘only had to ask’ if they needed anything. One service user commented, ‘It’s not as good as it used to be.’ One relative commented that they believed their loved one ‘was only alive due to the care they are getting in the home’. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is poor. Service users are not given sufficient opportunity to exercise choice and some control over their everyday lives. EVIDENCE: When the inspector arrived in the home at 8.50am most service users were up and just finishing their breakfast. As the morning progressed, eight people sat in the main communal lounge and one gentlemen spent time in the conservatory reading. Easy chairs are arranged in rows against walls of the lounge instead of being grouped socially in various parts of the room. This restricts the ability for residents to interact with each other. Some people watched television; a couple chatted to each other and some people dozed on and off. There was some evidence that service users are supported to maintain some of their interests. The care file of one gentleman recorded his interest in bird watching and he had several books in his room. The home supports another service user to keep her budgie in the home; it was in its cage in the communal lounge and other residents enjoyed its company. The home employs an activity co-ordinator for 6hrs each week and this consists of one full day each week when organised activities take place. There is no planned daily activity programme available in the home. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 14 Service users told the inspector that their families could visit at any time and were made to feel welcome. Some relatives were seen ‘popping in’ for a brief visit just after breakfast. Opportunities for service users to exercise some control over their daily lives is limited. For example, the home has a fixed routine of ensuring that people are up and dressed before 9am in order to have breakfast. This regime includes instructing the night staff to get a certain number of people up before the end of their shift. One of the reasons for this is that the midday meal is served at 12 midday. The management of the home could investigate alternative working practices to ensure that people living in the home have more say in how they spend their day. While it can be difficult to support service users with impaired cognition to exercise choice over their daily lives service users were observed to be excluded in simple decisions such as the choice of meal. Although the daily menu shows two choices of meal, in practice only one of the menu choices is prepared and given to all service users. An alternative is only given if a person requests it. Staff and a service user confirmed this during discussion with the inspector. One service user told the inspector, ‘if you want a cooked breakfast you have to ask for it the day before and they don’t always remember to get it’. The inspector joined service users in the dining room for their midday meal. The meal of cheese and potato pie, corned beef and beans followed by ice cream and bananas was presented nicely. During the course of the day service users were offered drinks at regular intervals. The dining room has been decorated since the last inspection and had a ‘café’ feel to it. Service users were encouraged to use the dining room and ten of them ate lunch there giving them the opportunity to enjoy socialising with each other over their meal. Staff sat next to service users at the dinner table where they required assistance or prompting to eat their meal and help was given sensitively and discreetly. One particular service user was in her room chatting to the inspector when her meal was delivered to her room on a tray as she preferred the privacy of her room rather than the dining room. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. Service users and their relatives are confident that their concerns are listened to and are protected from harm by the home’s policies and procedures. EVIDENCE: The home has a complaints policy which is accessible to residents. People are encouraged to raise their concerns with senior staff on duty and two residents spoken to confirm that this is what they do if they have any worries. They knew the manager’s name and felt comfortable approaching her. Since the last inspection the Commission has received information on three separate occasions raising concerns about staffing levels within this service. The information received was used during this inspection and, in particular, when assessing the ‘Staffing’ outcome group contained in this report. Staff had Abuse Awareness training in January 2005. This needs to be extended to the staff members who have been employed since then so that they can recognise and respond appropriately to allegations or signs of abuse. The home has an Adult Protection Policy and a copy of Joint Agency Guidelines for Adult Protection held in the home. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 16 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): Standards 19, 20 21, 22, 25 and 26 were assessed. Quality in this outcome area is poor. The home continues to be in need of some improvements to provide a well maintained, safe and comfortable environment for service users to enjoy. EVIDENCE: The quality of the environment provided for service users varies throughout the home. A number of the areas identified at the last inspection remain in need of attention and overall the home was observed to need a lot of maintenance work, decoration and refurbishment if a safe and comfortable environment is to be provided for the people living there. The large communal lounge is comfortable although some of the furnishing is ‘tired’ and ‘shabby’. The dining room has been redecorated and is bright and welcoming although the floor remains uneven in places and has a potentially slippery surface in the event of spillages. Staff told the inspector that there were plans to replace the flooring in this area. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 17 Service users bedrooms were varied in the quality of accommodation they provide. Some rooms viewed had recently been refurbished provided tastefully decorated, homely rooms. It was evident that some of the windows to the front of the home had been replaced. However, some rooms continue to need redecoration. The inspector was informed that an action plan for a refurbishment programme has been developed but was with the owner at present and not available for the inspector to see on the day of this visit. There are ensuite facilities that are shared between two bedrooms but the bathing facilities in many of them are not accessible to service users. Bathrooms viewed were cluttered with equipment and one contained a used overnight catheter bag on a stand; this was identified as a risk of infection during the last inspection but the practice still persists. One ensuite shower room was in a very poor state of repair with tiles missing from the wall and not replaced. There is an assisted bathroom on the ground floor, which is accessible to disabled service users, but it is clinical, sparse and uninviting. Only one of the two adjacent communal toilets on the ground floor are accessible to service users. A record of the temperatures of hot water outlets are monitored weekly and continue to demonstrate that the recommended temperatures are exceeded which presents a potential scalding risk for service users. The home does not have a passenger lift but has a stair lift for people who are accommodated on the first floor of the home. Risk assessments need to be completed for the three service users who have bedrooms on the first floor to ensure that they can safely access to the rest of the home. Staff told the inspector that only the trained nursing staff escorted service users when using the stair lift; this was not detailed in any care plans. Risk assessments must also be completed for prospective service users who may be accommodated on the first floor in future. The gardens of the home provide a patio area with some raised beds, a path goes round the outside of the home which is just wide enough to allow wheelchair access. There is a large lawn to the back of the home which is not accessible to most service users because it is on an incline but was mowed and provided attractive surroundings. The personal laundry for service users is done in the home and sheets are sent out for contract cleaning. The washing machines in the home do not meet with regulations as they do not have a ‘sluice cycle’; this was identified at previous inspections and remains outstanding. A sluicing disinfector is available in a small room within the laundry. Systems need to be implemented to ensure that dirty articles carried through the laundry room to the disinfector do not potentially contaminate any freshly laundered clothes. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 18 The laundry room contained a sink, which is used for soaking soiled articles. There are no separate hand washing facilities and there was no soap, paper towels or protective clothing such as gloves and aprons. Systems for the management of control of infection in the home need to be reviewed to ensure the risks to the health of staff and service users are minimised. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28 29 and 30 were assessed. The judgement for this outcome group is poor. The numbers and skill mix of staff on duty needs to be reviewed to ensure that all the personal, social and healthcare needs of service users are met. EVIDENCE: Four weeks of duty rota between 16th July and 12th August 2006 were examined and demonstrated the usual staff complement for the home as detailed below: 7am – 1.30pm 1.30pm – 8pm 8pm – 7am 1 Registered Nurse and 2 care staff 1 Registered Nurses and 2 care staff 1 Registered Nurse and 1 care staff The rota demonstrated that the manager has sufficient supernumerary hours to discharge her responsibilities. However, the actual hours worked by the manager are not recorded on the duty rota. Care staff informed the inspector that although the early shift started at 7.30am a member of care staff on the early shift starts at 6.30am to help the night shift staff in assisting service Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 20 users up out of bed. This was not reflected on the duty rota. The nurses on duty worked 8am – 3pm on an early shift and 3pm – 8pm on the late shift. Staff from nurse and care agencies are employed on shifts that cannot be covered by the home’s own staff in order that the numbers of staff on duty are the same as detailed in the table above. It was evident from the duty rota that some care staff are also employed in ancillary staff roles. It is of concern that the duty rota demonstrated that there are occasions when a staff member undertakes a day shift in the kitchen but is on a night shift the night before and the night after. A requirement made at the last inspection to assess the risks of this practice to the health and safety of staff and service users has not been addressed. It was evident through observation on the day of this inspection that basic physical care needs of service user are met. However, minutes of staff meetings evidenced that some care delivered is ‘task orientated’ rather than person centred; for example, it is recorded that the night staff must get eight service users up before 8am as the early shift staff have to get the remaining service users up before 9am in order that they have breakfast. The inspector made an analysis of the number of hours of nursing and care staff using the Residential Forum Staffing tool, which demonstrated that there were insufficient numbers of staff employed in the home. An immediate requirement was made for the provider to review the staffing levels in the home by 4th August 2006. The provider made a prompt response to this requirement and has informed the Commission that the home is currently advertising for care staff and intend to employ a further 29 hours of care staff. Five out of the eight care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 63 , meets the National Minimum Standard for 50 of staff to be qualified. The personnel files of three recently recruited staff were examined and all contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) were obtained before staff started working in the home. However, one file did not contain any references. There was evidence in two of the files that staff undertook an induction programme when they commenced employment. The staff training matrix demonstrated that mandatory training had taken place: The most recent Moving and Handling Training took place in April 2006 for most staff. Staff employed since then need to have this training. The most recent Fire Prevention Training took place in April 2006 for most Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 21 staff. Staff employed since then need to have this training. The most recent First aid Training took place in May 2005 for some staff. Abuse Awareness training took place in January 2005 for staff employed at that time. Staff employed since then need to have this training. The most recent Infection Control training took place in January 2005. Staff employed since then need to have this training. Some staff have Food Hygiene Certificates but this training needs to be made available to all staff. Other staff training includes Dementia Care, Wound Care, Palliative Care and Nutrition. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38 were assessed. Quality in this outcome area is adequate. The home has a qualified manager but improvements are necessary to ensure the home is run effectively and in the best interests of service users. EVIDENCE: The effectiveness of the management structure within the home has improved since the last inspection with the return of the registered manager from leave in January 2006. The manager is a registered nurse and has the Registered Manager’s Award (RMA) NVQ level 4. The owner of the home visits the home each week. During the inspection it was evident that the morale of some of the staff is low. Reasons included staff vacancies, changes to working practices and changes to the staff rota. One service user was able to discuss with the inspector that some staff were unhappy with the way the home is run. The owner and Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 23 manager must develop a management approach which creates an open, positive and inclusive atmosphere. The home has a quality audit system which includes a weekly audit of maintenance and presentation. This needs to be further developed to include a review of policies and procedures and monitor working practices in the home. There was evidence available that surveys were undertaken seeking the views of service users and relatives but there was no evidence that the information was collated, analysed and an action plan produced. Residents’ personal monies are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of two of the residents’ personal monies was found to be correct. There was evidence that service users have an appointee to act on their behalf and this is usually a family member. Solicitors are appointed to act on behalf of service users who have no one else to assist them with their financial affairs. Records demonstrate that staff supervision is not consistently carried out six times a year for all staff and a supervision plan has been developed but not effectively implemented. A selection of service records were examined to assess the home’s performance in maintaining safe working practices and demonstrates that service and maintenance of systems are mostly carried out:Annual Portable Electrical Appliance Testing (PAT) was carried out in April 2006. Hot Water Outlet temperatures are not completed regularly every week and continue to demonstrate that recommended temperatures are exceeded presenting a risk of scalding to service users. The annual Landlord’s Gas Safety Certificate was issued in November 2005 Hoists for moving residents were inspected in February 2006. Records demonstrate that the Fire alarm is tested weekly. Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 1 2 X X 2 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 2 Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 26 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered manager must ensure that a comprehensive pre admission assessment is completed for all prospective service users to ensure that their needs can be met. (Previous timescale of 31/01/05 not met) The registered manager must ensure that care plans are current and accurately record service users health, personal and social care needs. (Original timescale of 19/07/05 not met) The registered manager must ensure that risks to service user’s health are identified and action taken within a risk management framework to reduce he risks. The registered manager must make arrangements for the safe management of medicines in the care home and ensure the issues identified in this report are addressed. (Original timescale of 31/03/05 not met) The registered person must ensure that service users’ privacy and dignity are respected at all times. Timescale for action 30/09/06 2 OP7 15 31/10/06 3 OP8 12, 13 31/10/06 4 OP9 13 31/10/06 5 OP10 12(4)(a) 30/09/06 Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 27 6 OP12 16 7 OP14 12 8 OP15 16 9 OP19 13, 23 The registered manager must ensure that all service users are given opportunities for stimulation through leisure and recreational activities which match their cultural preference. (Original timescale of 31/03/05 not met) The registered manager must ensure service users are offered choice and the opportunity to exercise some control over their lives. The registered provider must review the menus and ensure that the choice of meals offered are varied, nutritious and wholesome (Original timescale of 31/03/05 not met) The registered provider must ensure that the accommodation provided by the home is accessible, safe and well maintained to meet service users individual and collective needs in a comfortable and homely way. 31/10/06 31/10/06 31/10/06 31/10/06 10 OP21 13, 23 11 OP21 23 The registered provider must provide the Commission with a detailed and timed action plan for the maintenance and refurbishment of the home. (Ongoing from Inspection of 19 July 2005) The tiling to the shower room 31/10/06 (lower floor) must be replaced and the room redecorated. (Outstanding from Inspection of 19 July 2005) 31/10/06 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. (Original timescale of DS0000052950.V306771.R01.S.doc Version 5.2 Page 28 Holmfield Nursing Home 12 OP22 16, 23 13 OP25 23 14 OP26 13,16,23 15 OP27 17 sch 4 18(1)(a), 3(a)(b) 16 OP27 17 OP27 13 (4)(c) 18 OP29 7, 9, 19 Sch 2(5) 31/03/05 not met) The registered provider must ensure that service users have access to all parts of their private and communal space. Arrangements for ensuring accessibility for service users accommodated on the first floor of the home must be addressed within a risk management framework. Hot water temperatures must be maintained within a legally accepted safe range of 38ºC 43ºC unless a resident requests a different temperature and a risk assessment has been completed to demonstrate that it is safe to do so. (Original timescale of 31/01/05 not met) The registered person must ensure that systems are in place to control the spread of infection in accordance with relevant legislation and published professional guidance. The registered person must ensure that an accurate record is maintained of which staff are on duty and in what capacity. The registered person must immediately review and keep under review the number of staff on duty to ensure that the numbers and skill mix of staff is appropriate at all times to meet the assessed health and welfare needs of service users. The registered person must risk assess the hours being worked by staff to ensure the risks to the health and safety of staff and service users are minimised. (Original timescale of 31/03/05 not met) The Registered Manager must ensure staff files contain DS0000052950.V306771.R01.S.doc 30/09/06 31/10/06 31/10/06 30/09/06 04/08/06 30/09/06 30/09/06 Page 29 Holmfield Nursing Home Version 5.2 19 OP30 20 OP32 21 OP33 22 OP36 23 OP38 evidence that appropriate references have been sourced and obtained prior to employing someone to work in the home. (Previous timescale of 28/02/05 not met) 18(1)(c) The Registered provider must ensure that all staff are up to date with Statutory training requirements. 12 The registered provider and manager must maintain good personal relationships with each other and with service users and staff. 24 The registered manager must implement robust quality assurance and quality monitoring systems. 18 The registered manager must ensure that staff receive a minimum of six supervisions each year and appropriate records are maintained. 12, 13, 16 The registered provider must ensure that there are systems in place to ensure the health, safety and welfare of service users. 31/10/06 31/10/06 31/10/06 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 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. Extracts may not be used or reproduced without the express permission of CSCI Holmfield Nursing Home DS0000052950.V306771.R01.S.doc Version 5.2 Page 31 - 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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