Inspection on 07/02/08 for Holmfield Nursing Home

This inspection was carried out on 7th February 2008.

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

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

Other inspections for this house

Holmfield Nursing Home 13/03/09

Holmfield Nursing Home 31/07/06

Holmfield Nursing Home 15/11/05

Holmfield Nursing Home 19/07/05

Holmfield Nursing Home 03/02/05

Holmfield Nursing Home 24/08/04

Holmfield Nursing Home 20/01/04

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 Lesley Beadsworth Unannounced Inspection 11:40 7 and 11 February 2008 th th 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.V357636.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.V357636.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 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.V357636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 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 not shown in the Service User Guide but additional charges are made for chiropody, hairdressing, toiletries and newspapers/magazines. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection included a visit to Holmfield Nursing Home. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The acting manager was available for part of the inspection but Mr. Barlow, the registered provider/home owner, was involved in the majority of the inspection. He, the acting manager and all staff present were cooperative and helpful throughout the visit. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over two visits between 11.40 to 6.30pm on the first day and 3.40pm to 8.30pm on the second day. What the service does well: All requirements from previous inspections had been met at this inspection. The home offers the people living there mainly comfortable surroundings, which are clean, free of offensive odour, safe and generally well maintained but with some shortfalls in relation to heating in the corridors. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 6 There is eight care staff that have achieved National Vocational Qualification (NVQ) Level 2 in Care, which is 66 of the care staff team, therefore exceeding the required minimum of 50 . There are a further 3 staff scheduled to complete their training by the end of March 2008. This qualification shows that the person has been assessed as competent in their role. Staff spoken with said that they felt the home was, “a happy place to work” and that the registered provider supported them. The acting manager also said that he felt supported by him and that he met any reasonable request for the home. Residents on going health care needs were being met with evidence of visits to or visits by the GP, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were very well groomed and looked well cared for. Appropriate risk assessments and health checks were in place in order to safeguard the residents’ health and well-being. Satisfactory measures were in place for risk assessing the occurrence of pressure sores. A resident with a major pressure sore had a care plan that described the care required. Staff completed a chart in the bedroom showing the care provided during the day. The care plan also showed that a tissue viability nurse was involved in the care of this person with regard to the sore. Residents were being cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Residents were being cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Four visitors were spoken with and all of them said that they were made to feel welcome. They were all happy with the service received at the home and described the staff as “wonderful” and “caring”. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. They are also able to bring in their own possessions to personalise their bedrooms. The menus consisted of varied and nutritious meals and those taken were appropriately recorded. Beverages were offered throughout the day. Residents spoken with said that they enjoyed the meals at the home. There was ample supply of fresh vegetables that, apart from peas, were used in preference to frozen vegetables and despite the registered provider saying Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 7 that he was due to do the food purchasing the fridges and food cupboards were stocked with appropriate and ample food. The home has appropriate policies and procedures to safeguard residents. There is a very good system for recording complaints and the action taken. There are sufficient care staff available to meet the needs of the residents. What has improved since the last inspection? All the outstanding requirements from previous inspections had been met and the home appeared to be managed satisfactorily by the acting manager and the registered provider. The home had been without a permanent manager for some time but the registered provider was able to advise us before this report was completed that a person with the appropriate qualifications and experience had been appointed. The Statement of Purpose and Service User Guide had been brought up to date and a brochure containing photographs of the home was available. These documents provided ample information to enable prospective residents to make a choice about living at the home. All staff felt that there had been improvements over the past year and were satisfied that they provided a good service. A new pre-admission assessment format had been devised and used since the last inspection. This covers all the areas of need and assists in completing an assessment that enables a decision to be made about whether the person’s needs can be met at the home. Care plans had improved since the last inspection but with some shortfalls. Care plans and risk assessments had been devised for the use of bedrails, ensuring that they were used in a safe manner. There had been a big improvement in the medication process, as was identified at previous inspections carried out during the year by the pharmacist inspector. At this visit it was noted that there was a safe medication procedure. The procedure and practice related to medication safeguard the health and welfare of the people living at the home. An outstanding requirement related to medication for accurate and up to date written records of the current medication was met on this occasion with Medication Administration Record Sheets showing what had been prescribed and administered. All observations and discussions made demonstrated that residents are cared for in a respectful manner ensuring that their dignity and self-esteem are Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 8 maintained. Notices in the bathroom considered to impact on the dignity of people living at the home had been removed. The care staff offer activity and occupation for a minimum of one hour each day. Bingo was taking place during one of the visits and staff spoken with said that other activities take place most days. Menus had been reviewed and residents were asked what main meal they wanted. There were also alternatives to the printed menu on offer, one resident having different to the menu each day. There had been a great deal of improvement with the décor of the home, having been decorated throughout and looked bright and cheerful. New windows had been provided in the lounge and good quality and attractive curtains had been hung. A communal toilet had been re fitted and refurbished providing a good sized assisted toilet that easily accommodates a person in a wheelchair and two care staff. Two ensuite bathrooms, one with a shower and one with a bath, had been recently refitted and tiled and were a great improvement, offering high standard facilities to the occupants. Some temperature control valves had been fitted since the last inspection, in order to prevent accidental scalding. These had been risk assessed so that those rooms occupied by a person who accessed the hot water independently were fitted first. A new stair lift had been fitted on the wider rear staircase giving residents safe access to and from the first floor. An infection control audit had been carried out by an infection control nurse and recommendations had been made as a result. Many of these had been already implemented and an action plan was in place for the remainder. Although the rota did not have a code as at previous inspections, once it had been made clear what was required this had been carried out by the second day of the inspection visit. Most staff daily hours worked are now of normal duration but one member of staff continues to choose to work a long shift. The registered provider said that he monitors this. Training carried out by staff included statutory training of moving and handling, fire training first aid and food hygiene. Further training undertaken since the last inspection includes, infection control, Protection of Vulnerable Adults and some staff have attended training related to Dementia, palliative Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 9 care, bereavement, promoting continence, life support and nutrition. This training gives the staff the skills and knowledge to work safely within the home and to meet the needs of the people living at the home. There were only ten residents in the home at the time of the visits but the registered provider had chosen not to reduce the number of staff working at the home. Observations made and discussion with staff showed that there were sufficient staff to meet the needs of these residents. All staff files looked at contained a Criminal Records Bureau check. This ensures that residents are safeguarded from the employment of unsuitable people. This safeguards residents from the employment of unsuitable people. The home has a training matrix that records all staff training. This showed that staff have undertaken appropriate training during the last year, in order to give them the knowledge and skills to work safely within the home and to meet the needs of the residents. Discussion with the owner, the acting manager and the other staff it was evident that there were good personal relationships and they interacted well together. Staff and resident interaction was also good. Staff meetings had been held regularly since the last inspection giving staff the opportunity to contribute to the way that the services are provided. A comprehensive and effective quality assurance audit was in place. This had been in place at the previous inspection but had not been fully carried out. The registered provider had therefore decided that he would complete this himself. The programme consisted of weekly, monthly six monthly and annual audits and had been completed throughout the year. The home therefore can show that it is monitoring the service in order to enable growth and improvement. The acting manager said that he supervised the nursing staff who in turn supervised the care staff and advised that this was on target for six sessions a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Records were not inspected on this occasion. Satisfactory health and safety systems and service and maintenance checks were in place and the registered provider monitored these. He also attended to any maintenance tasks necessary in the home. What they could do better: Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 10 Where practicable care plans should be signed by the resident and/or their representative to show their involvement. As with all documentation these should also be dated. The amount of detail within the care plans varied but all care plans need to be in sufficient detail to enable staff to meet the needs of the residents as relying on staff memory and the spoken word creates the risk of needs not being met. Corridors leading from the lounge were cold with the electric storage heater in one corridor not working and the thermostat on a radiator in the other being set wrong. In order to ensure that all areas of the home are warm enough for the people living there these faults must be addressed. The laminated floor by the doorway in the dining room had lifted or swelled which stopped the door closing properly. As this is a fire door, the registered provider should seek advice from the fire service. The central light fitting in the clinic room had been removed following a water leak through the ceiling. In order to provide sufficient brightness for people working in this room this needs to be replaced promptly. The ensuite bathrooms are not heated by the central heating system but by an out of reach electric wall heater. There must be a system in place to ensure that any person able to get up in the night to use the ensuite is warm enough. There was very noisy plumbing, possibly an air lock, in one area of the home, which reverberated along the first floor. This was disturbing and needs attention as soon as possible. Although all the walls throughout the home had been papered or painted the bedroom doors were still awaiting re-varnishing or painting and were badly marked by wheelchairs, detracting from the appearance of the home and the comfort of the people living there. The newly appointed manager must apply promptly for registration with us. 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. The summary of this inspection report can be made available in other formats on request. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 11 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.V357636.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide had been brought up to date and a brochure containing photographs of the home was available. These documents provided ample information to enable prospective residents to make a choice about living at the home. A new pre-admission assessment format had been devised since the last inspection, and was in use. This covered all the areas of need and enabled a decision to be made about whether the person’s needs could be met at the home. These need to be reviewed and revised as circumstances change. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 13 A care plan had been devised from the assessment in all the care files examined. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. The home has a medication system that safeguards the health and welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. These were chosen randomly but to include a care plan of a recently admitted resident and a resident with pressure area concerns. The care files showed records of a resident’s vital signs on admission to the home and their past medical history. The plans showed the care required to meet the needs of the residents and covered all needs identified in the assessments. Each need had varied detail, for example in one care plan the information related to personal care was in need of more detail as instructions included “needs help” whereas the instructions for ‘sleep’ was very detailed. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 15 One resident had suffered a very recent bereavement and staff were offering appropriate sympathy and understanding, this was recorded in the care plan, creating the risk that this need would not be picked up by all staff and therefore not met. All care plans need to be in sufficient detail to enable staff to meet the needs of the residents as relying on staff memory and the spoken word creates the risk of needs not being met. Care plans had not been signed by the resident and/or their representative and should be wherever this is practicable in order to show their involvement in drawing up the plan. We were told that relatives and residents had declined to do this and are kept up to date verbally by the home. Some had also not been dated. Residents on going health care needs were being met with evidence of visits to or visits by the GP, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were very well groomed and looked well cared for. Records for falls, pressure areas, weight, bathing and nail checks were in place within the files looked at. A completed Waterlow score identifying the risk for pressure areas, and risk assessments for nutritional screening and manual handling were in place. Weight charts and any medical interventions were available in each file. Individual risks were also assessed, for example to the risk to the individual in relation to alcohol intake. Where appropriate a risk assessment was in place for the use of bedrails thereby ensuring that they would not be used without discussion and to prevent any accidental injury to the resident. Preventative measures such as pressure relieving mattresses and cushions were in use. A resident with a major pressure sore had a care plan that described the care required. Staff completed a chart in the bedroom showing the care provided during the day. The care plan also showed that a tissue viability nurse was involved in the care of this person with regard to the sore. Discussion with nursing staff revealed that another resident had a minor pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) that had developed a couple of days previously. Whilst staff were able to describe the care that was being provided the care plan had not been updated at the time of the first visit. However this had been completed by the second visit and was in sufficient detail. Medication had been inspected on several occasions by the pharmacist inspector and improvements had been identified. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 16 At this visit it was noted that there was a safe medication procedure with medication being administered by nursing staff from a medication trolley. An outstanding requirement related to medication for accurate and up to date written records of the current medication was met on this occasion with Medication Administration Record Sheets showing what had been prescribed and administered. The pharmacy used had made some errors in the Medication Administration Record Sheets, which had been picked up by the home. There were no unexplained gaps or inappropriate codes seen in the Medication Administration Record Sheets. Handwritten instructions had been suitably countersigned to prevent errors and the reasons for any change was shown on the reverse of the sheets. A random audit of medication found no errors. Medication is also audited regularly by the acting manager and is part of the quality assurance system. Controlled drugs are kept in a locked cupboard in a safe location and were in good order. The procedure and practice related to medication safeguard the health and welfare of the people living at the home. Time was spent in the lounge and staff were observed in their work with the residents. Residents and visitors were also spoken with regarding staff and the services provided and made positive comments. Terms of preferred address were on the residents care plan and heard to be used by staff. Residents were being cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Conversations between staff and residents were respectful, including jovial banter and staff responded promptly and sensitively to the needs of residents. Notices in the bathroom considered to impact on the dignity of people living at the home had been removed. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had previously employed an activity organiser but the registered provider reported that this had not worked out and had reverted to the activities being the responsibility of the care staff. The minimum of an hour a day was allocated to this. Staff were seen to spend time with residents on a one to one basis and as a group. Birthdays and other special occasions are celebrated and photographs of Christmas showed this. A married couple living at the home had a diamond wedding celebration, which included a church blessing at the home. Bingo was being played in the afternoon of one visit and residents and staff spoken with said that other activities take place most days. Staff said that residents go out frequently in the summer and residents spoken with confirmed this. Magazines and the daily paper were available in the lounge for the residents. Holy Communion is held at the home each week for Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 18 those residents who wish to attend. There were no other specific religious needs, although Gideon bibles had been brought into the home recently and some residents had been happy to receive one. Whilst there seemed to be sufficient organised occupation for the people currently living at the home this needs to be kept under review as occupancy levels increase. Four visitors were spoken with and all of them said that they were made to feel welcome. They were all happy with the service received at the home and described the staff as “wonderful” and “caring”. Visiting time was at any time and whilst those seen at the home were entertained in the main lounge or the resident’s bedroom, the conservatory was also used on occasions for visitors. One relative had showed their commitment to the home by raising sufficient funds to buy a new television for the lounge. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. One resident had chosen to stay in bed until after 11am on the day of the visit and residents. Staff gave assurances that breakfast and drinks had been offered in the interim. Breakfast and lunch were taken in the newly decorated dining room. Food was served from the adjacent kitchen. Menus were on display on tables for residents’ use and included a choice of meals. These had been reviewed since the last inspection and residents were asked daily what main meal they wanted. There were also alternatives to the printed menu on offer, one resident having different to the menu each day. The menus consisted of varied and nutritious meals and those taken were appropriately recorded. Beverages were offered throughout the day. Residents spoken with said that they enjoyed the meals at the home. The kitchen was visited and found to be clean and well organised. There were several new items of equipment including a new microwave that had been purchased that day promptly after staff had reported the other broken. New windows had been fitted in the kitchen and fly screens were on order for them to prevent flies and other flying insects from entering the kitchen and contaminating the area or any food in there. Windows could be easily opened as they opened inwards so that screens could be fitted on the outside. There was ample supply of fresh vegetables that, apart from peas, were used in preference to frozen vegetables and despite the registered provider saying that he was due to do the food purchasing the fridges and food cupboards were stocked with appropriate and ample food. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 19 The record of meals taken was available in the kitchen and showed the variety of meals, including a large number of alternatives to the menu that had been taken by residents. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. Records are maintained regarding complaints and any action taken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure was available for residents and visitors and a copy was available in the Service User Guide. The complaints record was viewed, which was a good system of recording the details of a complaint and how it was managed. There had been no complaints made to the home since the previous inspection. However there had been several concerns in the first part of 2007 regarding various issues related to management, staff and environmental issues. There was no evidence that any of these concerns were currently in the home and discussion with the acting manager, the owner and with members of staff indicated that any issues there may have been previously had resolved with the current team. All residents and visitors spoken with were aware who to speak to if they had any concerns and were confident that they would be addressed satisfactorily. According to training records viewed, the majority of the staff had undertaken recent training related to protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 21 from abuse. There had been one allegation of abuse made since the last inspection. This was investigated by Social Services and the evidence shown at the time of the visit did not support the allegation. No further action had been taken. All recruitment practices safeguard residents from the employment of unsuitable people. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 Quality in this outcome area is good. The home offers the people living there mainly comfortable surroundings, which are clean, free of offensive odour, safe and generally well maintained but with some shortfalls in relation to heating in the corridors. Infection control has been well addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Holmfield Nursing Home offered comfortable, clean and hygienic surroundings for the people living at the home that were free of any offensive odour. The home has been decorated throughout since the last inspection. The main entrance is approached through a newly double glazed arched doorway and had been attractively decorated and furnished. Fresh flowers were in the hall on both days off the visit. The stairway that leads off the hall had been recarpeted. To one side of the hall was a doorway through to the lounge with the dining room and kitchen accessed from the other side. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 23 The dining room was large enough to cater for all the residents and was recently decorated and with new curtains and attractive plastic coated cotton tablecloths in place. The laminated floor by the doorway in this room had lifted or swelled which stopped the door closing properly. As this is a fire door, the registered provider should seek advice from the fire service. The lounge was roomy and pleasantly decorated, with new double glazed windows that had new, good quality and attractive curtains. Armchairs were of reasonable condition although the registered provider said that he had hoped to replace them and were placed in sociable groups. Good quality artwork and floral arrangements were displayed on the lounge walls. Residents spoken with said that they were pleased with the new décor. The room housed two new televisions so that everyone was able to view the chosen programme easily. The corridors off each end of the lounge led to bedrooms, a communal toilet and bathroom. These corridors were both quite cold at the time of the visit. One corridor also led to a bright and pleasant conservatory, which on the first visit were heated with portable heaters that were not fixed or guarded. Discussion with the registered provider led to these being removed and low surface temperature heaters ordered to remove the risk of any accidental burns. The storage heater further along the corridor was not working either day resulting in this area being very cool. The corridor leading off the other end of the lounge was also cold. The registered provider said that this was due to the thermostat valves being turned down and would address this, although it continued to be cool at the second visit. This needs to be addressed in order that all areas of the home are warm enough for the people living at the home. Some light bulbs were in need of replacing but these were replaced during the visits. The light fitting in the clinic room had been removed following a leak through the ceiling and a reading lamp was being used. This was not of sufficient brightness for staff to see clearly. All bedrooms had ensuite facilities each being shared between two bedrooms. Electric heaters fitted high on the walls and heated these and care pans showed that these were turned on 15 minutes before anyone used the bathroom. Although the registered provider advised that there was no current resident who used the bathroom without assistance there needs to be a system that ensures the heaters are left on for anyone who might use the toilet during the night. The main communal toilet had been refitted and refurbished and provided ample space for a resident to be assisted by two members of staff. Some items had been stored in here and appropriate storage cupboards should be provided or an alternative space found. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 24 Each ensuite had a bath or a shower plus a toilet and wash hand basin and was shared by two bedrooms with doors that could be locked from both sides from each room. All those viewed were clean although those not refitted were looking a little dated. Two ensuite bathrooms, one with a shower and one with a bath, had been recently refitted and tiled and were greatly improved offering high standard facilities to the occupants. Paper towels were available in a suitable dispenser in communal areas where staff would be expected to wash their hands to maintain standards of hygiene. There was very noisy plumbing, possibly an air lock, in one area of the home, which reverberated along the first floor. This was disturbing and needs attention as soon as possible. Some temperature control valves had been fitted since the last inspection, in order to prevent accidental scalding. These had been risk assessed so that those rooms occupied by a person who accessed the hot water independently were fitted first. All bedrooms viewed had been personalised by such possessions as ornaments, pictures, photographs and small items of furniture and were generally bright and comfortable. Although all the walls throughout the home had been papered or painted the bedroom doors were still awaiting re-varnishing or painting and were badly marked by wheelchairs, detracting from the appearance of the home and the comfort of the people living there. The first floor can be reached via the staircase leading from the front entrance hall or by the new stair lift that had been relocated to the wider rear staircase. The corridors on the first floor also had new carpets. The office and further bedrooms were located on this floor. Laundry facilities were inspected and found to be well organised, clean and hygienic. Laundry equipment provided the appropriate programmes. A new washing machine had been provided since the last inspection. Whilst there was one tumble drier out of order a second was in good working order and would be sufficient to meet the needs of the home. An infection control audit had been carried out by an infection control nurse and recommendations had been made as a result. Many of these had been already implemented and an action plan was in place for the remainder. One recommendation was a robust bedroom cleaning and ‘deep cleaning’ schedule, which also addressed hospital-transmitted infections such as MRSA. This cleaning schedule was displayed behind the door of each bedroom, in part to allay the fears about these infections that had been made known to the registered provider by some relatives. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 25 All cleaning materials were colour coded to reduce the risk of cross infection. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents but the low numbers of catering staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a rota that showed the shifts that had been worked. Although not fully coded on the first visit this was addressed by the time of the second visit when what was required was clarified. The registered provider advised that the staffing levels average at three care staff and a registered nurse in the morning and two care staff and a nurse in the evening if there are over 15 residents; if there are less than 15 there is usually one care assistant less on the morning shifts; a nurse and two care staff during the night when there are over 15 residents; one less care assistant when there are less than 15 residents. On both visits there were two care staff and a registered nurse on duty and rotas seen confirmed this for the rest of the month. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 27 There are also two domestic assistants and a part time cook. The cook works 7.30am to 1.30pm and the care staff need to be involved in providing the evening meal. This would reduce the time that should be spent with the residents. Another member of staff cooks, as extra hours, on the days that the cook is not on duty. There is eight care staff that have achieved National Vocational Qualification (NVQ) Level 2 in Care, which is 66 of the care staff team, therefore exceeding the required minimum of 50 . There are a further 3 staff scheduled to complete their training by the end of March 2008. This qualification shows that the person has been assessed as competent in their role. Four staff files were looked at and all contained the required information, including two references and a Criminal Records Bureau and Protection of Vulnerable Adults checks. Nurses’ files also included their PIN number to verify that they were registered with the Nursing and Midwifery Council. The recruitment procedure therefore safeguards residents from the employment of unsuitable people. Other training carried out by staff includes statutory training of moving and handling, fire training first aid and food hygiene. Further training undertaken since the last inspection includes, infection control, Protection of Vulnerable Adults and some staff have attended training related to Dementia, palliative care, bereavement, promoting continence, life support and nutrition. This training gives the staff the skills and knowledge to work safely within the home and to meet the needs of the people living at the home. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 Quality in this outcome area is good. An acting manager currently manages the home with oversight from the registered provider. Monitoring and auditing of the service and practices is carried out to ensure that all services operate in the best interests of residents. Health and safety practice protect people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was being managed as ‘Acting manager’ by a nurse with a Registered Mental Nurse training and with considerable experience working in nursing homes. The registered provider was recruiting to the post and before this report was completed the was able to advise that a person with the appropriate qualifications and experience had been appointed. The registered provider is urged to apply for registration promptly. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 29 The registered provider advised that he visited the home several times a week and the acting manager and other staff confirmed this. The acting manager was responsible for the clinical and care management of the home and the registered provider had taken over the responsibility of budgets, the quality assurance monitoring and the auditing, maintenance and all finances. There had been very good progress in meeting the outstanding requirements from previous inspections and the home appeared to be managed satisfactorily by the acting manager and the registered provider. They continued to be able to access support from the consultant previously employed by the registered provider. Staff spoken with said that they felt the home was, “a happy place to work” and that the registered provider supported them. The acting manager also said that he felt supported by him and that he met any reasonable request for the home. All staff felt that there had been improvements over the past year and were satisfied that they provided a good service. Relationships between staff and management appeared to be good. Staff meetings had been held regularly since the last inspection although the minutes of the most recent meetings had not been typed up. Handwritten notes showing that the meetings had taken place were available for inspection but it is useful to staff to see the minutes of any meetings and feel that they have been taken seriously. A comprehensive and effective quality assurance audit was in place. The registered provider said that this had been in place at the previous inspection but had not been fully carried out. The registered provider had therefore decided that he would complete this himself. The programme consisted of weekly, monthly six monthly and annual audits. It had been completed throughout the year and action had been taken as necessary. Records had been maintained. The home therefore can show that it is monitoring the service in order to enable growth and improvement. The acting manager said that he supervised the nursing staff who in turn supervised the care staff and was on target to be carried out six times a year for all staff. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Records were not inspected on this occasion. Some money is kept on behalf of residents. This is kept in a safe location and individual records maintained of all transactions. All money, receipts and records are kept together in individual wallets. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 30 Satisfactory health and safety systems and service and maintenance checks were in place and the registered provider monitored these. He also attended to any maintenance tasks necessary in the home. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X 2 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All care plans need to be in sufficient detail to inform care staff of the care they need to provide. This will ensure that the needs of the people living at the home are met. Suitable heating must be provided in all areas of the home to ensure the comfort of the people living at the home. Timescale for action 30/03/08 2. OP25 23(2)(p) 30/03/08 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. 3. Refer to Standard OP7 OP19 OP19 Good Practice Recommendations The resident and/or their representative should sign care plans wherever practicable. Repairs should be carried to prevent the noise emitting from the pipework in the home. Work to improve the appearance of the home should continue by completing the revarnishing of the bedroom DS0000052950.V357636.R01.S.doc Version 5.2 Page 33 Holmfield Nursing Home 4. 5. OP31 OP38 doors. The newly appointed manager should apply for registration promptly. The central light fitting in the clinic room should be replaced in order to provide sufficient light for people working in that room. Holmfield Nursing Home DS0000052950.V357636.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V357636.R01.S.doc Version 5.2 Page 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!