Inspection on 16/10/07 for Holmwood House

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Holmwood House 26/02/07

Holmwood House 11/10/05

Holmwood House 09/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmwood House Austin Fields King`s Lynn Norfolk PE30 1PH Lead Inspector Mrs Geraldine Allen Unannounced Inspection 16th October 2007 09:35 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 Holmwood House DS0000062973.V353178.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. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Austin Fields King`s Lynn Norfolk PE30 1PH 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) 01553 773529 01553 773529 pjordan@inhcare.com Integrated Nursing Homes Ltd Mrs Pamela Jordan Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th February 2007 Brief Description of the Service: Holmwood House is a care home providing personal care and accommodation for up to 35 older people. The home is owned by Integrated Nursing Homes Ltd. The home is located in the town of King’s Lynn, close to shops, pubs, post office and other local amenities. Holmwood House is a single storey, purpose built home. 50 of the rooms are en suite. There are small gardens at the front and rear of the home. The manager, Mrs Jordan, said the resident or their representative is advised verbally of the fee rate that will apply before the resident is admitted to the home. They are also advised at this time of the additional charges that may be relevant to the resident. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of Tuesday 16th October 2007. The manager, Mrs Jordan, prior to the inspection, provided information about the day-to-day running of the home and other matters. On the day of inspection, looking at some records, speaking with residents, staff and visitors and also observing staff practice obtained further information. Due to postal strikes, it was not possible to forward Commission questionnaires and a supply was taken to the home on the day of inspection. A total of three questionnaires have been received since the inspection and the views and comments have been incorporated into this report. An Expert by Experience, arranged through Age Concern, also took part in the inspection and spent time speaking with residents about their experiences at the home. Comments contained within her report have also been included in this report. Overall, it was found that people living at this home enjoy a good experience. The summary of the report provided by the Expert by Experience states: “In summary, this is a clean, bright and welcoming home. Staff are sincerely caring and well respected and liked. Extremely good interaction was observed between carers and residents. Throughout the home furnishings were cheerful and comfortable. In the spacious dining area all chairs were all on ‘skis’, enabling staff and residents to get to and up from table with ease. The two lounges were provided with comfy armchairs and pleasing décor and gave on to the sizeable garden, with its pathways for walking and thoughtfully laid out seating. It was good to notice a trolley full of books in one lounge, many in large print. Nobody made any severe complaints, but my observation was that they would probably only do so in extreme cases; they don’t want to bother anyone. One resident concluded, “I like being here. It’s very friendly.” At the time of inspection, work had commenced on a significant refurbishment of the home. Disruption to residents was minimal and mainly amounted to moving into an empty room whilst their room was being refurbished to their preferred colour scheme. This inspection demonstrated that the service has responded positively to the last inspection report and improvements were recorded. One requirement has been set, relating to a previous requirement that had been met in part. Seven good practice recommendations have also been made. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Storage facilities for larger items such as hoists, commodes and linen bins needs to be considered as these items are being stored in bath and shower rooms. Although there were conflicting views being given by residents, the service needs to consider how it offers and establishes choices at each meal. There also needs to be a review of people’s dietary preferences and these need to be recorded. The service needs to consider the provision of daily planned activity, both in and outside of the home, so that the quality of the resident’s social life is enhanced. The service must follow best practice when recruiting new staff. A minimum of two written references is required in all cases. It is also good practice to keep robust interview records. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 7 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. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 8 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 Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 9 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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place after a full needs assessment has been completed and if the service is confident staff can meet the needs of individuals. Needs assessments are completed either by the manager or deputy manager. The home does not provide intermediate care. EVIDENCE: There was evidence that no resident enters the home unless a full assessment of their needs has been completed. Residents spoke about visiting the home before moving in and also having a trial period before making a final decision to live at the home. The home does not provide intermediate care. Holmwood House DS0000062973.V353178.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service involves people in the planning of their care and subsequent reviews. Each plan is clearly written and provides guidance to staff. People who use the service have access to all healthcare services. The home has good medication policies and practice, which staff understand and follow. The delivery of personal care is responsive to individual needs and preferences. There has been significant improvement in the way confidential information is stored. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 11 EVIDENCE: Two care plans were looked at in detail. Each contained good information about the person’s needs and how staff should meet them. There was evidence that care plans are kept under regular review and the needs of each person are reassessed each month. There was also evidence that people can be involved in their reviews if they wish. The daily records need to include more information about how the person spent their day. Entries such as “all care given” should be discouraged, as they give no information. The last inspection raised concerns about how care plans and associated records were stored as this breached confidentiality. Significant improvements have been made although the care plan for a deceased resident was found in the bookcase in the entrance hall. This had previously been reported as lost. The deputy manager was observed completing the medication round at lunchtime. The home uses the Boots Monitored Dosage System. Good practice was observed. The medication records were seen and were up to date and properly completed. The controlled drugs register was checked for one resident against the stock held and was correct. Good recording practice was seen. The fridge temperatures were recorded and all recordings were within acceptable limits. Shelf life medications such as eye drops were dated on opening. All staff dispensing medicines received update training with Boots on 03/07 and certificates were seen. The interaction between residents and staff was observed. Generally this was good. Staff were friendly, polite and respectful. Interactions observed were appropriate. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 – 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to activity 2 days per week. People are able to have visitors when they wish. Activity outside of the home is limited. The food is satisfactory, well presented and meets dietary needs. Choices of food need to be offered at all meals. EVIDENCE: Six residents spoken to together said the activity co-ordinator is at the home two days per week. Posters were displayed in the home and showed a range of activities available for people to join in with. The residents said they had been out on a ½ day trip to Sandringham during the summer. Another ½ day trip to the coast had been cancelled as the coach broke down. Otherwise, one resident spoke about spending his time in the garden when the weather allowed. The residents said they had no activities planned for the afternoon of inspection and said they would sit & sleep, chat or read until tea. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 13 The Expert by Experience spoke to residents about activity at the home. Her report states: “In-home activities are organised by a popular ‘girl’ who does games and quizzes with residents on Mondays and Fridays. They clearly look forward to this and said they would like her to come more often to keep them occupied.” And “Expressed preferences for outing destinations included Hunstanton (firm favourite, including fish and chips on the sea front!), and Baytree Garden Centre at Weston, near Spalding, about 25 miles distant.” One of the lounges contained a large trolley with a good selection of books, including large print, available for people to read. Lunchtime was observed in the dining room. There were plenty of staff available to provide help as needed. There were also plenty of drinks being offered. One resident was enjoying a bottle of beer. This appeared to be a social event with conversation between residents and also with staff. Fourteen residents were eating in the dining room. The tables were attractively laid with cloths etc. and condiments. One resident was receiving support to eat their meal and this was discreetly provided. It was noted that those people having their meals on trays were given ill-matching crockery. Staff said there was not enough matching crockery to go around and so those eating in their rooms were given the spare. Staff were heard giving people various options for the food. Later in the afternoon, staff were seen asking residents what they would like for tea from a range of options. The Expert by Experience spent time with residents, including eating lunch with them in the dining room. Her report states: “With regard to food and meals at the home, residents were quick to praise, but, on probing, began to express further views, which were less satisfactory. The opinion that ‘they do the best they can’ and that the food was ‘reasonable’ was qualified by remarks that all was ‘far from fantastic’. When asked how often they were asked what they liked or would like to eat, the response implied ‘never; they know what we like’.” However, the six residents spoken to after lunch were very chatty and there were plenty of jokes being told. They said they had enjoyed their lunch “as usual”. They had sufficient to eat and described the alternatives they had been offered. Two of the three returned resident questionnaires also stated that they always enjoyed their food. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is displayed throughout the home. The home has policies and procedures in place about safeguarding adults and these are well known by staff. EVIDENCE: The complaints procedure was seen clearly displayed in the home. Residents said they knew who to speak to if they were unhappy or wanted to complain. They said they were confident they would be listened to. The service has stated that one complaint has been received during the last twelve months. This was dealt with in accordance with the complaints procedure and was unsubstantiated. Staff receive training about adult abuse and were able to speak confidently about these matters. All staff have Criminal Records Bureau and Protection Of Vulnerable Adults disclosures either in place or applied for. Staff knew about the abuse and whistle blowing policies. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-maintained and provides an environment that meets the needs of the people who live there. The home is well lit, clean, tidy and smells fresh. There is good infection control in place. EVIDENCE: A tour of the premises was conducted with the manager. Seven bedrooms have now been refurbished to a good standard. New doors were due to be fitted to all rooms. Coving is also to be fitted in all rooms and corridors. Corridors will also be redecorated. The refurbishment includes curtains, carpets, furniture, basins and flat screen televisions. The call bell was loud and intrusive, particularly at lunchtime when it sounded in the dining room, inhibiting conversation. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 16 The home continues to have storage problems. Hoists, commodes and linen bins were stored in shower/bathrooms. The manager said alternative storage for the hoists was being arranged. Despite the refurbishment work taking place, the home was clean and tidy. There were no lingering odours detected. The laundry was small but wellequipped. All laundry is done on site. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Rotas show that sufficient staff are employed to provide care in a timely way. People who use the service have confidence that staff have the skills to care for them appropriately. Staff receive relevant training to meet the needs of individuals using the service. There is a good recruitment procedure but this is not always followed. EVIDENCE: The rota for the week of inspection was provided. This showed that on the day of inspection, excluding the manager, there was the deputy and four care staff on duty during the morning, a senior and three carers during the afternoon and two during the night. In addition there were catering and domestic staff employed. There was evidence of good skill mix on each shift. Two staff files were looked at in detail. The home has a robust recruitment procedure but this was not followed in all respects. Both files looked at contained completed application forms and information about Criminal Records Bureau checks. However, both only had one written reference in place and this is regarded as inadequate practice. One did not have a completed interview record. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 18 There was a training profile for each member of staff. The manager confirmed that staff have received training in abuse awareness, health & safety, food hygiene, medication and first aid this year. Infection control and further manual handling training were postponed and together with fire training, new dates are awaited. The home uses ManorCourt induction training. Two staff were spoken to in private. Both have significant care experience and have completed NVQ training to either level two or three. Both demonstrated a good understanding about the needs of the residents and also how people should be protected from abuse. Both staff said they enjoy working at the home and feel well supported by the manager. They confirmed they receive formal supervision and also that staff meetings take place. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 19 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, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualification and experience and is competent to run the home. The service has sound policies and procedures. The service seeks the views of people living at the home. People are safeguarded by robust practice relating to personal allowances looked after by the service. Staff receive regular and recorded supervision. People who use or visit the service are safeguarded by good health and safety practice. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager has the required qualifications and has significant experience. She is competent to manage the home. The Annual Quality Assurance Assessment (AQAA) was completed and returned to the Commission by the manager and was discussed during the inspection. A copy of the last Quality Assurance survey carried out by the service was provided and demonstrates a thorough survey process that seeks the views of stakeholders. The findings are produced in graph format and easy to read and interpret. The last survey was completed June 2007. Resident’s personal allowances were checked. A safe has now been obtained and is fixed to the floor under the desk. This required the manager to get on the floor to extract the money. The money held for one resident was checked against the records for money held and was correct. Good records were seen but not all transactions had 2 signatures. There was evidence of a regular audit taking place. Staff supervision was discussed. The manager confirmed this was taking place regularly using a newly developed format. All staff have signed supervision contracts. There is also a new appraisal form. Either the manager or her deputy currently conducts the supervision sessions. Accident records were looked at. These were well completed and fully audited. There was evidence that all accidents are investigated. Other health & safety records showed that the electrical systems and appliances were currently being checked. Gas supplies and appliances were on service contracts. Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 4. Standard OP29 Regulation 19 (1) Requirement The registered persons must ensure that two written references are obtained for all staff employed at the service. This will mean that people are protected by robust recruitment practice. This requirement was set at the last inspection with a compliance date of 26/03/07 and was met in part. It is therefore repeated. Timescale for action 16/12/07 Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 23 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 Refer to Standard OP7 Good Practice Recommendations Daily records need to be improved so that there is more information about how the person spent their day and any other relevant matters. This will ensure that recording is holistic and individualised. Consideration should be given to providing meaningful activity and occupation in and outside of the home for residents each day. This will mean that people can enjoy improved social activity. The service needs to make sure that all people using the service are offered real choices each mealtime. This will ensure that the dining experience for all people is a good one. The service needs to purchase sufficient matching crockery and other utensils so that there is enough for all people living at the home. This will help to enhance the dining experience for people Consideration needs to be given to the call bell system as this is loud and intrusive, especially at mealtimes when it can inhibit conversation. Further consideration needs to be given to improving the storage arrangements of equipment so that communal areas are not used for this purpose. Two signatures need to be obtained for all transactions made on behalf of residents. This will ensure the risk of financial abuse is reduced. 2 OP12 3 OP15 4 OP15 5 6. 7 OP19 OP19 OP35 Holmwood House DS0000062973.V353178.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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