Inspection on 22/07/09 for Holmwood House

This inspection was carried out on 22nd July 2009.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmwood House 25/07/07

Holmwood House 06/06/06

Holmwood House 10/02/06

Holmwood House 07/09/05

Holmwood House 22/03/05

Holmwood House 13/10/04

Holmwood House 12/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmwood House Channels Hill Westbury On Trym Bristol BS9 3EU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 2 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Holmwood House Channels Hill Westbury On Trym Bristol BS9 3EU 01179500810 01179508070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Ghassan Al-Jibouri care home 41 Number of places (if applicable): Under 65 Over 65 41 old age, not falling within any other category Additional conditions: 0 41 Patients over 50 years of age sickness, injury and infirmity Manager must be a RN on part 1 or 12 of the NMC Register Staffing Notice dated 10/07/1998 applies Date of last inspection Brief description of the care home Holmwood House is registered to provide nursing care for up to forty-one people who are fifty years and over. The Home is a period style property, located in its own grounds, surrounded by residential housing and near to the local shopping centre. There are local shops, public houses and restaurants located within walking distance of the home. There are single and double rooms located on all three floors and a lift provides access to all floors. The home is near to major roads and bus routes. The mission statement describing the aims of the Home was displayed in the entrance hall. People who want to know about Holmwood House are able to find out about the home, the services and facilities it has to offer by requesting a copy of the homes brochure or information pack. This will detail the range of weekly fees and say what additional charges may be made. Care Homes for Older People Page 4 of 30 Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was completed on 25 July 2007 and our overall judgement about the quality of the service provided for the people who live in Holmwood House was they received a good service. We completed an annual service review in 2008 and were of the opinion that the service continued to be good. Following this review we scheduled a key inspection to be completed before the 25 July 2009. Prior to this inspection the registered manager (Matron) completed the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment had been completed in detail and told us about the improvements that have made over the last 12 months and identified Care Homes for Older People Page 6 of 30 those areas where they felt they could do better. We also sent survey forms to people who live in the home and we received five completed forms back within the timescale we had set. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to those staff on duty and the matron, and we observed the interactions between the staff and the people who live in the home. We also spoke to a number of people who live at the home and asked them what it was like to live there. At the time of this report the fees for placement in the home range between 516 and 675 pounds per week. Additional charges may be made for other services such as hairdressing, newspapers and chiropody, and these are detailed in the homes brochure. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Information about the home and the procedures in place when arranging admissions will ensure that placement is only offered to those people whose needs can be met. Evidence: The content of the Statement of Purpose and service users guide is unchanged since the last annual service review and inspection and both documents contain all the necessary information to enable people to make an informed choice about whether the home is the right place for them. A copy of the document is located in the main entrance of the home, and is provided for any prospective new person who enquires about the home. All newly admitted people will be provided with a statement of terms and conditions. A contract will be drawn up between the home and private fee paying people. A schedule Care Homes for Older People Page 11 of 30 Evidence: or payments is set up with the funding authority where this is needed - the health and social care department of the Council or the Primary care Trust if the person has been granted continuing health care funding. Copies of these documents were seen in a sample of files seen during the inspection. The home manager (Matron) will complete a pre-admission assessment of needs on any person before they are offered a place at Holmwood House to ensure that the home has the necessary equipment to be able to meet the persons requirements and the staff have the necessary skills to meet specific health care tasks. It is still the case that the majority of people come to the home directly following a stay in hospital. One person spoken with during the inspection said they had been visited by the manager and was told all about the home but my relative dealt with all the arrangments. The home uses a Long Term Needs Assessment and Care Plan tool to record the assessment and enable the manager to determine whether the home is able to meet the persons needs. The records of the most recently admitted person were inspected, and provided a clear insight into that persons needs. The assessment along with information obtained from the hospital, evidenced how the matron judged they could meet that persons needs. The home offers placement to older people who need assistance with personal care and nursing tasks. It is only able to accommodate people with low to moderate levels of dementia and confusion. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be met because of the arrangments in place to plan the care for each person. Medication systems are safe. Evidence: The care planning files of four people were looked at to determine the process the home follows in identifying peoples needs and then arranging the way in which people are cared for. The plans were based upon the information recorded during the assessment process and we noted that the needs of those people who had lived in the home long term, had been re-assessed and new documentation had been completed. The care plans on the whole were satisfactory and detailed the needs of the person and what actions the care staff were to take in meeting them. Some minor improvements were discussed with the manager during the inspection. Part of the care planning documentation includes a daily record of the personal care given to each person - of the four plans looked at, three had not been completed for a week. The care plans have not always been reviewed on a monthly basis, and there is no indication who was involved in reviewing a persons care - this review should show Care Homes for Older People Page 13 of 30 Evidence: whether the person and/or their representative were consulted about how their care needs were being addressed. In addition to the care plans a number of screening and risk assessments are undertaken in respect of manual handling procedures, the likelihood of developing pressures sores (waterlow) and nutrition. The manual handling risk assessments results in a safe system of work being devised so that staff know exactly how they must move and transfer a person. Waterlow scores are recorded for each person and reviewed monthly and appropriate pressure relieving equipment is in place where the need is highlihted. In respect of nutritional assessment, a MUST score was referred to but there was no indication how the score had been achieved. A falls screening assessment is not routinely completed and therefore a falls management plan may not always be devised where this is needed. People are registered with a number of different local health centres and GP practices, and the matron will ensure that registration with a new GP is completed upon admission where this is necessary. Where possible, people are encouraged to retain the services of their family GP. Records are maintained of all contacts with GPs and any other healthcare professionals as appropriate to the persons healthcare needs, for example specialist dietary nurses. Monthly observations to monitor healthcare are undertaken, for example blood pressure and body weight. The records were seen to be inconsistent and for one person these records had not been completed for three months. Baseline observations for another person had not been recorded at all despite this person having been resident for ten days. This lack of attention to record keeping has been referred to again under standard 37. During the inspection we spoke with two separate relatives and they both said their family member was well looked after and they were always kept informed of changes, or significant events. One relative responded in one of our survey forms since my relative has lived in the home, they have come on in leaps and bounds and their quality of life has improved tremendously. We were told that no changes have been made to the ways in which medications are managed in the home and we have previously stated that there are sound procedures in place for the ordering, receipt, storage, administration and disposal of medicines. We did observe the qualified nurse administering medications safely and in line with good practice and have no reason to have any concerns in this area. During the course of the inspection, the staff team were seen going about their duties in a kind, friendly and courteous manner. They were heard being respectful towards the person they were looking after, being attentive and in general, using first names to Care Homes for Older People Page 14 of 30 Evidence: address each person. One person said that they were helped with personal care tasks in privacy and that staff were always polite and respectful. Comments made in our survey forms included the staff are all very good and staff are very aware of individuals needs. The home looks after many people who have end of life care needs, some who will stay in the home for only a very short stay because they are so ill when they admitted. The home has good working relationships with the local hospice and will often take people who have continuing health care funding. The matron told us that when people are funded by South Gloucestershire Primary Care Trust there is an expectation that specialist profiling beds are available and have therefore increased the number of these beds in the home. We were shown the many complimentary letters sent to the home from bereaved relatives, full of praise for the way in which their loved ones had been cared for in their final days. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities that are offered would benefit more people if they were better organised and took account of individuals needs. People are provided with a well balanced diet where they can choose what they would like to eat. Visits from family and friends are encouraged. Evidence: The home employs two part time activity organisers, one who has worked in the home for many years and specializes in reminiscence work and the other who is employed for three sessions per week. There is no weekly plan of activities but we were told that craft sessions and exercise sessions are organised. The matron is aware of the need to plan and advertise an activity programme so that people are aware of what is going on and can choose whether to join in or not. There was a mixed response from the people spoken with during the inspection about what happens during the day. One person said I go out regularly with a friend of mine, I would be very bored if I had to stay here all the time whilst another said the highlight of my week is having my hair done. It was evident that people can choose where they want to spend their time during the day and whether to participate or not in any activities, however they could be better informed about what is on offer. We were told that a garden party is being Care Homes for Older People Page 16 of 30 Evidence: arranged for the following month and that families and friends are invited to join in several people said they were looking forward to it. Those people who were able to, were seen moving independently around the home using their walking aids, whilst others were asked where they wanted to spend their time. Several people said they liked to sit in the entrance hall and watch the comings and goings of staff, visitors and other people who live there. In this area there is a caged bird, music plays and the homes cat wanders in and out. One visitor spoken with, who had previously lived in the home until their health improved, said they now enjoyed visiting twice a week and socialising with new friends. The home has a menu plan and this is discussed on a regular basis with the people who live in the home, so that meals can be provided that they would choose. There is a choice of two main meals at lunchtime and people were heard being reminded about the choice they had made about what they wanted to eat. The meals served on the day of inspection were gammon and parsley sauce or home made pasties, along with chips, mashed potato and peas. The menu for the day is displayed on the notice board outside the dining room. We saw that the food was well presented on the plate, cold drinks were provided with the meals, and that a number of people needed to be assisted with feeding -this was undertaken sensitively and in an unhurried manner. A full english breakfast is provided for those that want one and there is a supper menu of hot snacks or sandwiches with home made soup. As usual we have just had a very nice lunch and I only wanted a sandwich today and they made me a nice one, you only have to ask were two comments made by people spoken with. People who completed our survey forms said that they always or usually liked the meals that were served. The chef explained that all dietary needs can be catered for, and that he will visit any new person who has specific dietary needs or preferences. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Holmwood House are cared for by staff who will safeguard and protect them, and will ensure that any concerns they have are appropriately addressed. Evidence: The home has a complaints procedure and this is displayed in the main reception area of the home, and is included in the service users guide that is provided for people who live in the home and their relatives. We have not received any complaints about this home, and we are assured that any complaints people who live in the home or relatives may have will be properly addressed by the matron. The Matron has dealt with a number of complaints in the last year but from the records she has kept we were able to evidence what actions she took and what measures were put in place to bring about a resolution. This shows us that people, and/or their relatives, can be assured that any concerns they have will be listened to and acted upon. In the last year there has been one referral, made by a healthcare professional in respect of the care of one person who lived in the home, under safeguarding of vulnerable adults procedures. The matron co-operated appropriately with the strategy meetings and investigations that followed the referral, and demonstrated a full commitment to putting things right and ensuring policies were in place to prevent a similar event occuring. The matron has also herself made a referral to the local Care Homes for Older People Page 18 of 30 Evidence: authority where she has had concerns for people in her care and has requested support from the Safeguarding Adults Team in making best interests decisions for those who do not have capacity to do so themselves. All this is evidences that the matron will safeguard the people in her care. The home has a copy of the Bristol City Council No Secrets guidelines. Discussions with those staff who were on duty evidenced their knowledge of adult safeguarding issues and an awareness of their responsibilities if they witness or are told about any bad practice. There is though a total reliance upon the matron to report any such concerns to the appropriate authorities. Staff told us that the matron has provided them with instruction about abuse issues and reporting procedures. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holmwood House is a safe and comfortable home that has an ongoing programme of redecoration and refurbishment. The provision of appropriate beds and nursing equipment will benefit the people who live there as they will be more comfortable. Evidence: Holmwood House is a detached period property, situated within its own large gardens, located on the outskirts of Westbury-on-Trym, Bristol. It is surrounded by large well established gardens that are full of wildlife, trees and shrubbery. The gardens are well maintained and have benefitted from having a gazebo built in the grounds. There are safe and quiet spaces for people to sit outside in the warmer weather. The front entrance is secured with a key-padded lock, and leads into a large entrance hall - it has retained the period wood- panelling, has a seating area, a pay phone, and is the main thoroughfare for the home. The reception area is also the living place for the homes cat and caged bird. A staircase leads off the reception area to the first floor. The communal areas are all on the ground floor. There are two linked dining rooms and new dining room furniture has been provided. The conservatory overlooking the rear gardens, is fitted with ceiling and window blinds and a fan, so that the temperature can be regulated in the warmer weather. There are two separate lounges and each of the rooms is equipped with comfortable furniture, and have been Care Homes for Older People Page 20 of 30 Evidence: redecorated since the last inspection and new curtains have been hung. The home has an ongoing programme of refurbishment and the exterior of the property appears to be well maintained. There are a number of toilets and bathrooms located throughout the home in sufficient numbers to meet the needs of the people in residence. There are specialist bathroom facilities to enable those with mobility difficulties, or who are frail, to be assisted to have a bath. Two shower rooms have been installed, these facilties being more appropriate to the needs of older frailer people. The home has sufficient moving and handling equipment having purchased additional hoists and wheelchairs. The home has 31 bedrooms, ten of which are shared rooms - privacy screening is available in each of the shared rooms. The bedrooms are located on three floors and a shaft lift between all floors makes all rooms accessible. Most of the bedrooms were viewed and a number of them are currently vacant. The matron told us that the owner is currently exploring the possibility of increasing the number of rooms with ensuite facilties in line with families expectations. People are encouraged to personalise their bedrooms and bring in small items of their own furniture to make their rooms familiar and more homely. A number of the bedrooms have ensuite facilities and those that dont, have a vanity unit. A number of these units are in need of relacement but this is already in hand. People are asked whether they wish to have a door lock fitted to their bedroom door, and we saw that some doors had locks fitted whist others didnt. New bedroom furniture as been provided since the last inspection, and lockable drawers with a key are now in each bedroom. The home was clean and tidy and free from any unpleasant odours on the day of inspection. Those people who completed our survey forms said that the home was always or usually fresh and clean. The home has housekeeping staff who complete domestic and laundry duties. The laundry room consists of two commercial washing machines and two large tumble driers, and this is adequate to meet the needs of the home. One person told us that their laundry often gets mixed up with others. The matron explained that they ask for all clothing to be clearly marked and when this doesnt happen, it causes difficulties but is an ongoing problem that they will deal with. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment and vetting of new staff is satisfactory which means that people are cared for by a staff team who are suitable to work in this environment. They will be trained to ensure they have the necessary skills to meet peoples needs. Evidence: The home currently only employs five registered nurses, one of whom is on extended leave, 25 care staff and ten ancillary workers. We were told that five new carers are due to be recruited soon and that there are vacancies for qualified nurses to join the staff team. Staff retention is generally good and there is only minimal use of agency staff - this means that people will be cared for by staff who are familiar with them and their care needs. In addition to the care team there are two chefs, kitchen assistants, housekeeping staff and a handyman. We were told that each shift is covered with one registered nurse plus six carers in the morning, five in the afternoon/evening anf two overnight. Examination of the staf rotas confirmed these arrangements. The matron is also included in the staff rota as part of the team that provides hands on care to the people who live there. In the pre-inspection annual quality assurance assessment (AQAA), submitted by the matron, we were told that over 50 of the care staff have obtained an NVQ Level 2 in health and social care qualification (the minimum standard expected), but other staff Care Homes for Older People Page 22 of 30 Evidence: are in the process of completing the award, or have equivalent qualifications (qualified nurses in their own country). Two staff have completed NVQ at Level 3. This evidences the homes committment to providing well trained staff. We looked at the personnel files of four newly recruited care staff, to check what procedures they follow to ensure they only employ suitable staff. We found that they follow safe vetting procedures and have sound recruitment practices in place. All job applicants have to complete an application form and attend for an interview with the matron. If offered a post they will then need to provide names and addresses for two references (at least one of them from a previous employer) and make application for a CRB enhanced disclosure. We saw that staff may start working in the home after a POVA1st check has been verified but before the CRB check is known, and were told by the matron and staff that new staff will shadow with an experienced staff member until they are able to work on their own. The matron must ensure that employment start dates are properly recorded to ensure that employment details are accurate. We looked at the staff training file and could evidence that the staff have received training in a wide range of relevant topics. As a result of a complaint made since the last inspection all staff have received basic life support training - this was an action point resulting from the safeguarding investigation. The matron organises a lot of the training and oversees the induction training of new staff. Induction training includes manual handling, fire safety, health and safety, protection of vulnerable adults and food hygiene. Examples of other training that has been attended by the staff team includes advanced care planning, mental capacity act (MCA) and deprivation of liberty safeguards (DOLS), managing challenging behaviour, epilepsy and medication handling. We were told that the home does not have a training plan or an allocated training budget. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holmwood House is well run with the best interests of the people who live there at the centre of all decision making. The matron would benefit from being able to have more management time so that records can be properly completed. Evidence: The matron, Mrs Serena Reynolds has been in post at Holmwood House for four years. She is a registered nurse and has already completed the Registered Managers Award. She has many years experience in the care of the elderly, and co-operated fully with the inspection process. She has a good awareness of the each persons specific care needs, and the quality and skills of the staff team. She is fully aware of those areas where the home still needs to improve. She completed our annual quality assurance assessment (AQAA) prior to the inspection, this gave us all the information we had asked for and detailed those areas where improvements have been made and the plans for the future. It is our opinion that the matron needs to have management time set aside from the staffing rota so that she can oversee the running of the home and Care Homes for Older People Page 24 of 30 Evidence: complete checks on documentation and quality control aspects. Staff spoke positively about the matrons management style, said they felt well supported and were encouraged and enabled to express their views about peoples care and the running of the home. Staff meetings are held on a regular basis. It remains evident that the matron provides very clear direction and leadership for the staff team however it is apparant that monitoring of staff development, staff supervision and auditting of the home records has fallen by the wayside whilst she completes nursing shifts. We were told that none of her working hours are supernumerary to the staff rota. The last formal customer service questionnaire was completed in June 2008 and although the responses were positive, there was no development plan devised. We were told that survey forms have just been sent out again and only one has so far been returned. Reg 26 visits to the home are completed by a representative contracted by the home owner, on a monthly basis. The records of these visits were not available for inspection and arrangments for a copy of each monthly report to be kept at the home must be made. This was discussed with the matron during the inspection. We were told that petty cash is held for some people, at families request and the home has a good accounting system in place to evidence transactions in and out of their accounts. A sample were checked and found to be correct. The matron explained that where possible, they prefer to invoice the families for additional services such as hairdressing and chiropody. Staff confirmed that they have formal supervision and the records were seen. The matron completes all formal supervision sessions, but the long-term aim is that supervisory arrangements will be split between the matron and one of the registered nurses and a senior carer. These two members of staff are currently completing a team leader training course. Records were seen to evidence that supervision has taken place. We were also told that a full hand over report is given at each shift change. As referred to throughout this report some of the recordings about peoples healthcare monitoring, risk assessments, staff records and quality assurance visits were not being consistently kept, or were not available for inspection. The matron needs to ensure that the homes records are kept up to date and are available for inspection. No health and safety concerns were raised as a result of this inspection. The fire logbook evidenced that all the necessary weekly, monthly and quarterly checks had been completed of the fire safety system. We were told that Fire Safety training was Care Homes for Older People Page 25 of 30 Evidence: completed with the staff team in July and that the fire officer will be returning to review and update the Fire Risk Assessment. Practice fire drills are held at least three monthly. The home has a number of hoists, and specialist bathing equipment, and these are serviced on an annual basis. The matron informed us that all service contracts are up to date. We would recommend that arrangments are put in place for the wheelchairs to be checked over on a regular basis as a number of chairs were seen with footplates missing. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16(2) M The programme of activities 15/10/2007 must be reviewed in consultation with residents to ensure that the activities offered satisfies residents social, cultural, religious and recreational interests and needs and all residents Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 12 The registered provider must make arrangements for appropriate and meaningful activities to be offered. This is so that peoples social and recreational, cultural and religious needs are met. This requirements is being made for a second time. 22/10/2009 2 33 26 The registered person must ensure that records in respect of visits made by their representative are available for inspection. This is so that we know how the service is being monitored by the provider and what actions are being taken to ensure good standards 22/08/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 28 of 30 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 37 The registered manager must ensure that the following records are accurately maintained : 1) The daily records of personal care given 2) Records in respect of nutritional assessments - the MUST tool 3) Falls screening assessments and risk assessment where needed. 4) Healthcare monitoring charts 5) The staff recruitment files - in particular start dates of employment. The registered manager must ensure that wheelchairs are checked regularly to ensure they are safe and in good working order. 2 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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