Inspection on 25/07/07 for Holmwood House

This inspection was carried out on 25th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holmwood House 22/07/09

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmwood House Channels Hill Westbury On Trym Bristol BS9 3EU Lead Inspector Jill Cornelius Key Unannounced Inspection 25th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holmwood House DS0000020280.V341206.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 DS0000020280.V341206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Channels Hill Westbury On Trym Bristol BS9 3EU 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) 0117 9500810 0117 9508070 Mr Ghassan Al-Jibouri Mrs Serena Hogg Lucas Reynolds Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 41 Patients over 50 years of age sickness, injury and infirmity Staffing Notice dated 10/07/1998 applies Manager must be a RN on part 1 or 12 of the NMC Register Date of last inspection 6th June 2006 Brief Description of the Service: Holmwood House is registered to provide nursing care for up to forty-one people who are fifty years and over. The Home is a classically styled 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. Prospective residents are able to find out about the home, the services and facilities it has to offer by requesting the homes brochure or ‘residents information pack’. The weekly fees range from £459 - 600 per week and additional charges are made for podiatry and hairdressing services. Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection was carried out midweek over eight hours in one day. Evidence was gathered from: examining previous correspondence with the home including; Regulation 37 (death, illness, other events notifications) and Regulation 26 (monthly reports carried out by the responsible individual); inspection reports; information from residents surveys (10), relatives comment surveys (2); talking to/observing residents, talking to the manager, talking to and observing staff, talking to visitors, talking to and case tracking residents; examining records, policies and procedures. Rates for a single room range from £500.00 to £600.00 per week. The rate for shared rooms is £472.00 to £490.00 per week. Rate for respite is from £500 to £600 per week. What the service does well: Holmwood House is a period property, having maintained many of the original features and is surrounded by established gardens. It is a pleasant place to live and has benefited from the recent addition of a conservatory. The home continues to have a good pre-admission assessment of procedures in place, to ensure that placement is only offered to those people whose needs can be met. The healthcare needs of residents continue to be met with good multidisciplinary working. People living at Holmwood are protected by robust recruitment procedures. The systems in place to promote the health and safety and welfare of residents and staff are satisfactory. Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and their representatives are given sufficient information to make an informed choice about the home and its services. The assessment processes adopted by the manager should ensure that each resident’s care needs are understood and met. EVIDENCE: Information about the home and its services are available on request. The information included a copy of the inspection report and statement of purpose. Two of the residents and their relatives spoken to during the inspection told the inspector that they had the opportunity to visit the home prior to their admission. They also said they “had been given information about the home at the time” One resident whose care was followed told the inspector that “ the manager had talked to them about their needs and they had helped to develop their plan of care”. Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 9 This resident’s plan of care-contained information about their personal preferences likes and dislikes and what was important to them. This supported the fact that the residents and/or their representatives are involved in the development of their plan of care. Two residents had their care followed as part of the inspection. Each care plan contained a comprehensive assessment of their care needs. A care plan had been developed from these assessments, which guided staff on how to meet the resident’s needs. Assessments included a risk assessment process for manual handling pressure sore risk and risk of falls. The manager advised assessments are reviewed regularly. The inspector was shown the admission assessment form used for recording the assessed needs of the resident prior to their admission. This covered all aspects of health and personal care and included contact details for the resident’s general practitioner and next of kin. During the inspection it was evident that the manager considers the impact of any new admission upon the existing residents. She explained that she prefers not to admit new persons at the end of the week, over the weekend or late in the day. The reasons for doing this she reported, is the to ensure that any placement does not go awry at the point of admission, when access to medical assistance is limited. This is good practise. The home continues to offer 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. Holmwood House DS0000020280.V341206.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. A supportive team meets the resident’s health care needs. Proper arrangements are in place for residents to access primary healthcare. The staff properly manage the administration of medication. EVIDENCE: Residents whose care was followed had a plan of care in place. These plans of care had been reviewed monthly or sooner if the residents needs have changed. The information recorded in the plans of care supports that the residents and/or their representatives were involved in the development of the plan of care. However, three out of five files viewed only had signatures of residents or their representatives. One resident whose care was followed told the inspector that staff had discussed their care needs with them. Two relatives who visited during the inspection told the inspector “they were very pleased with the care their relative was receiving.” They further commented they had “discussed their relatives changing care needs with the manager.” Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 11 Residents spoken to during the inspection told the inspector “staff are always friendly and kind to them.” One resident said that the staff called the doctor when they weren’t feeling well and the doctor has given them a new treatment. A record of the doctor’s visit was contained in the residents care plan. The information provided in the care plans support the fact that residents have access to healthcare professionals, which include; chiropodist, physiotherapist and specialist nurses. How wound care was managed was discussed with a registered nurse on duty. He advised that each resident who requires wound care has a plan of care in place, which identifies the wound and records wound healing. An example was seen during the inspection. Residents who required this were using a variety of pressure relieving equipment. This included relieving cushions and high dependency airflow mattresses. A risk assessment tool, which had been adapted by the manager, recorded the resident’s risks of developing pressure sores. Where risk had been identified measures had been put in place such as equipment to reduce the risk. During the inspection staff were discreetly encouraging and assisting residents in using the toilet. This was enabling residence to maintain continence. Continence assessments had been completed for the residents whose care was followed. Falls risk assessment had been completed for those residents identified as at risk. Where risk had been identified in one residents plan, a care plan had been put in place to guide staff on how to minimise the risk of falls. A registered nurse advised that bed guards are used to minimise the risk of fall from bed. He also commented that risk assessments are completed prior to the bed guards being used. Two were observed in residents care plans with a supported signature from the appropriate person. Nutritional screening had also been completed for the residents whose care was followed. A record of the resident’s weight as well as their dietary requirements and nutritional risk. The residents care plans also includes their food preferences. The home uses a blister pack system for the majority of their medications and observations were made of the safe practise of one medicine round. The ordering and disposal of medication was satisfactory. Care assistants were observed interacting with residents in a respectful manner and it was obvious from discussions with some of the staff that they knew the residents like and dislikes. In general residents are referred to by their first name. Each of the residents were nicely dressed and hair attended to with their individual styles. Holmwood House DS0000020280.V341206.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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are able to receive visitors when they wish and are able. People are assisted to have their say in how they wish to spend their time. Improvements are needed to ensure people living at the home are provided with recreational and meaningful activities on a regular basis. People in the home are offered choice in what they eat and are provided with a balanced diet. EVIDENCE: Two visitors in the home spoke of how they are made welcome by staff members. They are able to see their loved one in private or in communal areas. One resident said how ‘their family came into the home to have a celebratory meal’. Another told of how ‘their son and daughter visit at times that are suitable for them.’ Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 13 Some people around the home appeared to be uninterested in the television and were snoozing or looking outside the windows. When asked if they liked the TV on they said ‘no, it’s just on.’ Another person said ‘I am bored-there is nothing to do except sit and look outside.’ Two other people were reading, another person chatting with staff members. The home has no one taking the lead in activities. However, when looking at the reflective file the entries made for June 07 showed activities for Quiz, an annual event with family involvement, which was well supported. There were also afternoon teas. The home has a weekly event planned. From our survey comments made included: ‘I would like more activities’; ‘I would like to go out for trips’; ‘my loved one does not want to join in any activities’; ‘I just want to have my peace and quiet.’ One resident in their room had a radio on and was ‘quite content.’ Further exploration is needed for the range of activities on offer and a dedicated person would assist in this area. Menus for a two-week period were observed. There were two choices for main meals on offer. Snacks are made available with drinks throughout the day. Residents spoke of the ‘good food’; ‘all the meals are very good’; ‘I like my food’; I can have seconds if I want.’ One resident said they enjoyed having their family join them for lunchtime meals. The chef spoke of residents’ preferences and dietary needs such as diabetic diets, soft foods for some residents and special diet needs. The kitchen has been inspected by the EHO and requested some new flooring and tiles to be replaced. This has been done. Holmwood House DS0000020280.V341206.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 good. This judgement has been made using available evidence including a visit to this service. There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of POVA matters. EVIDENCE: The complaint procedure is prominently displayed in the hallway. The contact information for the area office of Commission for Social Care Inspection is included. The complaints record showed no complaints were received. The survey returns from relatives and residents indicated that there were no complaints. The home has a whistle blowing procedure in place, which is kept in the policies and procedure file. The Department of Health Guidance is available and there is a copy of the Bristol Local “No Secrets” guidance in the home. There have been no reported POVA incidents. Holmwood House DS0000020280.V341206.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): 19,20,22,24,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home’s premises are suited to its intended purpose. It is accessible, safe and well maintained. There remains an outstanding requirement, which is for all residents to have the availability of lockable drawers in their room. EVIDENCE: Since the last inspection the home has had the addition of a conservatory. The residents spoken with shared the following comments: “delighted to look out on to the garden,’ ‘nice and bright’ and ‘lovely addition.’ The kitchen was inspected from the Environmental Health Department and there were no outstanding details. The home is clean and pleasant and provision is made to control the spread of infection if it occurs. The home has a sluicing facility and a sluicing Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 16 disinfector. There is appropriate written guidance for the control of infection available to staff. It was noted that some doors did not have a sign or nameplate. It is required that signs are used as soon as possible to maximise residents’ independence and promote orientation. There remains no door locks to a number of residents rooms. Residents are asked it they would like this opportunity when they come to the home. A recently new resident commented ‘I do not want my room to have a lock on it’ another stated it was ‘un-necessary to have this’. It was noted that there are lockable storage drawers for a number of rooms viewed. Documentation needs to support residents wishing not to take this option. Holmwood House DS0000020280.V341206.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): Standards 27, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from staff who are inducted and receive regular supervision. They continue to professionally develop their skills by ongoing training and course updates enabling them to provide the care and meet the needs of the residents. EVIDENCE: The recruitment process was examined and all staff records examined showed that the hone follows a robust recruitment process. Records contained application forms, references, POVA first check and a CRB (Criminal Records Bureau) disclosure. The induction programme is comprehensive and covers all mandatory training, including Fire, Manual Handling, Health and Safety and the Protection for Vulnerable Adults. The home also has a “Skills for Care” workbook, which staff continues to work through during their practical induction. They also receive the Social Council Care Code of Conduct and a copy of “No Secrets Handbook” and Holm woods Staff and Policy Handbook. Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 18 The home also has a mentor system where all new staff is linked and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. Staff receives supervision with the manager once every six to eight weeks. Arrangements in place confirm that individual supervision is based on an agreement between the manager and staff member. An account of when supervision has taken place and recorded outcomes of the meeting were seen for three staff members. Holmwood House DS0000020280.V341206.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): Standards 31,32, 33, 37. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed efficiently. The systems in place to promote the health and safety and welfare of residents and staff are satisfactory. Feedback is effectively sought from residents about the service provided through anonymous user satisfaction questionnaires. EVIDENCE: Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 20 The manager has the appropriate RNI and care management qualifications. The manager has been in the post for three years and has attended relevant clinical update training. Residents spoke of ‘feeling supported’, ‘well supported,’ and ‘the manager is accessible for any concerns.’ Residents meetings are held and minutes were viewed with follow up actions taken were recorded. Evidence confirmed that the manager is resident focused and leads and supports a strong staff team who have been recruited and trained to a good standard. Formal supervision for all staff members has now been established in this home. This information was confirmed during the inspection. The fire log was examined and it was noted that all periodic tests and checks were up to date. There is now an up to date fire risk assessment in place, which was available for inspection. A client questionnaire has been produced and residents have returned comments such as ‘very caring staff,’ ‘a lovely house, lovely conservatory’ and ‘caring staff.’ Holmwood House DS0000020280.V341206.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 3 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 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 x 2 x 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X X 3 X Holmwood House DS0000020280.V341206.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. Standard Regulation Requirement Timescale for action 1. OP12 16(2) M The programme of activities 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 15/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holmwood House DS0000020280.V341206.R01.S.doc Version 5.2 Page 23 1. OP7 When care plans are reviewed, a note should be made of who is involved in the process. 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