Inspection on 07/09/05 for Holmwood House

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 25/07/07

Holmwood House 06/06/06

Holmwood House 10/02/06

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 Sam Fox Unannounced 7 September & 7 October 2005 09:30 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 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 D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Channels Hill Westbury on Trym Bristol BS9 3EU 0117 9500810 0117 9508070 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ghassan Al-Jibouri Mrs Serena Hogg Lucas Reynolds N Care Home with Nursing 41 Category(ies) of OP Old Age 41 registration, with number of places Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 22\3\05 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 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. There are local shops, public houses and restaurants located within walking distance of the home. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection taking place over ten hours – the purpose was to check progress on requirements and recommendations made at the last inspection and to consult with residents. In addition to this the premises were inspected and key health and safety records were viewed. Evidence was gathered through discussion with the manager, four members of staff and residents. Two relatives opinions were also sought. Records were also examined. This inspection took place over two visits, during the first day a number of immediate requirements were issued that the manager was asked to rectify urgently. These were then checked on the second visit. Issues in relation to this will be included in the body of this report. Not all standards were inspected and this report should be read in conjunction with others so a fuller picture of the home can be gained. What the service does well: What has improved since the last inspection? Improvements were made following the first day of the inspection. They were as follows: • A handyman had been employed who has begun a planned programme of maintenance. This included the painting and making good of rusty commodes – which has resulted in a safer environment. • The small lounge had been redecorated which has significantly improved this area for the residents who use it • Protective clothing has been bought for kitchen staff, thus reducing the risk of the spread of infection • Bed bumpers have been purchased for all residents who use bed rails thus improving their safety. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 6 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. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 Opportunities are given to new residents to visit the home so they can make an informed choice about their future care. EVIDENCE: The majority of these standards were not assessed and will be a focus of the next inspection. One relative confirmed that she was able to have a look around the home before moving her family member there. Some residents said that they were too poorly to look around but got their family to do so on their behalves. Relatives were also observed looking around at the time of the inspection. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 10 Some improvements need to be made to care plans to enable staff to provide a more consistent and individualised service. Relationships between staff and residents are respectful, some action, however, needs to taken to improve individuals rights to privacy. EVIDENCE: Opportunity was taken to view three personal files. These contained initial assessments, in- house care plans and keyworking reports. There were also risk assessments in relation to falling and the risk of developing pressure sores. The depth and accuracy of recording in keyworking reports and daily records varied and examples of this were discussed with the manager. She said that she has highlighted this as developmental need for some of her newly trained nurses. In addition to this, some records were not signed or dated. This will continue to be a focus of forthcoming visits. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 10 It was noted that of those residents who use bed rails, a significant number, did not have bed bumpers, pads which serve to protect them against injury. An immediate notification was issued for the home to obtain these. On the second visit the manager had obtained additional bed bumpers and these were in situ in residents’ bedrooms Care assistants were observed knocking on doors; however, two clinically trained nurses did not do so, thus compromising residents’ privacy. All staff should knock and wait before entering. Three residents said they liked living at the home and that the staff were kind. This was reiterated by one relative. She said that staff were patient and had looked after her mother well. Relationships between staff and residents were observed to be respectful and friendly. It was noted that some staff do not have English as their first language which may cause some communication difficulties. As a mark of good practice the manager has organised English lessons for these members of staff. Discussion took place with her about maintaining a balance within the staff team and she was aware of the importance of this. Residents were observed being referred to in the term of address that they preferred and they had their own individual styles of dress. Some residents share a bedroom and privacy curtains were in place. The home operates a monitored dosage system for the administration of medication. A visit has been made by a pharmacist ,employed by the CSCI, to inspect the system. This will result in the publication of a second report. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15 Residents can be assured that they will be supported to maintain links with their family and friends. Menus need to be expanded so that residents have a greater choice. EVIDENCE: On the first day of the inspection some residents were still in bed and it was apparent that they had the choice to have a lie-in if they wished. Members of staff confirmed this. Residents have the option of staying in their bedrooms or going to the lounges if they prefer. Daily routines and activities were not a major focus of this visit and will be looked at in more detail at the next inspection. Two relatives confirmed that they could visit at any time and one said they were always made to feel welcome. Visitors were observed entering the home at will during the time of the inspection. Opportunity was taken to observe the serving of the lunchtime meal. This was achieved in an unhurried and sensitive manner – staff were observed interacting with residents, maintaining eye contact and assisting them at their preferred pace. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 12 It was observed that all residents have plastic mugs and plates. This would now be considered institutional practice and these should only be used if there is an identified need. Opportunity was taken to speak with the chef. He was aware of individual preferences and of different dietary needs. He said he was satisfied with the equipment and resources he was given and with the quality of food. There is not a choice of two hot alternative meals at lunchtime although it was apparent that some residents are offered different food if they don’t like the main alternative. The home should now plan to offer more choice and it was discussed with the chef and the manager how this could best be achieved. The kitchen was found to be cleaned to a good standard and there were up to date recordings of fridge and freezer temperature charts. It was noted that there were no protective clothing for kitchen staff (or those entering the kitchen). An immediate requirement was made for the home to purchase these. This had been achieved by the second visit. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents can be confident that their concerns will be listened to. EVIDENCE: Holmwood House has a complaints procedure which is displayed in the foyer, it was noted that this needed updating to include the name of the new manager The manager has received three complaints since the last inspection and has fully recorded the actions taken to resolve these. From discussion with her it was apparent that she takes these issues seriously and listens to concerns. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,26 Residents’ benefit from living in an environment that is clean and homely but cannot be guaranteed their privacy will be respected. Improvements need to be made to the decoration of some parts of the home. EVIDENCE: A major focus of this visit was to tour the premises to ensure it was being well maintained. Holmwood House is situated in large grounds, which were found to be well maintained and provide a safe and quiet space for residents to relax in. Some of the premises was found to be well decorated, including the hallway. During the first visit there was an unpleasant odour which appeared to be caused by a bleaching agent used when cleaning the carpets. On the second day of the inspection this had significantly reduced. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 15 Residents’ benefit from two lounges on the ground floor and a conservatory area. By the time of the second visit the smaller lounge had been redecorated and this has significantly improved this room. The large lounge has a crack down one side of the wall and scuffed paint work. The manager said that this was not due to subsidence. This requires redecoration. Some areas of the home continue to need re-decoration; this included some of the woodwork in the corridors, which were scuffed so they appeared dirty even though they were not. The manager explained that the home had a planned programme of re-decoration and she was frustrated because the person employed to achieve this had been called away during the summer months. On the second visit this situation had improved as the home had employed a new handyman who had begun painting some of the woodwork. This will continue to be the focus of future inspections but not the subject of a requirement as the home has begun to improve the décor. All of the bedrooms were viewed, apart from four where residents were still in bed. It was apparent that residents are encouraged to bring in small items of their own furniture which made their rooms more homely. Some bedrooms were personalised to reflect individual tastes – indicating that choice and independence is promoted in this respect. There were no bedroom door locks. In order for residents to be able to maintain their privacy and to keep their personal possessions secure a planned programme should begin of installing these. On the first day of the inspection some commodes were rusty and in a poor state of repair. On the second visit these had been replaced or repainted. There were sufficient lavatory and washing facilities. The majority of the home was found to be cleaned to an adequate standard (although as noted earlier some of the paint work appeared dirty but in fact needed repainting). On the second visit there were no unpleasant smells. There was information about the control and spread of infection but this was not looked at in detail during this visit. Cleaning chemicals were stored safely. The matron said the washing machine was adequate to meet the needs of residents. The laundry door was found to be propped open. This should be closed at all times. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 Residents can be re-assured that there will be sufficient staff on duty to help them and that unqualified staff are given opportunities to improve their knowledge and skills. The recruitment procedure needs to be more robust to protect vulnerable adults. EVIDENCE: At the time of this inspection there were six care assistants on duty, one registered nurse and the matron. In addition to this there were ancillary staff including a cook, administrator and two domestics. These levels were sufficient to meet with the needs of those residents currently accommodated. The matron confirmed that there are no staff under 18 employed to provide personal care. Three care assistants spoken with have attained, or are in the process of obtaining, National Vocational Qualifications. It was apparent that they appreciated the opportunity to train and this had provided them with the opportunity for promotion. On the first visit opportunity was taken to view the personal files of two members of staff. It was noted that the most recent member of staff did not have two written references as the home was awaiting these from abroad and that a povafirst check had been carried out after they had commenced employment. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 17 The home must ensure that they operate a robust recruitment procedure that is in place for the protection of vulnerable adults. There should be no compromise in the obtaining of checks and references prior to employment. By the second visit the administrator had received further guidelines about criminal records and pova checks and undertook to ensure that these were being followed appropriately. This will remain as a requirement and continue to be a focus of forthcoming visits. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36,38 Residents can be confident that the home is run by a committed manager who endeavours to run the home in their best interests. Action needs to be taken to regularly service equipment to further promote safety. EVIDENCE: All members of staff consulted with spoke positively about the support they received from the manager and it was apparent that they felt listened to by her. She displayed a good awareness of her responsibilities under the legislation and has nearly completed her Registered Managers Award. She was aware of the strengths and weaknesses of the home and where improvements need to be made. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 19 Some care staff expressed a lack of confidence in the abilities of the some of the clinically trained members of staff. On further discussion with the manager it was apparent that some nurses, who have recently undergone adaptation courses to meet NMC criteria, were requiring additional training, supervision and support. She was aware of the issues involved and taking action to improve some workers performance. This has led to additional work for her and has meant that she has had to take greater responsibility for the upkeep of records as she has not been able to delegate. This will continue to be the focus of forthcoming inspections. The manager has a lot of responsibilities and at present has to provide a lot of support for her clinically trained staff. It is strongly recommended that she continue to try and employ a deputy who could help her in this task. The home uses a number of hoists and manual handling equipment – it was not clear whether these were being serviced to the manufactures guidelines. These had been serviced by the second visit. A requirement will continue to be made that all manual handling equipment is serviced regularly so it can remain a focus of forthcoming visits. All electrical equipment had been tested on 27\7\05. The fire logbook evidenced that tests and checks of the system are taking place at the appropriate intervals. The home has a workplace fire risk assessment which was collated in 10\4\03. This should now be reviewed. On the first day of the inspection the insurance certificate was out of date – it was verbally confirmed, however, that the home was insured but had not receive the new certificate. Members of staff confirmed that they have had formal supervision and records of this were seen at the time of the visit. The manager has clearly worked hard to ensure that this system continues despite the additional support required for some of the clinically trained staff. Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 x x 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 3 x 2 Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. 6. 7. 8. Standard 7 10 15 15 20 23 26 29 Regulation 15 12(4)(a) 12(4)(a) 16(2)(i) 23(2)(b) 12(4)(a) 13(4)( c) 18(a) Requirement Ensure all care planning records are signed, dated and regularly reveiwed Ensure all staff knock before entering bedrooms Ensure that the appropriate plates and cups are used Ensure that there are two main hot alternatives at lunchtime Re-decorate large lounge Implement planned programme of installing bedrooom door locks Ensure laundry door is kept closed at all times Ensure that two references are sought for new recruits and that they have a criminal and pova check prior to employment All manual handling equipment to be serviced according to manufacturers guidlines Review workplace fire risk assessments Timescale for action 30/11/05 07/10/05 30/11/05 30/11/05 30/12/05 30/11/05 07/10/05 07/10/05 9. 10. 38 38 23(2)( c) 13(4)(a) 07/10/05 30/11/05 Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 22 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 31 Good Practice Recommendations Employ a deputy Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holmwood House D56_S20280_HolmwoodHouse_V241808_040805_Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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