Inspection on 09/05/05 for Holmwood House

This inspection was carried out on 9th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holmwood House 16/10/07

Holmwood House 26/02/07

Holmwood House 11/10/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Holmwood House Austin Fields Kings Lynn Norfolk PE30 1PH Lead Inspector Christopher Handley Announced 09 May 2005 9:30am 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 v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Austin Fields Kings Lynn Norfolk PE30 1PH 01753 643106 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) Integrated Nursing Homes Limited Mrs Pamela Jordan Care Home 35 Category(ies) of Old Age (35) registration, with number of places Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15 September 2004 Brief Description of the Service: Holmwood House is a registered care home of modern design. There are 35 beds, all of which are on the ground floor,and 50 of the rooms are en suite. There are small gardens at the front and rear of the home. The home is situated close to the centre of Kings Lynn. Any nursing care required is provided by the District Nursing Service. Medical services are provided by the G.P. services. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and was carried out as part of the annual inspection programme. A full tour of the home was made by the Inspector accompanied by the Regional Operations Manager. Six Residents and five members of staff, were interviewed as part of this inspection. Fourteen Comment Cards have been received. A total of twenty two standards were inspected. The Inspection was observed by Mrs Pamela Jordan, Manager, and Mrs Ruth Hayes, Regional Operations Manager for Integrated Nursing Homes. What the service does well: What has improved since the last inspection? The activities programme is now a more structured and there is more activity within the home. All the residents’ rooms have been re carpeted since the last inspection. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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) 1,2,3.& 4 The management of the company provide a good range of information about the home to all prospective residents, to help them make informed choice about moving to the home. Detailed pre-admission assessments are carried out on all prospective residents so that the home and residents are assured the needs of service users can be met. EVIDENCE: The home’s Statement of Purpose, and Service Users guide, are provided to prospective residents, which were seen. These documents were read briefly and they contain all the information required. They are provided to the prospective resident in order to provide them with a picture of the home and the services provided. It is recommended that the print size in these documents be increased, so as to enable people who may poor sight to read them more easily. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 9 All residents are provided with a Terms and Conditions, a copy of which was seen. This document, which is an agreement, is signed by either the resident, or their relative, and one signed copy is kept in the office. The Manager said that she reads through this document with the resident and relative, to ensure their understanding of the contents of the document. Some residents spoken to were aware of these documents. It is recommended that the print size of this document be increased, so as to enable people who may have poor sight to read the document. A pre-admission assessment is carried out by the Manager on all prospective residents. These assessments are recorded in a book. In order to enhance the privacy of the contents of the assessment it is recommended that the information obtained be recorded on a separate designated record sheet, headed “ Confidential Information” which could then be put into the individuals file. When carrying out these assessments the Manager has identification on her thus protecting the security of the prospective resident. Prospective residents and their relatives are welcome to visit the home prior to admission. A tour of the home is undertaken, information is provided and residents and visitor may talk to staff and residents if they wish. The purpose of this process being to give the prospective resident and relative some knowledge of the home. Some of the residents interviewed confirmed that this process had taken place prior to coming to the home, and they said that they had found it useful. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,&10. The care planning system is not yet robust enough that the management of the home are sure that they are fully meeting needs. The security of the Controlled Drug cupboard needs to be improved, to ensure that the system is totally safe. Privacy is respected to some extent, but this could be improved. EVIDENCE: All residents have an individual care plan and four of these were read in detail. The elements of the care plan are not clear and distinct. In the documents read there was very little evidence of the residents being involved in their own care. In the present format the care plans do not appear to be effective working documents, they lacked clarity and structure. In some of the documents there are blank spaces where specific information is required, e.g. legal status. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 11 The home has the good practice of recording allergies in red, thus alerting staff to the potential dangers that the substance could present to the resident. Daily records were read, some of which had been very neatly written, most were signed but some were initialled. There was no record of activities in the documents seen. It is recommended that the Manager and Regional Manager undertake a major review of the documentation so as to ensure that they become more effective working documents. The Regional Manager undertook to provide an update training session on care planning. All residents have a G.P. and this is recorded. A wide range of personal care is provided by the staff of the home. Any nursing care required is provided by the District Nursing Team. If needed any other health care professional would be called to the home. Arrangements are made for residents to attend a clinic or out patient department if needed. One resident attended A & E, following an accident, but did not have to stay in hospital. At present there are no residents who have pressure sores, but there are four who use pressure mattresses to prevent them. The medicine system was inspected. The home uses a Monitored Dosage System. The administration of the medicines is neatly recorded. All staff who administer medicines have taken training for this. The home has a written procedure for medicines. A thermostatic controlled refrigerator was seen, and it was not over frosted. There is a Controlled Drug cupboard and when the member of staff went to open this it was found to be unlocked and the red warning light did not work. The Manager is aware of the serious ness of this and a requirement has been made about this. The Manager undertook to look into this matter. One Controlled Drug was counted and found to be correct with the Controlled Drug Resister. The cupboard was then locked. The home enjoys a good working relationship with the supplying pharmacist. If staff had any doubts about the medicines they would contact the prescribing GP. Medicines are reviewed on a regular basis. The home has the practice of knocking on residents door prior to entering, and this was seen on several occasions during the inspection. The provision of privacy forms part of the induction of staff. Residents interviewed said that the staff always knock before they come in, and the Comment Cards reflect this. However, not all of the double bedrooms have privacy curtains and this needs to be addressed. Some residents have chosen to have locks on the doors of their rooms. Any treatment or consultation would be provided in private the Manager said. At present there are five rooms which have phones and the Regional Manager said that it was intended to have phones in all rooms in the near future. There are privacy screens in double rooms. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 The home provide a wide range of activities which assists with meeting the residents’ social and cultural needs. The home is not able to demonstrate that they do provide a balanced diet as they do not record special diets. EVIDENCE: The content of the resident’s day is largely chosen by them. They choose when they go to bed or get up. There are 3 residents who have historically chosen to get up early. Most residents have breakfast in their own room. There are twelve residents who take a daily paper, and the local library visit on a regular basis. There is monthly communion in the home and several residents go out to church. A celebration for VE day was held on the 9th of May. The home now has a monthly in-house letter which consists of quizzes, and items of interest to the residents, it also informs residents of activities which are to take place. One of the senior carers is responsible for the activities which include Cooking, Musical Bingo, Floor Net Ball, Dominoes, Playing Cards. A notice of these activities is posted up in the home. It is recommended that this member for staff undertakes training in this matter to further enhance her skills. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 13 The residents spoke highly of the catering services, they said that there was “Always enough” “there was variety” and that they were “Well set out”. The menus were seen they appear nutritious, varied, and interesting, but on the documents seen, there was no mention of Special Diets and it is required that they should be recorded. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17, & 18 The home has a complaint procedure, which the residents are aware of. Residents’ legal rights are protected. There is an Abuse Awareness policy in the home, which is known to staff. EVIDENCE: There is a complaints procedure posted up around the home. Residents interviewed said that they were aware that there was a procedure it they wanted to make a complaint. Most said that they would see the Manager if they had any concerns. Since the last inspection the home has had an anonymous complaint made which was investigated by the Manger and none of the elements of the complaint were up held. Staff interview were aware of the complaints procedure. Residents legal rights are protected, and any consultation of this nature would take place in privacy. Legal representatives do call to the home from time to time the Manager said. Residents can vote if they wish, and over a dozen chose to use a postal vote during the recent general election. There is a detailed Abuse Protection procedure (Integrated Nursing Homes) in the home, which was seen. The staff interviewed knew what steps to take if they suspected that an abuse of any nature were taking place. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24, 25,&26 The location and layout are suitable for its stated purpose, but the building is not yet safe due to the failure to cover the hot water pipes. The residents’ rooms are highly personalised and appreciated by the service users. The home is maintained to a high standard of cleanliness. EVIDENCE: The home is on the ground floor which enables residents to walk freely around the home, and this was frequently seen during the day of the inspection. There is a programme of routine maintenance which was seen. The building complies with the local fire service and the environmental health department. The grounds are neat and tidy and some residents were sitting outside during the afternoon. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 16 Residents rooms are maintained to a high standard, the quality of decoration, and furniture is good, the rooms have been very much personalised with pictures, ornaments and photographs. The residents spoke very highly of their rooms “They are very nice, and warm” was one comment. All the rooms have views out over the gardens. All the rooms have been re-carpeted since the last inspection and the Company is commended for this, as it improves the appearance of the rooms. There are residents names on the doors of their rooms, which are limited in size and style and it is recommended that they be replaced with more suitable, and readable ones. Some residents choose to have locks on their doors so as to further maintain their privacy. A tour of the home was made by the Inspector accompanied by the Regional Manager. In the double room there are privacy screen and the inspector recommends that these be replaced with privacy curtains. The heating lighting water supply and ventilation of the accommodation meets the environmental health and safety requirements. Rooms are individually and naturally ventilated. Rooms are centrally heated and the heating can be controlled by the residents. There is emergency lighting throughout the home which is tested on a regular basis. Water is stored at 60C and distributed at 50C. There are fail safe devices fitted to the water system to provide water close to 43C. There are still several areas where there are small but significant pieces of exposed hot water pipe work, which present a risk to residents. The Regional Manager undertook to have this pipe work covered as soon as is possible, it is required that this work is carried out The premises were clean and tidy and free from offensive odours. The homes laundry has industrial machines which are maintained on a contract. There are hand washing facilities. The laundry floor is impermeable. Services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 The home meets all the remaining elements of Standard 26. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 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) 28,29, & 30 The home’s recruitment practice does ensure that the home recruits staff who are suitable for working with vulnerable people. The training programme continues to develop but needs further work to ensure that the skill mix of staff is adequate. EVIDENCE: The Manager provided the figures for the staff NVQ programme. There are 5 staff who have NVQ II, and 7 staff taking NVQ II. There are 3 staff taking NVQ III. The Manager is recommended to encourage staff to continue undertake take this training. Those staff interviewed who had their NVQ training said that they were pleased that they had done so, and that initially they were very hesitant to undertake the training. In addition to this, the Company have purchased twenty video training packages. The Manager intends to develop a training programme for staff with them. There appears to be a stronger emphasis on training and this can only bode well for the care of residents, and the development of staff. The home operates a thorough recruitment procedure based on equal opportunities and the ensuring of the protection of resident. Two written references are obtained, Police and POVA checks are carried out. Application forms have to be completed, two people conduct the interview. Job descriptions are provided. All staff are provided with Terms and Conditions and a copy of the Code of Conduct. The home does not use volunteers. The home has good employment practice and documentation, which was seen. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 18 Staff now undertake an induction training programme which meets NTO specification. As yet the home does not have Foundation training which meets NTO specification. Other training provided includes Fire Training, First Aid, Infection Control, Nutrition, and two members of staff are Moving and Handling trainers. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 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) 31,33, & 36 The home is not yet in a position to say whether they are running the home in the best interests of the residents as they have not collated the information for the survey they have carried out. Staff are not yet properly supervised and this needs to happen. EVIDENCE: The Manager is due to commence her NVQ 4 in the near future with the Isle College. The Regional Manager will be acting as her Mentor during this training. She has, however, many years experience of residential care. The home has undertaken a survey of the services which it provides, but as yet this has not been collated. It is recommended that the home collate the survey and then use this to inform their own programme for improvement of the service, which should be submitted to the Commission. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 20 The Manager said that staff supervision programme is to start next week. This will cover all aspects of practice, the development of the home, and career development needs. It is recommended that the supervision programme start as planned, and that it must be recorded. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x 3 2 3 STAFFING Standard No Score 27 x 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 2 x x 2 x x Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 22 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. Standard 9 15 25 Regulation 13.2 Sch.4 13 13.4 (a) Requirement It is required that the Controlled Drug Cupboard is kept locked when not in use It is required that special diets are recorded. It is required that the exposed hot water pipes be covered Timescale for action 09/05/05 09/05/05 09/05/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 1 2 3 7 12 24 Good Practice Recommendations It is recommended that the print size of the Statement of Purpose, and Service Users Guide be increased It is recommended that the print size of the Terms and Conditions be increased It is recommended that the pre admission assessment is recorded on a designated record, which is headed Confidential Information It is recommended that a major review of the care planning should take place, so that the documents become sound working documents It is recommended that the member of staff who provides the activites, undertakes training , so as to enhance her skills in this mater It is that new name plates be fixed to the doors of v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 23 Holmwood House 7. 8. 9. 10. 11. 12. 24 24 30 31 36 residents rooms. It is recommended that divider curtains be put in double rooms it is recommended that the NVQ training programme continue It is recomended that the Manager implement Foundation Training for staff. it is recommended that the manager undertake Management training. It is recommended that recorded, staff supervision be commenced. Holmwood House v218100 i55 s62973 holmwood house kings lynn v218100 090505 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF 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. 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