CARE HOMES FOR OLDER PEOPLE
Holmwood Nursing Home Warminster Road Norton Lees Sheffield S8 9BN Lead Inspector
Shelagh Murphy Unannounced 14th September 2005 09:05am - 2:20pm 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 Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Holmwood Nursing Home Address Warminster Road Norton Lees Sheffield S8 9BN 0114 2509588 0114 2580911 None Southern Cross Home Properties Limited 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) Miss Christine Hockley N - Care Home with Nursing 41 Category(ies) of DE(E) Dementia - over 65 (41) registration, with number of places Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: One individual named on the Registration Variation Application Form dated 12/9/03 who is in the category OP, Older People, may reside at the home. Date of last inspection 6th January 2005 Brief Description of the Service: Holmwood is a purpose built care home, which provides care for 41 older people who have Dementia. It is owned by Southern Cross Healthcare. The home is in a residential area of Sheffield with good access to public services and amenities. It is a two-storey building; the first floor is accessed by a lift. It is generally well decorated with good quality furniture and furnishings provided. All bedrooms are single with en-suite facilities. A private car park is provided at the front of the property. The gardens are landscaped and have a large patio area to the rear. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Shelagh Murphy carried out this unannounced inspection over five hours. Christine Hockley, registered manager was present during the inspection. Opportunity was taken to make an inspection of the home, examine a sample of records and policies and talk informally to residents, the manager, care and domestic staff and one relative. The majority of the residents were unable to speak to the inspector due to their high support needs but two residents and one relative gave their views. Three staff were formally interviewed and several staff were spoken to informally. What the service does well: What has improved since the last inspection?
Some new beds and chairs had been purchased for the residents to ensure their comfort. Many areas of the home had been decorated and furnished to a high standard. All of the residents’ bedrooms had been fitted with privacy locks. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 6 The grounds to the rear had been extended and a large patio area had been developed, this made the space much safer and attractive and was welcomed by all, as the residents had spent more time in the fresh air this summer. A training and development programme had been developed to meet TOPPS standards and as a result staff had received appropriate induction and some of the required statutory training. Eight staff had completed the NVQ2 care award. The manager has completed the NVQ4 care management award. Regulation 26 reports, which ensure that senior managers in the organisation are visiting and checking quality standards had been carried out more frequently than on previous inspections. More detailed information was being obtained before any newly recruited staff were able to start work at the home. What they could do better:
Some care plans must be improved to ensure that residents’ general health can be better monitored. Some health care appointment records need to be updated. The residents and their relatives must be offered the opportunity to discuss their wishes in the event of a death, to ensure that the home will follow their wishes at this time. The residents’ social and leisure needs must be reviewed and plans put in place to offer regular social activities for all of the residents in the home, who wish to participate. During the observation of the mealtime on the top floor a young carer was observed trying to feed two residents simultaneously. This practice was carried out in ignorance and the manager was advised at the time. In future all staff must be advised that all of the residents must be fed individually to protect their dignity. The staff training and development plan must be fully implemented to ensure staff are adequately trained to support the residents appropriately. Adult protection training will need to be offered to all staff to ensure they are able to respond appropriately to these issues. Some minor maintenance issues, which are listed in the environment standards, must be addressed to ensure the home is safe and comfortable for the residents. Gates must be fitted to the steps in the garden area to protect the residents from the risk of falls.
Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 7 All staff must be offered regular formal supervision to ensure they are appropriately supervised and supported to carry out their responsibilities. The manager needs to seek advice from the fire officer regarding the safety of the fire exits from the home especially the ground floor dining room. 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 Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standard 6 is not applicable to thei home. Residents’ needs had been assessed, by both local authority social workers and the homes manager prior to being admitted in to the home. EVIDENCE: Two resident files were checked and each contained a copy of their full needs assessments which had been compiled by a social worker and an assessment carried out by a senior member of staff at the home. The information from the full needs assessment had been incorporated into the resident care plans. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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, 10. Standard 9 was partially checked. The two care plans identified the majority of the health, and personal needs of the residents. There were some omissions and these will need to be addressed. There was evidence that a range of health care professionals regularly visited the home to meet the resident’s needs. Some of the records relating to these visits were not available. Two of the residents said that they were satisfied with the care they were receiving and that they liked the staff. The residents had received a satisfactory or good standard of personal care. Several of the residents’ medication sheets were checked and no issues were noted. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 11 EVIDENCE: Two care plans were checked. Two care plans set out in detail the majority of the resident’s needs and the action to be taken by the qualified and care staff of the home to ensure these could be met. There were some omissions and some information was not detailed enough, these included oral health, foot care, social interests, arrangements/wishes regarding death, and details of daily preferences for rising and retiring. A GP made a visit to the home to see the residents during the inspection. The chiropodist had visited the day before but on one care plan this had not been recorded and the manager addressed this issue during the inspection. All of the residents were well dressed in clean clothes and had received a satisfactory standard of personal care. Several residents had seen the hairdresser who was visiting the home at the time of the inspection. Two residents said that they were satisfied with the care they were receiving and that they liked the staff. One relative said they were satisfied with the care offered to their relative and advised they felt the staff were welcoming, friendly and approachable. Ten Medicine Administration Records (MAR) were checked and showed no omissions. Staff closed doors before assisting residents with personal care. Residents said that staff were polite. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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, 13 and 15. Some activities were provided for the residents from external entertainers but the resident’s needs for regular opportunities to take part in stimulating activities were not being met. The meals served at the home were of a good quality and offered choice. Overall the lunchtime meal was well organised and relaxed. Some inappropriate practices were observed and the manager was advised of these. Residents’ were supported by staff to make some choices, regarding their lifestyle within the home. The resident were supported to maintain contact with family and friends. EVIDENCE: The home pays for external entertainers to visit the home to provide entertainment to the residents and one relative confirmed this was very positive. The manager confirmed that there was no activities co-ordinator employed to plan regular activities with residents. The previous employee had left and the manager said they had experienced difficulties in filling this post. It was clear to the inspector from observations, that the residents’ social needs were not being met for the majority of the residents.
Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 13 There was a friendly, informal atmosphere in the home; the staff showed respect for the residents and a relative confirmed the staff were welcoming and warm in their approach. Several staff when interviewed said the best thing about their job were the relationships they had developed with residents and their families. Which, were observed to be appropriate and respectful. Lunchtime was observed on both the ground and first floor. The meal was served in a pleasant, calm and relaxed manner. Two residents said that they enjoyed their lunch. Residents were offered a choice of food and drinks. The staff supported the residents to cut their food and prompted residents who showed little motivation. Several carers were observed feeding residents patiently and respectfully, an inappropriate practice was observed on the first floor where a young carer was trying to feed, two residents simultaneously, who were eating slowly. This was brought to the managers’ attention. The residents were encouraged to make simple choices about daily living activities, staff were observed asking residents to make choices about what they ate, drank, whether they wanted to see the hairdresser, doctor etc. Two residents and a relative said that their visitors were welcomed at the home. The manager has a comments book on the reception desk, which invites comments good and bad from relatives. When this was checked it showed that many positive comments from relatives had been made recently. Any negative comments are followed up by the manager to address visitors concerns. This showed openness, transparency and confidence in the service. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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 and 18. There was an adult protection policy in place at the home. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home. Complaints procedures are in place to enable residents and relatives to feel confident that any concerns they voice will be listened to. The manager kept a central record of all complaints. EVIDENCE: Some staff had received information on adult abuse and some staff had received formal training. Other staff will need to be offered this opportunity. The staff said they found this training very useful. This will help to ensure that residents are protected from abuse. A complaints procedure was displayed in the home. The manager reported that there were three complaints investigations at the home at the present time. Two of these regarded fees, which the finance department were dealing with. One complaint was regarding care services and the manager had done preliminary investigations and had set up a meeting to address the relatives concerns. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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, 20, 21, 23, 24, 25 and 26. The environment within the home was on the whole well maintained, safe and clean providing a comfortable and safe environment for residents to live in. The residents had access to comfortable indoor and outdoor communal facilities. The residents’ all had individual and personalised bedrooms, which were safe, clean, comfortable and some people had brought their own furnishings and furniture. Overall, the home was clean, pleasant and hygienic. EVIDENCE: A tour of the premises showed that all areas of the home were clean and tidy. Lounge and dining areas were attractively decorated and domestically furnished, new chairs had been purchased for the lounges and these were appropriate to meet the resident’s needs. Four bedrooms were checked in detail and many others seen, all were comfortable and homely. Privacy locks had been fitted to all of the residents bedroom doors. Several new beds had been purchased and others had been budgeted for. The bed linen checked was clean and in a good condition.
Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 16 The grounds to the home were well maintained and attractive. A new patio area had recently been built and the residents, staff and a relative said this had improved the home significantly as residents could now spend time in the fresh air with staff and visitors during the summer months. Gates need to be fitted to the steps in the garden area to protect the residents from falling. The home was generally clean, with no unpleasant odours noticeable. Staff and two residents said that the home was always kept clean. Minor maintenance issues were noted during the inspection and included: -, corridor carpets needed cleaning, curtains in one residents bedroom had fallen down, a blind in a bathroom was missing and needed replacing, the floor covering under one of the specialist baths needed to be replaced Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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) 27 and 30. The staffing levels met those agreed with the previous registering authority. Most staff felt that the home employed staff in sufficient numbers. There had been improvements in the recruitment information obtained for new staff. Staff induction training to meet TOPPS standards had been introduced. The staff training records showed that training opportunities at the service had improved, but that not all staff were up to date with all of the statutory training required. EVIDENCE: The manager stated that agreed staffing levels were being maintained. The staff rota identified agreed staffing levels had been met. This will assist in making sure that service users needs are met. The staff interviewed had all been at the home for eight or nine years, said they were happy and fulfilled and felt that whilst you could always do with more staff the present staffing levels were adequate. There had been improvements in the recruitment information obtained for new staff; photographs of all staff were now on the files. A staff recruitment matrix had been devised by the administrator to clearly show what information had been obtained and what was outstanding prior to staff starting work. An induction training pack which meets, TOPPS standards had been introduced for all newly recruited staff.
Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 18 The staff interviewed said that there were good training opportunities available to them, which enabled them to feel competent to do their job. A staff training and development plan had been devised for the home and had been partially implemented. Several staff had completed the NVQ2 care awards and felt this had made them feel more confident to do their jobs. The staff training records showed that training opportunities at the service had improved, but that not all staff were up to date with all of the statutory training required by the regulations. The manager was aware of this and had taken steps to set up further training sessions. Eight care staff had completed the NVQ2 care award. However, the manager confirmed that the percentage of staff with the award would not meet 50 by the end of 2005. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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, 32, 33, 36 and, 38. There was a positive style of management in the home and staff morale was good. Regulation 26 reports had been completed more frequently than at previous inspections. Staff were offered informal supervision, but not regular formal supervision sessions. Some but not all of the statutory training for staff had been completed. Fire exits were checked, and found to be accessible, however, the manager was advised to seek the fire officers advice regarding one issue. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 20 EVIDENCE: The manager was spoken about fondly and positively by all of the people interviewed by the inspector. The manager said that she had completed the certificate in care management from Leeds Metropolitan University. Regulation 26 reports had been completed more frequently than at previous inspections. Staff said that staff morale was good and they all said that they enjoyed working at the home. The staff said they were receiving informal supervision and management support on a regular basis. However, there was no evidence that formal supervision was taking place on a regular basis and this must be introduced to support staff more effectively. Records were securely stored around the home, which protected the residents’ best interests and confidentiality. Some staff said they had received recent fire safety training .A sample of records showed that some staff had received this and other statutory training, but not all of the training required had been completed. At the time of inspection no fire exits were blocked but advice about the fire exit in the dining room must be sought from the local fire officer, as the inspector did not feel this exit was sufficiently clear for the residents to evacuate safely. Window restraints were in situ at first floor windows checked to prevent falls. Hazardous products were safely stored in the home. This will promote the safety and welfare of the service users. Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 3
COMPLAINTS AND PROTECTION 3 2 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 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 x 2 3 3 3 x x 2 3 2 Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard OP7 Regulation 15 Requirement Timescale for action 31.12.05 2. 3. OP8 OP10 4. OP12, OP14 5. 6. OP15 OP18, OP38 OP19 7. 8. OP20 Residents individual plans must contain all of the information required by the regulations in sufficient detail to ensure the residents needs can be met. 12, 15, 17 Residents helath care appointments must be accurately recorded. 15 Attempts must be made to seek the residents or their relatives views as to their wishes after death. 12 Residents social and leisure needs must be reviewed and as appropriate, regular, planned activities must be available to meet these needs. 12 Residents must be fed individually to maintain their dignity. 18 All staff must be offered adult protection training and all statutory training at the relevant frequencies. 23 The maintenance issues highlighted in this report must be addressed to ensure the home is kept well maintained and safe. 23 Gates must be fitted to the steps in the garden/patio area to
J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc 30.9.05 31.12.05 31.10.05 14.9.05 31.3.06 31.12.05 31.10.05
Page 23 Holmwood Nursing Home Version 1.40 ensure the safety of residents. 9. 10. OP36 OP38 18 23 All staff must be formally supervised. Advice must be sought from the fire office regarding the adequacy of the fire exit in the dining room. 31.12.05. 30.9.05 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. Refer to Standard OP30 Good Practice Recommendations 50 of care staff should have completed the NVQ2 award by the end of 2005 Holmwood Nursing Home J55 S21787 Holmwood V248206 14.09.05 UI Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ground Floor, Unit 3 Waterside Court Bold Street Sheffield, S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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