Inspection on 20/10/05 for Holmwood Nursing Home

This inspection was carried out on 20th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Nursing Home 15/12/08

Holmwood Nursing Home 10/01/07

Holmwood Nursing Home 26/05/05

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

CARE HOMES FOR OLDER PEOPLE Holmwood Nursing Home Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB Lead Inspector Deavanand Ramdas Announced Inspection 20th October 2005 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 Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holmwood Nursing Home Address Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB 01737217000 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) Robert William Kibble Mrs Urmila Kumar Care Home 36 Category(ies) of Dementia (8), Mental disorder, excluding registration, with number learning disability or dementia (8), Old age, not of places falling within any other category (20) Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. One named service user may be admitted to the home over 60 years of age. 26th May 2005 Date of last inspection Brief Description of the Service: Holmwood is care home providing nursing care to older people. It is located in a residential area in Tadworth, Surrey close to local amenities. The home provides accommodation for thirty six service users on two floors that can be accessed by stairs or a lift. The home has single bedrooms and shared bedrooms with en-suite facilities and comprises of a lounge, dining area, conservatory, laundry, kitchen, office and adequate bathing and washing facilities. The home is being extended and service users do not have access to a garden at this time. Private parking is available. The registered manager is Urmila Kumar. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector over a period of six hours. A partial tour of the premises took place and staff, relatives and service users were spoken to. Documents and care records were checked. The inspector would like to thank the director, manager, staff, service users and relatives for their contribution to the inspection. Feedback forms, comment cards and CSCI business card was left at the home for information. What the service does well: What has improved since the last inspection? What they could do better: The home must improvement its recruitment practice and update recruitment files with a recent staff photograph. The director must ensure contract of employment documentation is updated to reflect a change in ownership of the home. The home must ensure training is given to staff on handling dying and death and bereavement training is offered to ensure staff have the skills to adequately support service users. The director must ensure a statement is Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 6 available as to the financial viability of the home and is available for information. 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 DS0000062689.V259787.R01.S.doc Version 5.0 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 Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 the following standard(s): 3,4,5,6, The arrangement for assessment at the home ensures service users needs are assessed and identified before admission to the home. The arrangements for meeting the needs of service users are adequate ensuring service users needs are identified and met. The home offer trail visits enabling service users and relatives to assess the suitability of the home. EVIDENCE: The home has a pre-admission policy dated 2002. The director stated the home had introduced a standardised care planning system and the manager remarked qualified staff did assessments. The inspector sampled assessments and noted prior to admission a pre-assessment was completed and needs were assessed and identified. Areas of assessment covered personal, health and social care. Care plans were fully completed, dated and signed and well presented. The inspector noted staffs were trained in the care planning system and manual was available at the home for reference. A relative remarked her mothers’ needs are well met and commented I go on holiday knowing my mother is in safe hands. The manager stated the home had a service user of Jewish faith. The inspector sampled her assessments and noted care plans Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 9 were in place for managing her dying and death based on her religion. The director stated the training of staff was ongoing and the team had the collective skills to meet the needs of service users. The inspector sampled the roster and noted the home employed seven registered and each shift had a qualified nurse on duty. The manager stated a psychiatrist visited the home monthly to review the care and treatment of service users. The director commented the home offered trial visits. The inspector noted this was written in the condition of admission contracts and listed as Item 12. A visitor stated he was invited to visit the home, had a meal and was given the opportunity to stay for the day. The director stated the home did not offer intermediate care and this standard was not assessed. It was positive that standard 3 was assessed as exceeding the national minimum standards in view of a care planning system based on best practice, assessments being done by qualified nurses, ongoing staff training backed up by policies and procedures and positive outcomes for service users. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 the following standard(s): 9,10 &11. The medication at this home is well managed promoting good health. Personal support in this home is offered in such a way as to promote privacy and dignity. The arrangements for handling dying and death are satisfactory however the home must offer bereavement training to staff to ensure service users and their families are treated sensitively. EVIDENCE: The home had a policy on medication dated 2002. The director stated qualified nurses administered medications. The inspector sampled staff files and noted qualified staff registrations were up to date. The home had a clinic room that was used to store medications. The inspector noted medications were stored in a locked cupboard secured to the wall. The manager stated the home had controlled drugs. The inspector sampled the control drug register and noted the records were up to date and correct. Medication record sheets had a photograph of the service user attached and records sampled were signed and dated by staff. The disposal of medications was arranged through the local pharmacy supplier. The inspector noted service users were addressed by their preferred names and staff knocked on doors before entering service users bedrooms. The home had a policy on death and dying dated 2002. The Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 11 manager stated the home had experienced nurses who provided support to service users and carers. A relative remarked you could stay overnight and use the facilities of the home that was confirmed by the director. The inspector noted the home did not offer bereavement training to staff. This was discussed with the manager and director and action has been required in respect of this matter. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 the following standard(s): 12,13 & 14. The arrangements for social activities at the home are satisfactory ensuring service users social and recreational interests are satisfied. The arrangements for maintaining community contact are adequate ensuring service users have the opportunity to maintain relationships with families and friends. The systems at the home enable service users to exercise choice over their lives. EVIDENCE: The home has a policy on social activities hobbies and interests dated 2002. The director stated the home employed an activities co-ordinator working three days a week. The inspector noted the home had an activity schedule that reflected arts and crafts, movement and music, puzzles, current affairs and floor exercises. The inspector noted one service user was doing a jigsaw puzzle and others were interacting with staff, relatives, listening to music and watching television. The home had a visitor’s policy that allowed relatives to visit the home anytime that gave the opportunity for relatives at work during the day to visit in the evening. The manager stated the home had contact with the local church and communion had been held monthly at the home. The home had a policy on choice dated 2002. The director stated service users are helped to exercise control over their lives. The inspector sampled a care plan and noted one service user had a choice of when to retire to bed that was recorded and other service users had personal possessions in their bedrooms. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 13 The director stated many service users had their finances managed by the Court of Protection and the inspector noted copies were held in the director’s office for information. During the inspection a relative visited the home and wanted to see the director to discuss finances. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 the following standard(s): 16 & 17. The complaints process in this home is satisfactory with complaints information available to staff and relatives. The arrangements at the home for safeguarding legal rights are satisfactory ensuring service users rights are safeguarded and protected. EVIDENCE: The home had a complaint policy dated April 2005 that was displayed in the main entrance for information. The director stated the home kept a record of complaints that were sampled. The inspector noted the last complaint was recorded on the 12th September 2005 and management action had been taken. A relative remarked he was aware of the complaint procedure. The home had a policy on advocacy and rights dated 2005. The director remarked the rights of some service users at the home were safeguarded by the Court of Protection. The inspector noted the affairs of twenty residents were under the Court of Protection and records were available. A visitor who is a member of the Alzehmeir’s Society commented he is actively involved in the affairs of a service user at the home. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 the following standard(s): 19 & 26. The standard of the environment within this home is good providing service users with an attractive and homely place to live. The arrangements at the home for hygiene are satisfactory ensuring the home is clean and hygienic for service users. EVIDENCE: On the day of the inspection the home was clean, well ventilated and free from mal-odour. The director stated the home is being refurbished and the inspector noted some parts of the home had new furniture, new carpets, new furnishings and equipment. Some bedrooms had new beds, sinks, baths, wardrobes and bedside lockers. The standard of décor was excellent in the areas that had been refurbished. Due to building works service users did not have access to the back garden and the director stated plans are in place to landscape and develop the back garden. The communal areas were well presented with adequate lighting and furniture. The home had infection control measures and the inspector noted staff washed their hands regularly. Gloves, aprons and hand wash were available. The manager stated she had a Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 16 certificate in infection control awarded by Guildford College. The home had a policy on infection control dated 2002 and a contract for the disposal of clinical waste with a reputable waste disposal company. A relative stated she visited the home regularly and it never has a bad odour. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27&29. The arrangements for staffing at the home is satisfactory ensuring there is sufficient numbers of staff to meet the needs of service users. The standard of recruitment and vetting practices must be improved to ensure service users are protected from risk of harm. EVIDENCE: The director stated the home employed thirty staff and staffing levels were agreed with the Commission. The manager remarked the staffing levels were 2 registered nurses and 5 carers in the morning, 1 registered nurse and 4 carers in the afternoon and 1 registered nurse and 2 carers at nights. In addition, the home employed a laundry assistant, a kitchen assistant, a handy man, and a part-time activities co-ordinator. The inspector sampled the roster and noted it reflected the numbers of staff on duty and an extra member of staff was booked on duty on the 25th October 2005 for escort duties. The manager stated the staffing levels were adequate that met the needs of the service users. The home had a policy on staff recruitment dated 2002. The inspector sampled staff recruitment files and noted they had completed application forms, two references, a declaration form, CRB disclosure and terms and references. The inspector noted recruitment files did not have photo identity of staff and that terms and conditions were in need of updating following a change of provider. This was discussed with the manager and action has been required in respect of this matter. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,37&38. EVIDENCE: The home has a registered manager who had a professional qualification in nursing. The inspector sampled records and noted the manager had registration with the Nursing and Midwifery Council that was current. The manager stated she had five years experience as a registered manager that was confirmed by the director. The inspector noted the manager was aware of her role and responsibilities that was managing care and managing staff. A relative stated the management is approachable and I can’t find anything wrong. The director stated the home had a quality assurance system that was based on surveys of staff and relatives. The inspector noted the home had a quality assurance folder that contained completed questionnaires. The director stated he sent questionnaires to service users and relatives annually and had regular meetings with staff to seek their views about the home. The inspector Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 19 noted the home met all of the previous requirements and recommendations. The home has liability insurance that expires on 31st August 2006 that is displayed in the hallway. The director was asked to produce a statement as to the viability of the business and action has been required in respect of this matter. The home has a policy on financial affairs dated 2002. The director stated service users managed their own finances and it was the home policy to invoice families for any services provided such as hairdressing. The director stated he was an appointee for one service user and records were kept of financial transactions. The inspector sampled records and documents and noted they were up to date. Care plans were signed and dated and stored in the manager’s office in a locked metal cabinet. Recruitment files and other sensitive documents were stored in the director’s office in a locked filing cabinet. The home has a policy on health and safety dated 2002. The director is responsible for health and safety within the management structure. The inspector noted the director had a certificate in safety compliance dated November 2004. The inspector sampled service records and noted they were up to date. A fire certificate was issued on the 9th November 2004 hoists were serviced on the 12th April 2005. The home kept records of accidents and incidents that were sampled. The inspector noted the last incident recorded in the staff incident book was dated 8th August 2005 and management action was taken. The water temperature check for legionella was sampled that was up to date and ranged between 20 and 22 degrees centigrade. Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 2 3 X 3 3 Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 Page 21 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 NMS-OP 11 Regulation 18(1)(a) Requirement The registered person must ensure staff have bereavement training to adequately manage dying and death of a service user. The registered person must ensure recruitment files have a recent photograph of staff and contracts are updated to reflect the care home is under new management. The registered person must ensure a statement is submitted to the Commission without delay to demonstrate the financial viability of the business. Timescale for action 01/03/06 2 NMS-OP 29 7,9, Schedule 2 01/03/06 3 NMS-OP 34 25(3)(c) 01/03/06 Holmwood Nursing Home DS0000062689.V259787.R01.S.doc Version 5.0 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 2 Refer to Standard NMS-OP NMS-OP Good Practice Recommendations The registered person shall ensure a copy of the National Minimum Standards for Older People (3rd Edition) is available at the home. The registered person shall ensure a copy of the Care Home Regulations 2001 (As amended) is available at home. 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