Inspection on 26/05/05 for Holmwood Nursing Home

This inspection was carried out on 26th May 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 20/10/05

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

CARE HOMES FOR OLDER PEOPLE Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB Lead Inspector Mr D Ramdas Unannounced 26th May 2005 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 H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holmwood Nursing Home Address 53 The Avenue Tadworth Surrey KT20 5DB 01737 217000 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) Robert William Kibble Mrs Urmila Kumar Care Home 36 Category(ies) of DE - Dementia (8) registration, with number of places MD - Mental Dissorder (8) OP - Old Age (20) Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Holmwood is a privately owned home providing nursing care for thirty six older people. There is provision for up to eight beds being used for the care of service users with dementia or mental disorder. The home is situated in Tadworth Village and is close to all local amenities. Accommodation is provided on two floors with twenty one single and seven double bedrooms. The home has a large lounge, dining areas, a conservatory, bathing and washing facilities, a laundry and a kitchen that has been refurbished to a high standard. The home has a large, well maintained garden and a large patio area with wheelchair access to the rear of the property. Parking is provided for visitors. The registered provider is Mr. Robert Kibble and the registered manager is Mrs. Urmila Kumar. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over a period of 5.5 hours. A full tour of the premises took place, staff, service users and relatives were spoken to and care records and other documents were inspected. The inspector would like to thank the service users, staff and relatives for their input during the inspection. For the remainder of this report service users will be referred to as residents, in line with their preference. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure care plans are reviewed monthly and that risk assessments are frequently and regularly reviewed. Documents such as the Statement of Purpose and Service User Guides must be updated to ensure residents have accurate information. The home must ensure it has regular team meetings and involve all of the staff in the shift changeover to promote good communication. The home must provide a plan outlining the refurbishment work to be undertaken in respect of conversion of the loft, replacement of beds and Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 6 bedroom doors, and the painting and decorating of some bedrooms with timescales attached. 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 H58_s62689_Holmwood_v220552_260505_stage4.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 Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.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 Residents and prospective residents were provided with details of the services the home provides enabling an informed decision about admission to the home. However they must be improved to ensure residents have up to date and accurate information on which to make decisions. EVIDENCE: The home had a Statement of Purpose and Service User Guide that contained information about how the home operated. It had been revised in April 2004. The Director stated, the Statement of Purpose and Service User Guide were kept in the office and made available to residents and relatives on request. The home had a philosophy of care that was openly displayed in the hallway. The inspector found the Statement of Purpose needed to be updated. The names of the previous providers have not been removed, the organisational chart was out of date and the information contained in the complaint policy did not reflect that a complaint could be made at any stage to the Commission should the complainant wish to do so. The Service User Guide needed to be updated. Residents had an up to date written contract that was kept in the Service User Guide. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 9 Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.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) 7,8,10 The health needs of residents are met with evidence of other health care professionals being involved on a regular basis. However, the review of care plans and risk assessments must be undertaken regularly to ensure they are appropriate to the needs of residents. Personal support in this home is offered in such a way as to promote and protect residents’ privacy and dignity. EVIDENCE: The Director stated care plans were in the process of changing to a new improved system. Care plans were sampled, the inspector noted some care plans had been dated February 2005. Risk assessments were found to be inadequate with no evidence of frequent and regular reviews undertaken. The home had a key worker system and qualified nurses were responsible for assessing and planning care. The Director stated the home had one resident with MRSA who had been transferred to hospital for treatment. The nurse in charge stated the home had one resident with a pressure sore. The inspector found evidence in the care plan that the pressure sore was regularly reviewed and appropriately managed. It was recorded the resident had seen a GP and prescribed a course of treatment. The home had a wide range of pressure relieving equipment. Residents were treated with respect and their privacy upheld. Staff addressed residents by their preferred names. The Director was observed to knock on residents bedroom doors and sought permission before Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 11 entering their bedrooms. One relative remarked, ‘I am very satisfied. Nursing care is good’. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.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) 15 The meals in the home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The inspector checked the kitchen that was recently refurbished with new flooring, cupboards and equipment. The home had a written menu planned over four weeks that provided variety and choice. The home employed a kitchen assistant who is responsible for preparing breakfast and supper. Lunch is cook-chilled and provided by a catering company. The inspector observed liquefied meals to be presented in an attractive manner and meals were taken in a relaxed and unhurried way. Staff behaviour was observed to be appropriate with plenty of interaction observed between staff and residents. A relative remarked, meals are well presented and liquefied meals are in individual portions. One resident remarked the meals were good but she did not like jam in her rice pudding. This remark was discussed with staff. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 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) 16,18 Arrangements for protecting residents are satisfactory safeguarding them for the risk of harm and abuse. EVIDENCE: The home had a complaint policy that was kept in a Policies and Procedures Folder in the staff office. The inspector noted the procedure did not state that a complainant could contact the Commission at any stage should the complainant wish to do so. The home had a complaint book. The last entry was made on the 11. 8. 03. Staff stated they had been made aware of the complaint policy during their induction. The inspector sampled the induction file of a new staff and found evidence the complaints policy had been discussed. A relative commented, ‘I know about the complaints procedure’ ‘I was given a copy when my husband was admitted to the home’. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 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) 19,20,21,22,23,24,25,26 The standard of the environment is good providing residents with an attractive place to live in. EVIDENCE: The home had a good standard of décor. The hallway, dining and lounge areas were well furnished. Carpets throughout the home were clean and the home was found to be free from mal odour. The heating and lighting was adequate. Bedrooms were found to be clean, well presented and personalised with family photographs, pictures, radio, television, and ornaments. The bathing and washing facilities were found to be clean and hygienic. Adaptations and aids were fitted such as grab rails, hoists and assisted toilets and baths to help residents maintain their independence. An aid call system was in use throughout the home. The laundry facilities were inspected and found to be adequate. There was evidence of infection control measures operating within the home. The home had a large well maintained garden and a large patio area that had wheelchair access. The garden was private and secure. A relative commented, the cleanliness of the home had improved and this was down to the new cleaning staff. Another relative stated that their wife’s bedroom was Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 15 very nice. At the time of the inspection refurbishment work was being undertaken at the home. The Director was advised to ensure the home was regularly risk assessed to maintain a safe environment for residents and that he produced a development plan for the home. The Director stated he had planning consent to extend the property to increase the accommodation provided from 36 to 42 beds. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 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) 28,30 The arrangements for the induction of staff are good with staff having a clear understanding of their roles. However, staff did not have a named supervisor for the period of their induction. EVIDENCE: The Director stated the home had an active NVQ training programme and that 15 staff had achieved the NVQ in Care Award. The inspector interviewed three staff on duty that confirmed they had completed the NVQ Level 2 Care Award. The inspector checked the induction files of two staff that joined the home recently. The files contained an induction checklist, areas of training completed had been dated and signed by both the employee and the supervisor, training included food hygiene, first aid, health and safety, moving and handling, fire safety and training on policies and procedures. The inspector interviewed one staff who was doing a 12 week course on dementia care. The Director stated he had a contract with a private trainer who did staff training and he also used the local colleges. The inspector noted recent new employees did not have a named supervisor to support them during the period of their induction. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 17 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) 32,36 The management of this home is satisfactory overall but communication is not well managed. This practice could potentially place residents at risk. EVIDENCE: The Director and Manager stated they had an open style of management and staff could see them at any time if they had a problem and needed support. The inspector interviewed seven staff on duty and they commented, ‘the management was good’, ‘they get plenty of support and that staff are asked about their views’. They remarked, the Director and Manager are ‘visible and always listen to staff’. Staff reported, that team meetings were not happening frequently and shift handover did not involve all staff on duty. The inspector checked the folder that contained the staff meeting minutes and found that the minutes of the last meeting was dated 29th April, 04. The inspector was informed a meeting had taken place this year but the Director was unable to produce any evidence of this. The Director and Manager confirmed not all staff was involved in the shift changeover as some staff had Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 18 to observe residents. The inspector stated that the home must improve the process for communication and hold more frequent and regular staff meetings. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 19 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 2 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 2 x x Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 20 No. 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. Standard OP1 Regulation 4(1)(3) Requirement The registered person must update the Statement of Purpose to reflect the change in name of the provider, the change in the management arrangement of the home and for the complaints section to be amended. The registered person must ensure care plans and risk assessments are reviewed monthly and maintained up to date during the transition period whilst implementing the new care planning format. The registered person must ensure the complaints procedure is updated to reflect a complaint can be made to the Commission at any stage should the complainant wish to do so. The registered person must must ensure that the home is risk assessed daily to ensure that all parts of the home to which the service users have access are free from hazards to their safety. The registered person must ensure that a member of staff who is appropriately qualified and experienced is appointed to supervise a new employee for Version 1.30 Timescale for action 01.08.05 2. OP 4, 7 12(1)(a) (b)13(4) (c) 01.06.05 3. OP1 15(1)(e) 01.07.05 4. OP38 13(4)(a) (c) 01.07.05 5. OP36 18(2)(b) 01.07.05 Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Page 21 6. OP32 10(1)21 (2) the duration of the new employees induction training. The registered person must make arrangements to enable staff to participate in frequent and regular staff meetings and that all staff are involved in the shift handover. 01.07.05 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 Good Practice Recommendations No recommendations were made. Holmwood Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Nursing Home H58_s62689_Holmwood_v220552_260505_stage4.doc Version 1.30 Page 23 - 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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