CARE HOMES FOR OLDER PEOPLE
Holmwood Nursing Home Warminster Road Norton Lees Sheffield South Yorkshire S8 9BN Lead Inspector
Jayne Barnett-Middleton Unannounced Inspection 5th January 2006 09:15 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 DS0000021787.V274232.R01.S.doc Version 5.1 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 DS0000021787.V274232.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holmwood Nursing Home Address Warminster Road Norton Lees Sheffield South Yorkshire S8 9BN 0114 250 9588 0114 258 0911 holmwood@highfield_care.com 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) Southern Cross Home Properties Limited Miss Christine Hockley Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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. 14th October 2005 Date of last inspection 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 well decorated with good quality furniture and furnishings provided. All bedrooms are single with en-suite facilities. A private care 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 DS0000021787.V274232.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Jayne Barnett-Middleton carried out this inspection over five hours. Christine Hockley, registered manager was present for most of the inspection. Opportunity was taken to make an inspection of the home, examine a sample of records and talk informally to residents, the manager and staff. What the service does well: What has improved since the last inspection?
The care plan format had recently been reviewed to a good standard. The format included all of the required information and the layout was accessible and easy to track. Four care staff had been promoted to senior care. Part of their role was to ensure that a plan of daily activities was provided. A good programme of activities had been devised which included bingo, ball games, arts and crafts and a ladies pampering session.
Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 6 All staff was scheduled to attend refresher Adult Protection training to enable them to identify and the procedure to follow should they suspect any abuse at the home. A new patio area had recently been built and this had significantly improved the outdoor space available for residents. Gates had been fitted to the steps to protect the residents from falling. A staff-training matrix had been devised which clearly demonstrated the training that staff had attended and refresher training that they required, to ensure that they were conversant with changing legislation and safe working practices. The manager had sought advice from the local fire officer in relation to the adequacy of a fire exit in the ground floor dining room. Shrubs outside the exit had been cleared and the exit was sufficiently clear for residents to evacuate safely. What they could do better:
Residents preferred funeral arrangements were not recorded, to ensure that their wishes following their death could be respected. One care plan that was checked did not contain risk assessments in particular to falls and nutrition. The resident had resided at the home for only a short time and the information included to date was very detailed. However, these need to be completed to ensure that the healthcare needs of the resident can be fully met. The recording and storage of medication was checked on a sample basis. One medication administration record checked did not clearly record the amount of stock that had been received, and it was difficult to track the specific amount that had been received. The administration instructions on one medication administration record (MAR) checked did not correspond with the administration instructions on the medication. Staff files required some minor amendments to ensure that they included the required information. Staff received informal supervision, but regular formal supervision was not currently offered. Records demonstrated that staff had received fire training. However, fire drills were not being conducted on a regular basis, to ensure that all staff were conversant with the specific action that was required in the event of a fire. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 7 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 DS0000021787.V274232.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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 the following standard(s): 3. Residents were not admitted to the home without their needs being assessed, to ensure the home was able to meet their health, social and care needs. EVIDENCE: A full needs assessment was carried out for all residents prior to their admission. Staff from the home also visited prospective residents prior to their admission. This confirmed that the service was appropriate for the resident and provided staff with the information to formulate an individual plan of care. The home does not provide an intermediate care service. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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): 7,8,9 and 10. The care plan format had recently been reviewed to include all of the required information. One care plan that was checked was only partially completed. Residents received personal support, which promoted their privacy, dignity and independence. Resident’s physical and emotional needs were met. There was evidence that a range of healthcare professionals regularly visited the home to meet the resident’s needs. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place. EVIDENCE: The care plan format had recently been reviewed to a good standard. The format included all of the required information and the layout was accessible and easy to track. Two care plans were checked and both set out in detail the action that was required by staff to ensure that all aspects of the residents care needs were met.
Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 11 Residents preferred funeral arrangements were not recorded, to ensure that their wishes following their death could be respected. The manager confirmed that she was in the process of contacting the resident’s next of kin to ensure that any specific arrangements could be recorded. Records of healthcare visits were maintained and these evidenced that healthcare professionals, e.g. general practitioner and chiropodist were visiting residents on a regular basis. Risk assessments were in place, which clearly identified the individual risks that were presented to residents on a daily basis and the action required to reduce the risk, which promoted the safety of residents. One care plan that was checked did not contain risk assessments in particular to falls and nutrition. The resident had resided at the home for only a short time and the information included to date was very detailed. However, these need to be completed to ensure that the healthcare needs of the resident can be fully met. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of residents. The recording and storage of medication was checked on a sample basis. One medication administration record checked did not clearly record the amount of stock that had been received, and it was difficult to track the specific amount that had been received. The administration instructions on one medication administration record (MAR) checked did not correspond with the administration instructions on the medication. The senior staff agreed to contact the resident’s g.p to clarify the correct time that the medication should be administered. Throughout the day staff were observed to treat residents with dignity and respect. All residents seen were well cared for, they were clean, hair and nails had been attended to and male residents were shaved. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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 and 15. Routines with the home were flexible and residents were encouraged to spend their day as they wished. A good programme of activities was in place that was appropriate for the needs of the residents. Residents were able to receive visitors at any reasonable time. A good choice of menu was offered and specific dietary needs were catered for. The lunchtime meal was well organised and relaxed. EVIDENCE: There was a relaxed atmosphere within the home. The residents were encouraged to make simple choices about their daily living activities. Staff spoke in detail about their daily routines and confirmed that they were flexible to the needs of the residents. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 13 Since the last inspection four care staff had been promoted to senior care. Part of their role was to ensure that a plan of daily activities was provided. A good programme of activities had been devised which included bingo, ball games, arts and crafts and a ladies pampering session. Two senior care confirmed that the activities were working relatively well and that they were still in the process of determining what activities were popular with the residents. The home also pays for external entertainers to visit the home on a regular basis, which staff reported were very popular. Residents were encouraged to maintain links with their family and friends. Staff confirmed that visitors were welcome at any reasonable time. The staff team said that they received good support from relatives and spoke positively about a recent Christmas party that many relatives had attended. A good choice of menu was offered and special dietary needs were catered for. The cook had a good knowledge of resident’s dietary requirements. She confirmed that the staff were good in ensuring that she was kept informed of any residents changing dietary needs. The lunchtime meal observed was relaxing and residents were given sufficient time to eat their meal. Carers were observed to be assisting residents to eat in a respectful and patient manner. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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 and 18. The complaints procedure was clear and accessible. Complaints made by residents and their relatives were listened to and action was taken to deal with complaints promptly. There was an adult protection procedure in place at the home. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home. EVIDENCE: A complaints procedure was displayed at the home. The complaints procedure ensured that residents and their relatives were aware of how to make a complaint and who would deal with them. The manager kept a central record of all complaints. No complaints had been received since the last inspection. All staff spoke positively about the attitude of the manager. They stated that she was approachable and that she would always listen to any concerns that they may have. There was an adult protection policy and procedure that promoted the protection of service users from harm or abuse. All staff was scheduled to attend refresher Adult Protection training to enable them identify and the procedure to follow should they suspect any abuse at the home. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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): 19,23 and 26. The home was clean, comfortable and well maintained. Residents were provided with an environment that was safe, accessible and homely. EVIDENCE: The home was clean, tidy and odour free. All areas seen were well maintained and pleasantly decorated. Furnishings were clean which promoted a comfortable and homely environment. Several bedrooms were checked and all were clean and pleasantly decorated. All the rooms had been personalised by the resident with small items of furniture, photographs and mementoes, encouraging them to retain their own identity. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 16 The grounds to the home were well maintained and attractive. A new patio area had recently been built and this had significantly improved the outdoor space available for residents. Gates had been fitted to the steps to protect the residents from falling. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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): 29 and 30. A caring and committed staff team supported residents. Staff received induction training and support appropriate to their role. The home operated a recruitment policy that promoted the protection of service users. Staff files required some minor amendments to ensure that they included the required information. Staff training records had been reviewed to identify the statutory training that staff required. EVIDENCE: Most of the staff at the home had worked there for sometime. It was evident that the staff had formed positive and appropriate relationships with residents. All the staff spoken to were professional, relaxed, friendly and were able to demonstrate a good knowledge of residents individual needs. Staff spoken to confirmed that they had received training appropriate to their role. A staff-training matrix had been devised which clearly demonstrated the training that staff had attended and refresher training that they required, to ensure that they were conversant with changing legislation and safe working practices. The manager confirmed that she was in the process of planning training to ensure that all staff were up to date with all the statutory training required by the regulations.
Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 18 Two staff members who had recently been employed at the home confirmed that they had received the appropriate induction and support to carry out their role in a safe manner. Both commented that the staff team were very friendly and that they had been “supportive” during their initial days of employment. A recruitment policy and procedure was in place. Two files checked contained a range of information including two references, declaration of health and qualifications/training. One file did not contain a full employment history of the employee. All staff employed had undertaken a Criminal Records Bureau Check at the enhanced level to promote the protection of service users. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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 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): 31,32,33,35,36 and 38. Residents and staff benefited from the ethos, leadership and management approach. Staff morale was good and all staff spoke positively above the management team. Staff received informal supervision, but regular formal supervision was not currently offered. Resident’s financial interests were safeguarded by the procedures at the home. The homes policies and procedures promoted the health, safety and welfare of service users and staff. Staff had received Fire training. However regular fire drills were not being conducted. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 20 EVIDENCE: The manager had experience within the caring profession that enabled her to contribute to the care of service users and communicate a clear sense of leadership to staff. All staff spoke positively about the manager and it was evident that all were confident in her abilities to manage the home. Staff meetings were held on a frequent basis to enable them to contribute to the development of the service. Staff said that the meetings were “useful” and commented that any general issues would always be resolved. Staff felt that there was good teamwork within the home. All staff spoken to said that enjoyed working at the home. Arrangements were in place for residents who were unable to manage their monies due to their mental health. Monies were securely stored and records checked evidenced that service users were able to access their monies for hair care and personal items as they wished. The staff said that they were receiving informal supervision and management support on a regular basis. Formal supervision was not taking place. However the manager confirmed that all staff had been allocated to a senior member of staff and a format had been agreed. It was anticipated that formal supervision would commence within the very near future. The manager had sought advice from the local fire officer in relation to the adequacy of a fire exit in the ground floor dining room. Shrubs outside the exit had been cleared and the exit was sufficiently clear for residents to evacuate safely. Records demonstrated that staff had received fire training. However, fire drills were not being conducted on a regular basis, to ensure that all staff were conversant with the specific action that was required in the event of a fire. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard OP7 OP8 OP9 OP9 OP11 Regulation 12,15 13,15 13 13 15 Requirement Care plans must include specific details of the service users care needs. Risk assessments must be completed for all residents. Records of medication in stock at the home must be maintained. A record of the current medication for each resident must be maintained. Attempts must be made to seek the residents or their relative’s views as to their wishes after death. (Requirement made 14.09.05) Staff files must include the full employment history of the employee and any gaps in employment must be accounted for. All staff must be formally supervised. All staff must be offered statutory training at the required frequencies. Regular fire drills must be conducted. Timescale for action 01/04/06 01/03/06 01/03/06 08/01/06 01/04/06 6. OP29 19 01/04/06 7. 8. 9. OP36 OP38 OP38 18 18 23 01/04/06 31/03/06 01/03/06 Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 23 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 all care staff must achieve a National Vocational Qualification (NVQ) level 2 in care. Holmwood Nursing Home DS0000021787.V274232.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Sheffield Area Office 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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