Inspection on 22/07/05 for Holmwood Residential Home

This inspection was carried out on 22nd July 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 Residential Home 08/01/07

Holmwood Residential Home 21/12/05

Holmwood Residential Home 24/01/05

Holmwood Residential Home 31/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Holmwood Residential Home 37 Upper Olland Street Bungay Suffolk NR35 1BD Lead Inspector Jane Offord Unannounced 22nd July 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 Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holmwood Residential Home Address 37 Upper Olland Street, Bungay, Suffok, NR35 1BD 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) 01986 892561 01986 896030 None Mr N Sheldrake Mrs S OGrady Care Home 32 Category(ies) of Older People - 32 registration, with number of places Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24/1/05 Brief Description of the Service: Holmwood is registered to meet the needs of older people and is situated in the small market town of Bungay. The home, which has been owned by the Sheldrake family since 1977, is in well cared for gardens and close to local shops and amenities. The house has been significantly extended twice since 1992 and now offers accommodation for thirty two residents. The final phase of building work is taking place to offer new bathing, clinical and laundry facilities. The renovations to the dining room and new kitchen are completed and these facilities are in use. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 9.00 a.m. and 4.30 p.m.. The manager and deputy manager were available throughout the day and the registered owner introduced themselves during the visit. The inspector spoke to some staff, both care and ancillary, several residents and three visitors. Everyone was co-operative and complimentary about the care the home offered. During the inspection some staff files, three residents’ files, some of the policies for the home and Medicine Administration Sheets (MAR sheets) were seen. There was also a tour of the building and explanations offered about the ongoing building work. The inspector found that most previous requirements had been complied with. The bathroom is in the process of being upgraded and, because walls have been demolished, does not cover the same floor space as at the last inspection. The Protection of Vulnerable Adults policy and training needs to be brought into line with the county guidance. The home was clean and tidy. The décor and furnishings were attractive and appropriate for the clientele who particularly liked the new dining room. What the service does well: The care offered by staff is respectful and takes account of individual choice. Concerns raised by residents and/or visitors are taken seriously and every effort made to resolve them. Relatives and visitors are made welcome at any time and included in six monthly reviews of care with the residents’ agreement. Health and safety issues are well managed. The ongoing building work has meant that some areas of the home could have posed risks to frail residents but care has been taken to minimise that. The meals are nicely presented and offer a choice at each meal. The new dining room is attractive and the tables set with attention to detail. The manager and deputy manager are involved in the day to day running of the home and residents recognise their availability and willingness to discuss issues of concern. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 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 Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 People who are considering using this service can expect to have their needs assessed, information about the services offered by the home and an opportunity to visit prior to making a decision about entering the home. If they decide to enter the home they can expect a written contract including the terms and conditions of their residency. EVIDENCE: The Statement of Purpose and the Service User Guide both refer to preadmission assessment of needs. There was documented evidence in residents’ personal files that assessments were undertaken. The areas of assessment included personal care, diet, religion, mobility, communication and a medical history. Care plans developed reflected the areas of need identified. There were signed contracts in files too. One resident spoken with said they had been unable to visit the home prior to admission as they were in hospital but close friends had been welcomed on their behalf. The friends also spoke to the inspector and confirmed that they had been able to satisfy themselves about a number of issues prior to recommending the home to the resident. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 9 Another visitor had chosen the home for their relative and said that several members of the family had visited prior to deciding to accept a place. They had been able to talk to staff and other residents during their visits. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 9, 10 People who use this service can expect to have their health care needs met, be protected by the home’s methods of dealing with medication and be treated with respect. They cannot be assured that the care plans developed will address needs other than physical needs. EVIDENCE: Staff said that there were weekly GP visits for residents who needed medical care or who had requested to see a doctor. The surgery was always available in an emergency. The residents’ personal records documented any visits from the doctor to the individual. The district nurse visits regularly to do dressings and take blood samples to monitor warfarin levels. The district nurse arrived during the inspection and communicated with the senior carer after the visit about further care that was needed for one resident. There was documented evidence of other health professionals attending residents such as a chiropodist, a physiotherapist and, for one resident, a dietician. Staff said Occupational Therapy assessments also took place. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 11 Observation of part of a medication round showed that correct practice was taking place. There was a photograph of the resident with the MAR sheet and the sheets were correctly completed, using the provided code if medication was not administered. Due to the building work taking place the drug trolley and some medication were in two separate storage places, however staff were conscientious about securing the two areas. The controlled drug book was seen to be correctly completed and used medication patches were being disposed of appropriately. There was evidence of individual stocks of common medication such as paracetamol and lactulose. To allow for an audit trail of medication, doses of ‘as required’ (PRN) drugs should indicate the numbers given each time if there is a prescription stating ‘one or two tablets PRN’. One resident needs continuous oxygen and has an oxygen concentrator to supply that. In case of a power cut the home keeps some cylinders of oxygen that have been stored according to guidance from the supplier. The supplier and the district nurse have instructed staff on the use of the cylinders. Staff were observed knocking on doors to residents’ rooms and waiting to be asked in. The manager said that the workmen had all been respectful and aware of the particular needs of working in a care home. Residents said that staff called them by their chosen name and gave them choices about how their personal care was undertaken. There were screens available for use in a double room. The care plans seen included actions to cover mobility needs, personal care, communication and diet. There was no evidence that psychological or social needs were addressed by the plans. One resident’s spouse was terminally ill and lived a distance away making contact difficult. There was no reference in the care plan to management of the anxiety and emotional problems the situation was generating. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 14, 15 People who use this service can expect to receive a balanced diet, have choice about the lifestyle they wish to pursue and be encouraged to maintain contact with family, friends and the local community to the degree they choose. EVIDENCE: The new kitchen was seen and the staff felt that it was an improved environment to work in. The stainless steel surfaces looked clean and professional. The food storage cupboards, refrigerators and freezers were all well stocked. There was a good store of fresh fruit and vegetables. The temperatures of refrigerators and freezers was monitored and recorded and was within safe limits for storage of food. Food in freezers was labelled and food in refrigerators was labelled with use by dates. The inspector spoke to a kitchen assistant who prepares afternoon tea and evening meals. The evening meal IS varied and in the past week home-made soup, kedgeree and poached eggs had been on the menu. The assistant was aware of special dietary needs for some residents. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 13 The meal that was served at lunchtime was well presented and hot. Residents spoken with said they could choose where to have their meals and they could ask for alternatives to the set menu. One resident felt that the new dining room was especially attractive and that the use of linen napkins and napkin rings was noteworthy. The home offers a variety of activities for residents. There is a craft teacher who visits weekly and helps with basket making, word quizzes and, at the right time, making Christmas or Easter decorations. There are visits from bell ringers and an accordion player, a mobile library and clothes retailer. Special days such as VE day and birthdays are celebrated. The home organiseS trips out to visit other towns, such as Southwold, or garden centres. There is an annual trip to the pantomime and a week before the inspection there had been a river trip and picnic, which several residents had enjoyed and commented on. The home is close to the local church and a number of the residents attend services there or other church activities. Contact with family and friends is encouraged and there were a number of visitors, including a dog, on the day of the inspection. Visitors were happy to tell the inspector of their experience of the home and staff, all of which was complimentary. One resident told the inspector that ‘nothing is too much trouble for the staff’ and another said they had ‘felt supported after a hospital stay’. One resident spoke of a friend who visits daily and brings cross-word books and flowers for their room. They had a daily newspaper delivered to their room. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 18 People who use this service can expect to have any concerns they or their family and friends raise taken seriously and addressed, however they cannot be assured that the present level of staff training will protect them from abuse. EVIDENCE: The manager said that there had been no complaints since the last inspection. There is a complaints policy in place for the home which is in the Statement of Purpose and the Service User Guide. One visitor told of an issue that had been taken to the manager on behalf of their relative. They said the issue had been handled sensitively and rapidly. Their relative had received an apology from the staff involved and there had been no recurrence. Residents spoken to were all able to identify a member of staff or family they could speak to if they had anything worrying them. Staff spoken with were unable to identify recent training in Protection of Vulnerable Adults and although they could recognise abuse were not clear on the procedures for dealing with the situation correctly. The Protection of Vulnerable Adults policy for the home was found to have inaccuracies in the process to be taken to report incidents of suspected abuse. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 23, 24, 25, 26 People who use this service can expect to live in safe, comfortable and clean surroundings with their own belongings in their rooms, if they choose. EVIDENCE: On the day of inspection the home was clean and tidy. Corridors were free of obstructions and rooms not in use due to the building programme were clearly identified with large notices. Doors to the outside that led to areas of work were locked and explanatory notices displayed. Staff said that building work did not start until 9.00a.m. and noisy work was stopped for mealtimes. Workmen were observed to knock on doors before entering rooms. The communal areas of the home were attractively decorated and furnished. The gardens were very well maintained and there was a colourful display of begonias visible from the front of the house. There were level exits from the house to the garden and a variety of garden seating available for use. Residents’ bedrooms were furnished with some of their own furniture and there were many photographs, cushions and knick-knacks to personalise them. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 16 Bathroom and toilet provision could not be properly assessed at this inspection due to the building work being done. This needs to be looked at during the next inspection. The laundry facilities are also in the process of being upgraded but the machines seen had a sluicing programme. There were adequate hand washing provisions throughout the home and staff were able to explain the procedure for dealing with soiled linen and how the policy for MRSA is implemented. There were no unpleasant odours present on the day of inspection. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 29, 30 People who use this service can expect to be cared for by a competent staff team who have been recruited following the correct practices. EVIDENCE: Staff spoken with felt that the level of staff for the present care needs was sufficient. For an early shift there is a senior carer and three other carers and for a late shift there is a senior carer and two other carers. When the resident numbers increased from 28 to 32 the staffing ratio was increased as well. Staff said that if care dependency increased management would increase staffing to reflect that. The inspector was told that there was no staff sickness at the time but there was not pressure on staff to fill shifts during holiday periods or to cover vacancies. There was evidence in staff records of training undertaken in Moving and Handling, fire safety and infection control. The fire training was confirmed in the fire training register. One senior carer spoken with had completed their National Vocational Qualification (NVQ) level 3 in care. They had also done courses in First Aid, administration of medication and were doing an Introduction to the Management of Difficult Situations, which covered assertiveness and handling confrontational situations. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 18 Specialised training from specialist nurses such as The Diabetes nurse and the Parkinson Disease nurse had been offered to the staff team. Two staff personal records were seen. One showed evidence of all the required checks being undertaken prior to the commencement of employment. The other file had a Criminal Record Bureau (CRB) check obtained under the guidance in place at the time of the application. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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, 36, 38 People who use this service can expect to be cared for by a staff team led by a competent, well-qualified manager in a home where Health and Safety are promoted, however, although care staff are supervised regularly residents cannot be assured that other staff receive supervision to monitor their practice and training needs. EVIDENCE: The manager is a registered nurse and midwife and has had experience in NHS management. They are also qualified to assess and supervise staff. Both the manager and deputy manager are undertaking NVQ level 4 Management. Other staff spoke of training undertaken relevant to their role, such as infection control, moving and handling and food hygiene. Further qualifications such as NVQ’s were not looked at during this inspection. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 20 The care staff records showed documented evidence of supervision taking place regularly. Care staff spoken with talked of supervision and appraisal and said they felt supported by these sessions and were able to raise issues of concern or training needs. Ancillary staff said that initially they received appropriate training for the job but they did not have supervision or appraisal. As noted earlier in this report issues of Health and Safety are managed well at this home. Evidence was seen of checks made on fire doors and extinguishers and the certificate was valid until December 2005. The fire officer had recorded a visit in December 2004. Water that was too hot in hand basins, which were part of the building programme, were clearly labelled with a caution and the manager confirmed that the work on them would be completed in the next two weeks. Staff were observed placing warning notices of the risk of slipping in areas that had wet floors. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 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 x x x 2 x 3 Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 18 Regulation 15 (1) 13 (6) Requirement Residents care plans must be developed to include psychological and social needs. The policy for Protection of Vulnerable Adults must be written to reflect the up to date county processes and regular staff training must be undertaken to protect residents. A supervision programme for ancillary staff must be put in place to monitor training needs and competence. Timescale for action 5/9/05 immediate. 3. 36 18 (2) 31/10/05 4. 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 9 Good Practice Recommendations Specific numbers or doses of as required (PRN) medication should be recorded to allow for an audit trail. Holmwood Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 23 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ 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 Residential Home I54-I04 S24420 Holmwood V241341050722 Stage 4 (2).doc Version 1.40 Page 24 - 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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