Inspection on 03/03/09 for Holyport Lodge Nursing Home

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Excellent service.

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

Holyport Lodge Nursing Home 01/08/07

Holyport Lodge Nursing Home 18/05/06

Holyport Lodge Nursing Home 06/12/05

Holyport Lodge Nursing Home 17/05/05

Holyport Lodge Nursing Home 17/02/05

Holyport Lodge Nursing Home 26/10/04

Holyport Lodge Nursing Home 22/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holyport Lodge Nursing Home Holyport Maidenhead Berkshire SL6 2JA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Holyport Lodge Nursing Home Holyport Maidenhead Berkshire SL6 2JA 01628781138 01628781707 saylem@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (BNH) Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 45 Number of places (if applicable): Under 65 Over 65 41 0 old age, not falling within any other category physical disability Additional conditions: 0 4 The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Holyport Lodge is a large Edwardian house, situated on the edge of the Village Green in Holyport, near Maidenhead in Berkshire. It is owned by BUPA and registered to provide care for up to 45 older people, some of whom may have a physical disability. Care Homes for Older People Page 4 of 31 Brief description of the care home The home has been converted but retains many of its original features and character, including an oak staircase and hand carved oak panelling. There is a drawing room with a grand piano, a TV room overlooking the terrace and gardens, an activities room, and a large well furnished dining room. The gardens are attractively landscaped, and add to the ambiance of the home. The village of Holyport is situated close to the towns of Maidenhead and Windsor. Central London is easily accessible. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and took place over 7.5 hours. The inspection was carried out by Mrs. Helen Dickens, and the Registered Manager, Mrs. Fiona Eccles represented the establishment. A partial tour of the premises took place and a number of files and documents, including three residents care plans, staff training and recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA), were examined as part of the inspection process. We used an Expert by Experience at this inspection and she spoke with 11 residents during the day. The inspector also spoke with four residents, and three members of staff. A total of 9 surveys, from residents, from professionals who know this home, and from staff, were returned to CSCI prior to Care Homes for Older People Page 6 of 31 this inspection and the results have been used to write this report. The current fees at this home range from 1000.00 to 1550.00 per person per week depending on the size of the room and the facilities on offer. The inspector would like to thank the residents and staff for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? What they could do better: No Requirements were made as a result of this inspection. Three recommendations have been made and can be found at the end of this report. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by having a comprehensive assessment of their needs, prior to, and during the early days of moving into the home. Evidence: The AQAA states that comprehensive written information is provided and the option of a trial visit is offered to prospective residents. Three service user files were sampled during the inspection and all three had full assessments, carried out by staff from the home, and completed using the very comprehensive BUPA QUEST format. All three were completed in full and dated and signed by those completing them. Where even minimal needs had been identified, this automatically highlighted that a care plan was needed on that subject. A variety of care plans were seen for example in relation to personal care, mobility, use of wheelchair etc. One file was that of a regular respite resident. Staff were using an earlier assessment from a previous admission, Care Homes for Older People Page 11 of 31 Evidence: and there was documented evidence that this had been completely reviewed for the current admission. None of the residents files sampled had assessments from other professionals. The manager said some original assessments from other professionals had been archived as residents had lived at the home for some time. She also said that as most residents were privately funded, social services had not been involved in their placements, and therefore there were no care managers assessments. However, there were plenty of examples of advice and formal assessments following each residents admission, including from the dietitian, tissue viability nurse, and physiotherapist. Service users and relatives are involved in the assessment and there was a good level of detail about all their care needs, and a good record of preferred daily routines. For example the assessment noted what time people like to get up and go to bed, whether and what newspaper they had, and how they preferred to spend their day, for example where they would like to have their meals. Specialist community staff who were involved with residents made some positive comments about this home including, from the dietitian; Clients are screened well using the nutritional screening tool. Five surveys were returned by residents to CSCI, all of whom had had assistance from a member of their family. Four said they had received a contract and the fifth could not remember. One resident noted that they came on a ...convalescent basis and decided to make it permanent. The manager takes prospective residents on a tour of the home herself and she said she delegates this to a senior member of her team when she is not on duty. Prospective residents are all are given the brochure pack which contains recent relevant information to give a flavour of life at the home including the coming months activities plan, and the current menu. A specific BUPA leaflet describes what to look for in a care home, and this is available when prospective residents and their families visit the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by having a detailed person centred support plan, and by the arrangements in place to ensure their health care and medication needs are met. Residents are treated with dignity and respect at Holyport Lodge. Evidence: Three residents support plans were sampled. All had the standard BUPA format and all those seen were completed in full and demonstrated a person centred approach. A named person (trained nurse) was noted on each plan as the staff member responsible for drawing up the support plan, and keeping it under review. A key worker is also allocated from the care staff. Care plans and accompanying documentation are given to each resident to keep in their rooms. Those residents spoken with said that either they or their families looked at them often. There is excellent guidance to staff on how each resident would like their personal care delivered. Care plans sampled covered all the relevant areas including communication, lifestyle, mobility, and mental state. Residents are asked if they would prefer a male or Care Homes for Older People Page 13 of 31 Evidence: female care worker and this is clearly documented; the manager said they have sufficient staff of each gender to meet residents stated preferences in this regard. Good arrangements are in place for promoting the health of residents. A local GP surgery is paid to visit the home three times per week, though the manager said residents do not have to use this surgery and are free to keep existing arrangements if they have come from the local area, or choose another surgery. The manager said regular GP visits ensure they keep on top of medication reviews for residents, and GPs get to know the residents well. A physiotherapist visits weekly for exercise sessions in the activities room, and residents who are able, are accompanied by staff on short walks, for example to the duck pond on the nearby Green. Risk assessments on the three files sampled included nutrition, moving and handling, skin viability (using the Waterlow tool), and falls. Where needs are identified, evidence was seen of the follow up action for example a pressure relieving cushion and mattress were in place for one resident at risk of pressure ulcers, and reviews by the tissue viability nurse were recorded. Nutrition is monitored using a recognised risk assessment tool, and residents are weighed regularly. The kitchen had noted who needed special diets including soft, pureed, and diabetic diets. Care plans cover the mental state of each resident, and BUPA has a standard Mental Capacity Act (MCA) assessment format. The manager said that three staff had attended the external MCA training course run by the local council, though it is recommended that all staff have some training on this matter. The manager was familiar with the Deprivation of Liberty Safeguards Guidance which will come into force on 1st April 2009. One file sampled showed the resident had moved into the home with a pressure ulcer and there was a clear audit trail regarding the treatment and monitoring in relation to this. Specialist advice had been sought and recorded, and regular photographic and written records were being kept. Aids and equipment are provided to encourage independence, and to ensure the safety of residents and staff. For example there were hoists, special beds and mattresses, emergency call bells, including some which can be worn around the neck, and bath aids. Some residents had telephones with large print key pads. Residents are assisted to access optical and dental advice, and help with their hearing. On the residents surveys returned to CSCI residents said their health care needs were either Always met, or Usually met, and one added More difficult at weekends. Two Care Homes for Older People Page 14 of 31 Evidence: health care professionals surveys returned to CSCI were very complimentary about the home. One noted; Staff are very friendly with a can do attitude. If there is a problem in terms of nutritional intake all effort is made to seek further advice from our Department. The Staff are proactive in keeping monthly weights and highlighting any problems. The other wrote; They are usually good at notifying me in advance if any new residents require physiotherapy. The home follows the BUPA medication policy and guidelines. Important medication safety notices were on the medication trolley, and only trained nurses give medication. One medication session was observed and the trolley was noted to be kept clean and tidy, and was locked securely between each administration. The controlled drugs cupboard was checked, and found to be satisfactory. The home use monitored dosage system packs from the local pharmacist, who also inspects the medication arrangements at the home. On the last inspection the pharmacist had made two recommendations and the manager said these had both been addressed. The pharmacist also noted the home had Very efficient procedures in place for the ordering, receipt, and storage, of medicines. Residents were observed to be treated respectfully by staff. Excellent records are kept of personal preferences, including each residents preference for male or female staff to help with personal care. Staff were seen to knock on doors before entering, to include residents in conversations, and to deliver personal care in private. Lunchtime in particular demonstrated the respectful attitude towards residents and maintaining their privacy and dignity. All residents are given their own individual serving dish with their vegetables enabling them to take as little or as much as they like. Those residents who needed full help to eat their meals, or had special diets, were seen to be given the same consideration. This was confirmed by the dietitian who returned a survey to CSCI. She noted Clients can be seated separately in the dining area should they want to have their meals either on their own or with the rest of the residents. She ticked Always in answer to the question Does the service respect individuals privacy and dignity? Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a offered a variety of social and cultural activities, and encouraged to maintain family and community links. They are given opportunities to exercise choice and control over their daily lives, and are offered a very pleasant mealtime experience. Evidence: Two part time activities co-ordinators are employed by the home and they arrange a variety of activities including arts and crafts, outings, in-house entertainments, the BUPA cruise, physical exercises and quizzes, and games. The piano in the drawing room is kept tuned, and they have regular piano recitals at Holyport Lodge. The home has a regular hairdresser and a designated area in the activities room is used for this purpose. Those who prefer to stay in their rooms still benefit by some one to one activities as one activities co-ordinator will visit individuals, whilst the other runs the set activities. On the day of the inspection six residents were making cards in the activities room. One co-ordinator has particular skills in this craft, and had obtained plenty of card making materials, enabling cards to be produced to a very high standard. Residents Care Homes for Older People Page 16 of 31 Evidence: were working on their own individual projects though recently the whole group had made Valentines cards. Five service users surveys answered the question about whether there were sufficient activities; four answered Always and one Usually. The Expert by Experience who assisted at this inspection spent time with residents during the day and spoke with nine in some detail. One topic she covered was activities and the following is an excerpt from her report. Two activities co-ordinators walked around the dining room at lunchtime, spoke to each resident and arranged for people to meet or be brought to the activities room at 2pm. The residents and activities co-ordinators told me that whenever the weather is fine they take the opportunity to walk around the beautifully laid out garden, or sit on the patio and chat, or better still they take the residents in relays down to the local duck pond, approximately 300 metres down the lane. One gentleman said that he loved to go out for a walk every day, and that so long as he booked a time, he could go out with a carer whenever the weather permitted. Another resident said she loved the piano and played the Grand Piano in the Green Room whenever she liked. One resident said I love the activities. I am a very social person and enjoy the company, but I wish they would continue over the weekends too. The home also has a pet cat, Buffy, and a cockatiel which lives in a cage in the TV room. Residents are encouraged to have family and friends to visit. There are booklets available in the reception area which are aimed at relatives. Residents can have family and friends to join them for a meal and there is a special table set up in the drawing room for more private lunches. Some residents are taken out by their families and the home organises outings and opportunities to spend time in the local community. It was clear from speaking to residents that families were encouraged to be involved in their care, and several residents said that family members looked at their care plan, which is kept in individual residents rooms. Residents are encouraged to make choices in their day to day lives and there were many examples of this. For example in relation to meal times, activities, and their personal care. Care plans contained very detailed guidance to staff about choices residents had made. Bedrooms were very personalised with residents bringing their own ornaments, pictures, and photographs. Holyport Lodge offers a pleasant dining experience and there is a daily menu on each table in the dining room. The menu board in the dining room has a menu for the whole week and includes breakfast, 3 course lunches, and the teatime menu. The Nite Bite Care Homes for Older People Page 17 of 31 Evidence: menu is available from 6am to 6pm and consists of light snacks such as toast, cakes, yogurt, biscuits or a sandwich. The inspector briefly observed lunchtime arrangements and noted residents had a choice of juices for example cranberry, apple, or orange or an alcoholic drink. It was noted vegetables are served in individual separate serving dishes for each resident including for those who needed assistance with their meals. The meal options on the day of the inspection included homemade steak and kidney pie, or poached salmon with parsley sauce. There was mushroom soup to start, and a choice of puddings to follow. Special diets are noted in the kitchen, and it was observed that soft and pureed diets were well presented. The MUST nutritional risk assessment tool is used to identify any concerns about each persons nutritional needs. The Expert by Experience had a meal with residents and commented very positively on the taste and presentation of the food. The following is an excerpt from her report. Prior to lunch I was able to speak individually with four residents, who all said how good the meals were. They said breakfast was always served in their rooms and they had a vast and varied choice of juices, cereals, toast, and/or cooked meal, accompanied by tea or coffee which were Always nicely served. For lunch they always have a choice of two main courses, and for supper there was usually soup (homemade), and a sandwich, or a light cooked meal. I asked all four residents if they took advantage of the Nite Bite menu. None of them were aware of the service but one said If ever I should want anything to eat, at any time of day, I know I only have to ask and something would be provided...I would never be afraid to ask. One resident said The food is excellent, they never stint us in any way...if we want more we just ask. Residents who need help with their meals were taken into the dining room and assisted by individual care assistants. All were treated with utmost dignity and respect throughout their meal. They were encouraged to eat without a feeling of being rushed and timely drinks were offered throughout their meal. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident their complaints would be taken seriously, and there are policies and procedures in place to protect them from abuse. Evidence: The BUPA complaints policy is used at Holyport Lodge and monthly returns are made to BUPA who monitor complaints and compliments at each home. The inspector sampled the two most recent months, January and February 09. Three compliments and no complaints were made in January, and neither complaints nor compliments were received in February. Five complaints had been made in the 11 months since the new manager arrived, and three were discussed in more detail. The manager said that all had now been satisfactorily concluded. Actions had been taken as a result of complaints received including a monitoring form being placed in once residents room for staff to sign when they visit, to ensure this resident is not left for long periods without being checked. A trained nurse on each shift now has responsibility for monitoring call bells to ensure they are answered in a timely fashion. The manager said the complaints had reduced over the last year and none had been received so far in 2009. BUPA also notes compliments and three had been received so far this year. Comments in letters and made verbally to the manager included; Care Homes for Older People Page 19 of 31 Evidence: Staff kind, helpful and friendly, Delighted with the food, Home was always spotlessly clean, and Id give the night staff 10 out of 10! Four out of the five residents who returned a survey to CSCI answered Yes to the question Do you know how to make a complaint? One answered No, but said their family would find out for them. One protection of vulnerable adults issue has been reported in relation to this home since the last inspection and this has now been satisfactorily concluded. Staff records showed that all staff, including the most recent recruits, had had training in the protection of vulnerable adults, and the home had both the BUPA policy, and the local multi-agency procedures, for safeguarding vulnerable adults. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holyport Lodge provides a safe and well maintained environment, which is furnished to a very high standard. The home is clean, pleasant and hygienic throughout. Evidence: The AQAA states that the planned refurbishment for 2008 went ahead including redecoration in communal and private areas, and replacement of all carpets, curtains and light fittings. Soft furnishings have been replaced in public areas and residents rooms. The home is very well kept and furnished to a high standard. Residents have a choice of communal rooms including the veranda/TV room which overlooks the landscaped gardens, and the drawing room with its own grand piano. This room also has a private dining table for any residents who wish to have a family lunch. The activities room is very popular and includes a hairdressing facility, and tables and chairs for crafts and games. The room has ample storage areas and equipment for arts and crafts, as well as some armchairs for those who prefer to watch rather than sit up at the table to join in. There is also physiotherapy equipment including a set of parallel bars. The walls show off artwork and photographs of recent activities. Care Homes for Older People Page 21 of 31 Evidence: The dining area is very pleasant with linen tablecloths and napkins on each table, and plenty of space for wheelchairs or for those with mobility problems needing to walk with a frame. The tasteful notice board sets out the menus for the week, including the Nite Bite menus. Four residents bedrooms were also visited and found to be comfortable and personalised with residents own personal photographs and memorabilia. There are very pleasant outdoor spaces for residents to enjoy including a large patio area with garden furniture, and access to the large landscaped gardens. The nearby Green and duck pond offers additional opportunities for a short walk on a fine day. Residents who wished to go out were seen to be accompanied on short walks though the weather was not quite warm enough to sit out on the day of the inspection. The inspector noted that there are a number of posters and instructions for staff on walls throughout the home, including guidelines on safe bathing aimed at the staff who bathe residents and these are fixed to bathroom walls. The inspector felt this detracted somewhat from the otherwise homely ambience in the home. The manager said it was BUPAs policy that such safety notices were displayed. It was also noted that whilst the majority of communal and private rooms were furnished to a high standard, some of the bathrooms and toilets, whilst being kept clean and tidy, were fairly basic and not furnished to the same high standard as the other rooms. The home was clean and hygienic throughout, with no unpleasant odours in any part of the building. All staff have had infection control training and there are good hand washing facilities throughout the home. Domestic staff are employed to keep the home clean and there were a number of compliments in this regard. All five service users who returned a survey to CSCI ticked Always in response to the question Is the home fresh and clean? Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers and skill mix of staff are sufficient to meet the current needs of residents. Whist recruitment and training arrangements are well organised and benefit residents, more care staff need to obtain qualifications in care work to meet National Minimum Standard 28. Evidence: The manager said the current staff complement is based on the expected occupancy levels, the needs of residents, and the challenges of the building which is large, and with bedrooms that are spread over 3 floors. There are currently 22 residents and the manager said they are currently very well staffed. At night there is a trained nurse and three care workers, whilst in the morning, the busiest time, there are a total of seven staff, one or two of whom will be trained nurses, and five staff in the afternoon. There are also two part time activities coordinators, and sufficient domestic staff to maintain standards relating to food and mealtimes, and to keep the home clean and hygienic. Surveys from residents showed that one ticked that staff were Always available when they needed them, and four ticked Usually. At the Annual Service Review carried out by CSCI in July 2008, a number of comments were made in relation to staffing Care Homes for Older People Page 23 of 31 Evidence: numbers at the home, including the high number of agency staff, and the time it took to answer call bells. The manager outlined the actions she would be taking to address these issues and, during this current inspection in March 2009 significant progress had been made. She said the number of agency staff had slowly reduced and in the week prior to the inspection, no agency staff had been used. She also outlined the monitoring arrangements relating to answering the call bells and this is discussed in the management section at the end of this report. Standard 28 looks at how many care workers (not the Registered Nurses) have a qualification in care work, for example an NVQ Level 2. The AQAA returned from the home noted that out of 21 permanent care staff, only three have completed NVQ Level 2 qualifications. A number of others are currently undergoing this training. This falls well below the NMS which recommends that a minimum of 50 of care staff should have this qualification. The AQAA also noted there had been a high staff turnover (22 staff had left) during the last 12 months, and some staff who had left had got a qualification in care work. The manager said that though a number of staff had left, there was now a settled and stable staff team who worked well together, and who had completed the relevant mandatory training provided by BUPA. She said more care staff had now started the NVQ qualification and she expected the percentage of staff with this qualification to improve in the near future. Recruitment records are well kept, and three files were sampled by the inspector. Each had the appropriate documentation including an application form, a full employment history, a CRB and POVA check, photographic identification, and appropriate references. One appeared to have some gaps in employment history and when this was discussed with the manager, she said she knew these gaps related to time off paid employment due to child rearing responsibilities. She was asked to get this confirmed in writing so that the employment history for this person clearly stated when time had been taken out for these family responsibilities. The manager was asked to fax this information to CSCI within 24 hours and the information was received at CSCI within that time. Training records are well kept at this home and one nurse is responsible for coordinating the training arrangements. The staff training matrix shows at a glance how many staff have done the mandatory training courses and when refreshers are due. The inspector sampled three specific training courses on safeguarding vulnerable adults, infection control, and moving and handling, and found that all staff had completed all the relevant training courses. The staff training programme is arranged by BUPA and there is a rolling programme of relevant training for staff. Those staff files sampled for new staff showed they were completing their induction and the manager said the BUPA induction is based on the recommended Common Induction Care Homes for Older People Page 24 of 31 Evidence: Standards. Two staff surveys were returned to CSCI and both confirmed staff thought that the correct employment checks had been carried out, they were offered appropriate training for their roles, and they had regular supervision. One noted that The manager is always happy to send staff to different training. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by living in a well managed home, which is run in their best interests. Arrangements for involvement with service users finances protect them from abuse. Residents benefit by the well organised health and safety arrangements in place at this home. Evidence: The current manager has been in post since April 2008 and was registered with CSCI in September 2008. She is a registered nurse and a qualified midwife, who managed another home before she came to Holyport Lodge. She has had 5 years management experience and 8 years working with for older people. She has continued to keep her own training up to date and has recently completed fire safety, safeguarding adults, and managing health and safety in a care home training. She has also attended a workshop on disciplinary procedures. There are clear lines of accountability within the home and a number of improvements Care Homes for Older People Page 26 of 31 Evidence: have been made since the new manager took over. For example she has reduced the number of agency staff being used, and recruited permanent staff to Holyport Lodge. She has improved the call bell answering times by monitoring the weekly print outs of answering times since last September. She had documented evidence of the work done on improving call bell answering times and was able to show that now 99 of call bells are answered within 5 minutes. When she first started monitoring in September 2008, 20 were not being answered within 5 minutes. She addressed this in a number of ways including monitoring this personally, emphasizing to staff (at meetings and in supervision) the importance of answering call bells, and by making the lead nurse on each shift responsible for ensuring bells are answered in a timely way. A number of positive comments were received about the overall management of the home including; Delighted with the care, and there is a nice atmosphere. (Relative) The service has a personal touch to it and staff are further encouraged by related training and feedback. (Staff) It always seems a happy, well organised care home when I visit. (Health professional) Matron meets RGNs frequently to keep us up to date. (Staff) The manager informed the inspector that she has been offered another position and will be leaving Holyport Lodge in April. She said BUPA are already working on finding a replacement and were interviewing for the post during the week of this inspection. Quality assurance arrangements at Holyport Lodge follow the BUPA policy including, according to the AQAA Support from national team of Quality and Compliance officers whose role includes supporting quality issues within the home, auditing, and providing guidance on policies, procedures and practice. There are a Variety of audits to check the standard and quality of the service, for example in relation to health and safety, medication, and care plans. Annual surveys and ad hoc surveys are used.The dining meeting was an ad hoc event that focused on meals. BUPA have internal and external customer services surveys, and get feedback from relatives and residents in twice yearly meetings and during Regulation 26 visits to the home. BUPA reviews their policies and procedures in light of changing legislation and good practice. The manager said there was no annual development plan drawn up last year but this years plan will be devised with outcomes from the recent residents surveys. The manager was open Care Homes for Older People Page 27 of 31 Evidence: to any suggestions or feedback given by the inspector and the single Requirement made at the last inspection has now been met. Standard 35 looks at safeguards in relation to service users finances. The manager said the home does not look after cash for residents. Families have the option to leave a float, which is a small amount of money for residents to use on their day to day expenses and the administrator balances this when anything is spent. Any money is kept in a joint account and interest credited to each individual resident. Residents can take cash from this account, for example if they wished to take their friend or relative out to lunch. Health and safety arrangements are well organised at this home, and they use the standard BUPA policies. Regular monitoring of health and safety is carried out within the home. The maintenance worker supports the manager with health and safety matters and regular meetings are held involving representatives from each area for example housekeeping, the kitchen, and the care staff. Audits are carried out for example in individual bedrooms. Health and safety training is part of the induction for new staff. The maintenance worker has also had specialist training in risk assessments. There were examples of good practice seen at this home including the cleaners trolley has an additional lockable cupboard where any hazardous cleaning materials are kept locked whilst it is parked up during her rounds. Risk assessments are in place to minimise risks, for example in relation to moving and handling, falls, and the use of cot sides. The home has a number of measures in place for the prevention of legionella, including having water samples tested, monitoring water temperatures in tanks, and running taps in empty rooms. However the manager was not sure if a risk assessment had been carried out, or whether the current arrangements met with the best practice guidance from the Health and Safety Executive. The manager was asked to look on the HSE website and obtain their booklet concerning preventing legionella in care homes, to ensure the existing arrangements in place at Holyport Lodge meet with recommended guidance. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 The home should consider whether alternative storage areas may be found for the hoists which are used to assist residents. They are currently stored in an upstairs corridor which detracts from the otherwise homely feel that staff try hard to create. It is recommended that the home reviews arrangements for ensuring that care staff gain a qualification in care work, to meet the National Minimum Standard that states at least 50 of care staff should have a qualification. The home should obtain the Health and Safety Executive booklet on prevention of legionella in care homes to ensure their current arrangements follow recommended guidance. 2 28 3 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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