Inspection on 24/04/08 for Holywell Bay Care Home

This inspection was carried out on 24th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holywell Bay Care Home 21/04/09

Holywell Bay Care Home 11/11/08

Holywell Bay Care Home 08/10/07

Holywell Bay Care Home 16/05/07

Holywell Bay Care Home 04/12/06

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

CARE HOMES FOR OLDER PEOPLE Holywell Bay Care Home Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT Lead Inspector Ian Wright Unannounced Inspection 24th April 2008 09:30 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 Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 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. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holywell Bay Care Home Address Rhubarb Hill Holywell Bay Newquay Cornwall TR8 5PT 01637 830801 01637 831119 holywellbay@yahoo.co.uk 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) Newport Care Limited Sherran Thompson Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (45) Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 4 adults under the age of 65 years An application must be made to the CSCI by the home manager to become the registered manager within 6 months following the registration date. 8th October 2007 Date of last inspection Brief Description of the Service: Holywell Bay provides care and accommodation for up to 45 older people- all of whom may be diagnosed with dementia and/ or mental disorder. The registered provider is Newport Care Limited. The registered manager is Ms Sherran Thompson. Holywell Bay care home is situated in the village of Holywell Bay, which is on the north coast of Cornwall near the town of Newquay. The home has pleasant views of the sand dunes, golf course and sea. The home is a large two-storey property which has been extended. There is a choice of communal areas for example a large dining area, which also has a seating area, a large lounge, a TV lounge, and a smoking room. There are also other rooms which the registered manager said the provider is planning to redecorate so they can be used. The home also has an enclosed garden which residents can use. At the time of the inspection fees were between £550 and £2000 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the home’s management or the CSCI website. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place over sixteen and a quarter hours, in two days. All of the key standards were inspected. The methodology used for this inspection was: • To case track four people who use the service. This included interviewing the people who use the service about their experiences and inspecting their records. • Interviewing staff about their experiences working in the home. • Informal discussion with staff and other people who use the service. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred) were used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: This key inspection has resulted in nine statutory requirements. The registered persons are required to take appropriate action, by law, within the timescales set. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 6 In summary the registered persons must: • • • • • • • Ensure medication is managed correctly. Improve information in care plans Improve practices to ensure people living in the home are protected from bad practice and abuse Improve the physical environment of the home including ensuring decorations and facilities are improved. Improve planned activities provided to people who use the service. Improve staff training. Improve health and safety standards The commission will monitor progress regarding these legal requirements to ensure the registered persons comply with the regulations. 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. The summary of this inspection report can be made available in other formats on request. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided to people who use the service (e.g. regarding what service is offered, and individual assessment of need) is appropriate. This will help ensure people who use the service, and their representatives, have satisfactory information regarding the rights and responsibilities, and what service they can expect. EVIDENCE: A copy of the statement of purpose was inspected and appears to provide satisfactory information regarding the service provided. A copy of the service user guide was also inspected. The registered manager said a copy of this is provided to people who use the service, and / or their representatives at the time of admission. The service user guide however should include a contact telephone number for the Commission for Social Care Inspection. Currently all people who use the service are funded by social services or the National Health Service. Subsequently they are issued with a contract from Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 9 these parties. The registered persons have developed what appears to be a satisfactory contract for privately funded people using the service. The registered provider has a satisfactory policy regarding the assessment of potential residents. For example, one of the senior staff will visit the person before admission is arranged. Copies of pre admission assessments are contained on individual files. Assessment information contained in the files of people who use the service is satisfactory. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care standards are generally satisfactory, although some improvement is required to care planning and medication standards. People who use the service and their representatives said they were happy with the care provided. EVIDENCE: A sample of care plans for some people who use the service were inspected. Every person living in the home appears to have a comprehensive care plan, and these appear to be regularly reviewed. However some improvement is required to care planning: • There should be a record when each individual has last seen a chiropodist, dentist and optician. This will help care staff monitor when people who use the service last saw these medical professionals, and ascertain when they need this medical attention again. • There should be a life history and profile for each person. This should include for example whether the person has any family or friends, where the person lived before they came to the home, what their interests are / Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 11 were, their occupation, any likes or dislikes, preferred times of getting up and going to etc. This will assist staff to get to know the person; particularly if verbal communication is difficult. Although people who use the service, who the inspector spoke to, did not appear to be aware of their care plans, all people who the inspector could speak to said the care they received was appropriate and carried out in a manner according to their wishes and needs. The inspector completed a formal two-hour ‘dementia mapping’ type observation on the first day of the inspection. This used the Commission for Social Care Inspection’s ‘ Short Observational Framework for Inspection’ (SOFI) tool. This in essence is a ‘fly on the wall’ observational exercise where the inspector records, at five-minute intervals, levels of resident engagement, resident mood, and whether staff interactions are satisfactory for randomly picked people who use the service. The inspector concluded that staff interactions were generally good, there was some evidence that residents were engaged in what was going on around them, and residents appeared to be generally happy. Staff appear to treat people who use the service as individuals, support people with their needs to a good standard, and interact with them well. Staff did not appear to be too rushed, and made as much time for individuals as they could. People who use the service appeared to be well dressed and supported well with their personal care. The Commission for Social Care Inspection is currently involved in two investigations regarding staff interventions. These are being completed under the Department of Adult Social Care’s (Cornwall Social Services) Adult Protection procedures: • A man had a series of seizures, there appeared to be a delay in the man seeking medical attention. The man died several days later in hospital. The nurse in charge has been suspended. The coroner is assessing what happened. • A lady was unwell. The nurse in charge called medical help. The paramedic who attended to the lady alleges moving and handling techniques used by staff, when assisting the lady, was not appropriate. There have also been three other adult protection alerts since the last key inspection in October 2007. Details of these are in the complaints and protection section of this report. Health care support appears to be satisfactory. People who use the service said they could see a doctor or other medical practitioner when this is necessary. Nursing staff said people who use the service could see appropriate medical professionals such as chiropodists, opticians, dentists etc. when necessary. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 12 The medication system was inspected. Medication is administered via a monitored dosage system. Storage is organised to a satisfactory standard. There is an appropriate medication policy in place. Some errors in regarding the recording and administration of medication were noted during the inspection of the system. For example: • Some dosages of medication were signed as administered, but did not appear to have been given to people using the service. • A controlled drug (temazipam) did not appear to be recorded in the controlled drugs book. The prescription had been changed from a liquid to tablet form. The liquid form seemed to be no longer required, but be disposed of appropriately. • Training regarding medication needs to be improved. Some care staff who administer creams appear to have undergone training for this. However records are not completed for all staff. Qualified nursing staff, and any other staff who administer medication need to receive external training from a pharmacist. The registered manager agreed to arrange this as soon as possible. The previous requirement regarding this matter is renotified. People who use the service, and their relatives spoke positively regarding the attitude and practice of staff. The inspector also observed staff attitudes and practice, and staff appeared to treat people who use the service with dignity and respect throughout the inspection. Staff were observed knocking on the doors of people who live in the home, before entering. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is generally good. This judgement has been made using available evidence including a visit to this service. Routines are flexible to meet the needs of people who use the service. However, some improvement is required to ensure people who use the service have more activities and stimulation. This will ensure people who use the service have more opportunity to live a varied lifestyle. Food provided is to a good standard so people have a varied and nutritious diet. EVIDENCE: The inspector spent most of the inspection in the main lounge, either carrying out formal observation work, talking with people or informal observation while checking records. Care standards seemed good, and staff did their best to interact with people using the service, at all times. When not busy completing necessary tasks, staff sat with people using the service to assist them to occupy their time e.g. talking with them, reading people’s magazines and newspapers with them etc. Both the SOFI and informal observation showed there is a need for more structured activities. The registered persons have acknowledged this and have recently employed an activities worker. This person was present on the second day of the inspection as part of their induction. A priority must be for more individual and group activities to be set up, so people living in the home have Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 14 the opportunity to enjoy a more varied lifestyle. Training and guidance could enable staff to give some people who use the service further opportunity to be involved in basic tasks such as baking, laying tables or helping with drying up dishes. The provision of a daily newspaper, local newspapers, magazines etc. could help people who use the service keep some contact with the wider world. People who use the service appear to be able to get up and go to bed when they wish, and routines appear to be flexible according to individual needs. Several people who use the service received visitors on the days of the inspection. The inspector spoke to some of the relatives who were positive about their relatives’ care. Due to the nature of peoples’ mental health needs and/ or level of dementia capacity to enable choice is limited. There are some physical restrictions in the home, which prevents total freedom of movement. For example, the door from the main dining room to the hallway is locked, although people who use the service could move between several rooms and the garden during the daywithout supervision- unless this is required for safety reasons (e.g. due to the risk of falls). Staff state the restrictions are to help ensure the safety of individuals. The doors to the bedroom corridors are also alarmed, and one of the bedroom doors of a resident’s room is alarmed. There is a keypad on the front door. People who use the service seemed to enjoy the food provided. The inspector observed people who use the service having their lunch. The inspector shared a meal with people who use the service on the first day of the inspection. Food was to a satisfactory standard. The meal was sausages and vegetables, followed by marmalade sponge and custard. Staff support was appropriate. Where appropriate fluid and records of food eaten are kept for individual residents. A record is also kept of all food prepared. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is generally adequate. This judgement has been made using available evidence including a visit to this service. Although there are satisfactory procedures regarding complaints and protection, there have been significant concerns since the last key inspection. This is in regard to whether people living in the home are satisfactorily protected from abuse, negligence and poor practice. Although improvements have been made, it is too early to state that the commission is confident that people who use the service are appropriately protected by the registered persons. EVIDENCE: The registered persons have appropriate procedures regarding complaints and adult protection. Staff have attended or are due to attend adult protection training. There are no recorded complaints regarding this service either received by CSCI or received by the registered persons. However a concern was raised regarding the management of one person’s personal finances. This was raised by the Department of Adult Social Care (Social Services). The Commission looked into this matter, and concluded procedures are appropriate. It would have been more helpful however if the person’s next of kin was provided with more information regarding the management of the person’s money, so unnecessary anxieties could have been allayed without formal investigation. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 16 The Commission for Social Care Inspection has received five adult protection alerts regarding this service. The first four of these alerts were received by the Devon and Cornwall ambulance service: 1. A lady had a fall and appeared to be inappropriately lifted by staff on to a chair despite a fractured hip. The subsequent investigation involved the police as well as CSCI. It is debatable whether the lady should have been moved after the fall. However staff felt what they had done was in the lady’s best interests. Information regarding this matter is contained in the CSCI random inspection report dated 24th October 2007. 2. A man had an unexplained series of seizures. It appears he did not receive medical attention in a timely manner. The man died three days later after he was admitted to hospital. The adult protection investigation is still ongoing (we are pending the outcome of a coroner’s review of the case). Information regarding this matter is contained in the CSCI random inspection report dated 12th December 2007. 3. A man left the building and had a fall, which resulted in substantial injuries. The nurse in charge had propped open internal doors, which should have been locked. Locking the doors would have prevented the man exiting the building. The registered persons however have taken appropriate disciplinary action against the nurse in charge. Information regarding this matter is contained in the CSCI random inspection report dated 4th February 2008. Staff appropriately called an ambulance for a lady who had breathing difficulties. Paramedic staff were concerned about the moving and handling procedures used by the nurse in charge. The adult protection investigation is still ongoing. Information regarding this matter is contained in the CSCI random inspection report dated 2nd April 2008. 4. Staff appropriately called an ambulance for a lady who had breathing difficulties. Paramedic staff were concerned about the moving and handling procedures used by the nurse in charge. The adult protection investigation is still ongoing. Information regarding this matter is contained in the CSCI random inspection report dated 2nd April 2008. 5. The practice of an agency staff nurse when taking blood from a person using the service was not appropriate. The home’s manager has reported the nurse to the Nurses and Midwifery Council (the governing practice body). The nurse claimed she was not given appropriate handover, and equipment did not work satisfactorily. She subsequently claims her actions were appropriate in an emergency situation. The Department of Adult Social Care wished the matter to be investigated under Cornwall County Council’s Adult Protection procedures. The number of safeguarding referrals did result in the Primary Care Trust and Department of Adult Social Care (Cornwall Social Services) stopping referrals and admissions to this service. Improvements made, and in progress, have now given both departments satisfactory assurance to recommence referrals to the service. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 17 The registered manager said she is concerned about some of the referrals which were made by the ambulance service. The inspector has advised her to contact the ambulance service, and arrange a meeting with them to discuss her concerns. However, it is clear from at least 1,2,3 above that practice of nursing staff could have been better, and if it had been the referrals would not have occurred. In regard to 5 the Commission should have been notified of the incident (i.e. the registered persons should have notified CSCI of the initial reason for hospitalisation and the allegations made). Although improvements have been made at the home, it is obviously impossible to state whether there will be other incidents, which will result in further adult protection referrals. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there has been some improvements, significant development of the building is still required to make it a suitable facility for people living there. EVIDENCE: The building was inspected. Holywell Bay is a large building with considerable potential as a care facility. There are several communal rooms. A large lounge, a large dining room with a lounge area, a TV lounge, a smoking room, a Chapel room (currently not used) and a hairdressing salon. The garden is readily accessible to people living in the home. Bedrooms are primarily situated along two long corridors. There is a large kitchen, and laundry areas. The home has a sluice facility. The lounges, dining room and the TV room are all reasonably decorated and have suitable furnishings. Part of the downstairs facility (smoking lounge, chapel area and hairdressing area) need significant improvement although it appears some work has commenced. For example the smoking room is very Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 19 scruffy and furnishings are very poor. The toilet in this area also needs redecoration as it is only decorated to a very utilitarian standard, and is not a particularly inviting facility. Bathroom facilities are still unsatisfactory. Although many of the bedrooms have bathroom facilities, these are in many cases inappropriate for the group of people accommodated. Currently there are three working bathroom facilities. The registered provider is planning to have a walk in shower facility upstairs. However, the siting of the proposed facility is not satisfactory. The current plan will only result in two bathing facilities upstairs. Both facilities will be at one side of the building, resulting in a considerable distance for some people who use the service to travel to use a bathroom. Subsequently, the additional bathroom facility needs to be at the other end of the building if satisfactory facilities are to be provided. The home has a range of hoists. These appear to have been serviced appropriately. However there is an ‘Arjo’ bath hoist in the upstairs hallway, for which there is no record of recent service. The registered manager said this is not used, and she said it would be disposed of shortly after the inspection. All bedrooms were inspected. A programme of upgrading bedroom facilities is currently being completed. This includes the painting and decorating of the corridors. Work completed so far appears satisfactory. There is still some need to bring further improvement. For example: • Replacement of carpeting and furnishings in some bedrooms. One carpet in room 31 was loose and presents a trip hazard. The registered manager said she would ensure this was attended at the end of the inspection. • There was dry staining on the ceiling in room 14A as reported in the previous key inspection report. • Many of the bedrooms do not have a lock. People using the service should at least have a lockable facility e.g. for personal possessions or valuables, if it is not appropriate for them to have a lockable bedroom door. • The painting of the outside of the building needs to be completed. The registered manager said this would be completed in the forthcoming months. • The toilet in room 6 does not appear to work. • The external exit from the kitchen (at the side of the building) has a sign stating it is a fire exit. There is however a code lock on one of the doors preventing free exit. The registered manager said this was no longer a fire exit. If this is the case the signage needs to be changed, otherwise the code lock needs to be removed. Any changes to designated fire routes, or locks preventing exit via a designated fire exit, must be discussed and agreed with the fire authority. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 20 A timescale of 01/10/08 was given in the previous key inspection report dated 8th October 2008 to improve facilities. The Commission will monitor to check environmental standards continue to improve. The home was clean on during the inspection and there were no unpleasant odours in the home. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory for the number of people currently accommodated in the home. Recruitment practices and staff induction are satisfactory. However staff training and development needs improvement so staff have the appropriate skills and knowledge to work with the people accommodated in the home. EVIDENCE: On the first day of the inspection the following staffing was provided: • • • • A registered nurse throughout the waking day and night. (A second registered general nurse is currently on duty each day from 0800 until 1600.) Five care staff from 0800 to 2000. Three care staff on duty from 2000 to 0800. Ancillary staff (e.g. maintenance, cooks, cleaners, laundry staff) In addition the registered manager and an administrator were working in the office. Rotas indicate staffing levels are satisfactory considering the number of people who are currently accommodated. The SOFI observation, on the first day of the inspection, showed staffing levels are generally satisfactory to meet the needs of people currently living in the home. As there are only 26 people currently accommodated, staffing levels will Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 22 need to be kept under review, and increased as necessary, as and when the numbers of people accommodated increase. People who use the service were positive regarding the support they received from staff. The staff, the inspector spoke to, said they did not believe there was any bad practice in the home, and felt staff worked well as a team. The registered provider has a suitable approach to enabling staff to have the opportunity to obtain a national vocational qualification (NVQ) in care. The registered manager said currently 80 of staff have an NVQ 2 or 3 in care. It is essential the registered manager ensures a copy of the NVQ certificate is placed on individual files. Recruitment checks have improved considerably since the last key inspection in October 2007. Fourteen staff files were inspected. New staff files inspected have two references and a Protection of Vulnerable Adults ‘First’ check (POVA First). All staff files assessed had a Criminal Records Bureau check (CRB). The files of nursing staff all had satisfactory evidence that their registration with the Nurses and Midwifery Council is up to date. The registered persons have developed an induction checklist for new staff. There is suitable evidence that staff in the sample, who commenced employment since the last key inspection, have received an induction. The inspector spoke to two of the staff who have recently been employed and they confirmed they had received an induction. They said this included working shadow shifts along side more experienced staff before being allowed to work unsupervised. Training records were also inspected for the same sample of employees. By law all staff must have: • Regular fire training in accordance with the requirements of the fire authority. • There must always be at least one first aider on duty (at appointed person level). • All staff must have manual handling training. • All staff must have basic training in infection control. • If staff handle food they must receive training regarding food hygiene. Records kept to evidence appropriate staff training show some improvement has occurred since the last key inspection in October 2007. The assessment of files show in regard to: • Fire Training. Twelve of the staff had received fire training, although two of these only appear to have received this training in 2004. • First Aid. All of the staff files inspected for qualified nursing staff have an appointed persons first aid certificate. Seven of the eight care staff files showed these staff had received some basic video based training Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 23 • • • regarding first aid- although this does not qualify them to act as a first aider. Manual handling. Ten of the fourteen staff have up to date training. The other staff had no record of training in this area. Infection control. Ten of the staff in the sample had received training in this area. Food hygiene. Ten staff in the sample had training in this area. Staff also need to have specific training regards the needs of the people accommodated in the home. Four of the staff in the sample have evidence of training regarding dementia. None of the staff have had training regarding challenging behaviour /aggression, although three of the staff in the sample are qualified mental health nurses. Similarly none of the staff had received any training regarding mental health although three people are qualified mental health nurses. It is disappointing that training in these areas has not been delivered. Lack of training could put staff and people who use the service at risk, and /or result in people using the service receiving poorer quality care. However the registered manager said training in these areas is planned shortly. The registered persons must ensure staff receive appropriate training. Subsequently the registered persons must provide the Commission with a: 1. Training policy which outlines what training staff will receive when, and within what timescale. 2. Plan outlining how they will ensure all staff receive training required in the report. This must include a current ‘audit’ of what training people have received, and when the required training will be delivered. 3. Update of the delivery of staff training on 1st October 2008 regarding all staff. Following the adult protection concerns outlined above, on this inspection an audit was carried out by the inspector of recruitment records, training and development of all nursing staff employed. It is of concern that there is little evidence that nursing staff have received specific training and development to keep up and develop their knowledge and skills. The registered manager said she had tried to develop links with the National Health Service to obtain training for the nursing staff but this had been unsuccessful. The registered manager has been advised to write to the Primary Care Trust regarding this matter. It is essential that the registered persons ensure nursing staff receive regular training to keep their knowledge and skills up to date, and every effort is made by them to obtain appropriate training for their staff. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements are generally satisfactory. The current registered manager has made satisfactory progress to improve the service. However further work needs to be completed by the registered persons to improve the service. This will then ensure Holywell Bay provides a satisfactory service for the people who live there. Subsequently external stakeholders can then be more assured people who live in the home will receive a good quality service, and will be safe and secure at the home. EVIDENCE: The registered provider is Newport Care Limited. The registration of the manager Ms Sherran Thompson has recently been approved by the Commission. The registered persons have carried out a lot of improvement since the last key inspection in October 2007. There are improvements to assessment, care planning, policies and procedures, cleanliness, recruitment Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 25 processes, and health and safety. Money has also be spent to improve the environment of the home. Staff who work in the home have said there has been significant improvement in the last year how the home is managed. However, since the last key inspection there have been a significant number of adult protection concerns. There is still significant work required to improve the environment of the care home for example to ensure bathing facilities are to a reasonable standard. Although staff training has improved, there are still gaps in what is required by regulation. This is despite a number of reassurances from the registered persons that staff would receive appropriate training within the timescale set. Significantly, training of nursing staff needs significant improvement so they receive appropriate updates of their skills and knowledge. In fairness, the registered persons have had a significant amount of work to complete within what is a short space of time. The Commission however does need to see sustained improvement in the shortfalls outlined in this report if we are to be totally assured the service meets the needs of the people who live in the home. The registered persons have a satisfactory quality assurance policy. However the organisational policy should be implemented in full i.e. surveying all stakeholders (only people living in the home appear to have been surveyed in the last survey), the development of an annual development plan (although the registered persons have met the regulatory requirement of developing an improvement plan for the commission’s purposes). However people who use the service, their relatives and staff, who the inspector spoke to, were all positive about the service. There are also a number of ‘thank you’ cards on file from relatives. The registered provider’s responsible person is also completing their monthly visit to the home, in line with regulation 26 of the Care Homes Regulations 2001. Copies of this report are being regularly forwarded to CSCI. Policies and procedures appear to be satisfactory. A copy of the current insurance certificate for the home was inspected. Management of the monies of people who use the service is to a satisfactory standard. A concern was raised by the Department of Adult Social Care regarding the management of one person’s finances. The Commission investigated this matter, and found the money appeared to be managed to an appropriate standard. On this inspection the system for all people using the service was inspected. Appropriate records appeared to be kept for people’s individual finances, including receipts (where appropriate) for any expenditure. Staff supervision records were inspected. There appears to be a satisfactory system in place for care assistants’ supervision. However, there is no evidence that senior care staff or nursing staff are receiving supervision. It is important a suitable system is developed for all staff, to assist staff development and Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 26 skills. Staff responsible for supervising staff should also be able to access suitable training in supervisory management so they are equipped to complete this task. Day to day supervision arrangements however appear to be satisfactory. The registered manager is on duty during the week. The clinical manager also works during the week. There is also a qualified nurse on duty throughout the 24-hour period. A senior care assistant is also on duty during the 24-hour period to guide and direct the care staff. The registered provider has a health and safety policy. The fire prevention system and fire extinguishers have been serviced. The home has a fire risk assessment. Staff regularly test the fire alarms. However there is no record of staff testing the emergency lighting system or that fire doors are checked as working satisfactorily. Health and safety risk assessments have been completed. These are to a satisfactory standard. A risk assessment, and a system to help prevent legionella was not available for inspection. As necessary this needs to be developed. The passenger lift appears to be satisfactorily maintained and was last serviced in March 2008. The assisted ‘Parker’ bath, bath hoists, and mobile hoists have all been serviced this year. Portable electrical appliances, the electrical hardwire system, the call bell system have all been serviced appropriately. The registered manager said the oil central heating has been serviced, and an invoice appeared to validate this. A letter from the company, which serviced the oil appliances, stated that cracks in the oil tank needed to be sealed. The registered manager stated to the inspector that any remedial work has been completed. The registered manager could not provide the inspector with a valid gas certificate. This work needs to be completed, as necessary, and a copy of a certificate to state gas appliances are safe needs to be forwarded to the Commission for Social Care Inspection. The registered manager said thermostats had been fitted to control the temperature of hot water (in line with Health and Safety Executive Regulations). However she produced an invoice to state thermostats had only been fitted to eleven wash hand basins. It appears the water temperature for baths and the remaining hand basins is still not controlled. This work needs to be completed within the timescales set, and evidence of this must be forwarded to the commission. The Environmental Health Officer has just visited the home to inspect food standards. The report stated that standards are satisfactory. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 27 Accident reports appeared to be completed to a satisfactory standard. The registered manager said she has set up a system to auditing accidents (and thus assisting in the process of minimising these in future.) Training in various aspects of health and safety still needs to be improved so the registered persons meet legislative requirements (e.g. moving and handling training, fire training). This is outlined in the previous section of the report. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 28 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 2 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 29 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. Standard OP7 OP8 Regulation Requirement Timescale for action 01/10/08 2. OP9 12, 13, 15 Care plans need to include information regarding: • The person who uses the service’s personal background, to assist with their psychological, social and educational needs being met. • All medical appointments to assist in ensuring all healthcare needs are being met. These measures will help to ensure the health and personal care needs of people who use the service, are appropriately met. 13(2) The registered manager must ensure the medication system operates appropriately. For example: • All prescribed medication is recorded on medication sheets or returned to the pharmacist. • Medication is always recorded when administered. If not administered, it is not signed for and the reason DS0000068129.V362569.R01.S.doc 01/05/08 Holywell Bay Care Home Version 5.2 Page 30 3 OP12 16(2)(m) 4 OP18 10, 12, 13(6), 37 5 OP19 16, 23 is recorded (i.e. on the back of the medication sheet). Develop more social, and 01/10/08 recreational activities for people using the service now that an activities worker has been employed. This will ensure people living in the home have more opportunity to have a varied lifestyle. (Previous timescale of 01/03/08 not met Second Notification) 01/10/08 The registered persons must conduct the service so people who use it are protected from abuse and poor practice: 4.1. The Commission for Social Care Inspection must be notified of all incidents notifiable under the Care Homes Regulations 2001. (As notified in inspection report dated 14th April 20083rd Notification) 4.2. Staff must receive appropriate adult protection training. (Previous notification of 1st January 2008 not met 3rd Notification) 4.3. The registered persons must continue to monitor care practices to ensure people are protected from poor practice and abuse. These measures will help to ensure that people who use the service are protected from poor practice and abuse. Complete improvements 01/10/08 identified in environmental action plan produced by provider dated October 2007. Address appropriately concerns identified in the body text of this report. These measures will ensure DS0000068129.V362569.R01.S.doc Version 5.2 Page 31 Holywell Bay Care Home 6 OP19 OP21 16, 23 7 OP28 OP29 OP38 13, 18, 19, 23 Holywell Bay is a satisfactory facility to operate as a care home. The home must have suitable 01/10/08 bathing facilities, in sufficient numbers to meet the needs of people accommodated in the home. Bathing facilities must be suitably adapted to meet the needs of the elderly and disabled. Bathing facilities must be within a suitable distance to the bedrooms of people who use the service. Complete the identified training 01/10/08 programme so all staff receive: (a)Training required by regulation such as infection control, food hygiene, fire training, manual handling training and first aid. (b) Training regarding people with challenging / aggressive behaviour, dementia and mental health needs. (c)Suitable records of training e.g. NVQ, induction training and other training certificates need to be maintained and available for inspection. The registered persons must submit to the commission: (a)A training policy which outlines what training staff will receive, and when. This should be forwarded to CSCI as soon as possible. (b) A plan outlining how the registered persons will ensure all staff receive training required in the report. This must include a current ‘audit’ of what training people have received, and when the required training will be delivered. (c) An update of the delivery Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 32 of staff training on 1st October 2008 regarding all staff. 8. OP30 18 Qualified nursing staff must receive appropriate training and development opportunities so they can maintain and develop their nursing skills and knowledge. The registered persons must improve health and safety standards in the following areas: 1. Ensure a risk assessment is completed regarding the prevention of legionella, and any necessary preventative measures are taken to prevent Legionnaires’ disease. 2. Emergency lighting and fire doors must be tested at intervals prescribed by the fire authority. 3. Gas appliances must be serviced. 4. Thermostatic valves must be fitted, where appropriate, to wash hand basins and baths- in line with HSE guidelines. Appropriate evidence must be forwarded to the Commission within the timescale set. (Timescale of 01/01/08 not met 2nd Notification) 01/10/08 9 OP38 13, 23 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 33 1 2 OP33 OP36 Implement the company’s policy regarding quality assurance in full. Ensure all staff have regular supervision. Staff responsible for carrying out one to one supervision sessions should receive training in supervisory management. Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Holywell Bay Care Home DS0000068129.V362569.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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