Inspection on 14/02/06 for Holywell Nursing Home

This inspection was carried out on 14th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holywell Nursing Home 14/11/07

Holywell Nursing Home 19/09/06

Holywell Nursing Home 19/08/05

Holywell Nursing Home 19/01/05

Holywell Nursing Home 09/09/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Holywell Nursing Home Brent Street Brent Knoll Somerset TA9 4BB Lead Inspector Barbara Ludlow Announced Inspection 14th February 2006 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 Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 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 Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holywell Nursing Home Address Brent Street Brent Knoll Somerset TA9 4BB 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) 01278 760601 01278 760912 Ms Sarah Elizabeth Joyce Ms Sarah Elizabeth Joyce Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care. Two places for persons of either sex, aged 40-59 years, who require nursing care by reason of physical disablement, convalescent or respite care. Up to three places for personal care. Date of last inspection 19th August 2005 Brief Description of the Service: Holywell Nursing Home is a large detached property situated in the village of Brent Knoll. The home benefits from ample parking, pleasant gardens and views of the surrounding countryside. Accommodation is provided over two floors with a shaft lift giving access to the first floor. Holywell is registered with the Commission for Social Care Inspection to provide general nursing care for up to 25 service users over the age of 60 years (see also conditions). The registered provider/manager is Sarah Joyce who is a dual registered nurse (RGN/RMN). Registered nurses provide 24hr cover at the home. The home has 17 single bedrooms and 4 double bedrooms. Eleven bedrooms have ensuite toilet facilities, some of which are screened by curtains. All bedrooms are fitted with a wash hand basin as a minimum. Some shared rooms have limited space. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out by B Ludlow for CSCI over one day. This was a very positive inspection. The Manager had agreed to have a community nurse present to observe the inspection process, this was appreciated. The inspector met with the Manager to discuss the pre inspection questionnaire and changes to the inspection programme for 2006/2007. Ten service user and thirteen visitor comment cards were returned to CSCI the analysis of this information is included within the report. A tour of the premises was made and bedrooms were sampled. There were 23 service users in residence and two vacant places. Service users and their visitors were seen and spoken with, in private and in the communal areas of the home, during the day. Staff were observed at their work and were spoken with. All staff and service user interactions were friendly, respectful and caring. Records were sampled; these included care plans, medication records, and equipment servicing and maintenance records. What the service does well: What has improved since the last inspection? Redecoration and upkeep of the premises has continued, both internally and externally. New armchairs, bed tables and bedding have been purchased. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 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 Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.NMS 6 does not apply. The home has information for prospective service users to make an informed choice of care home place at Holywell. Pre-admission assessment is made and contractual information is clear. EVIDENCE: The home has a Statement of Purpose; the pre inspection information indicated that there have been no changes made to the homes Statement of Purpose since the last inspection. Pre-admission assessment is made by the homes Manager to assess if the prospective service users care needs can be met at Holywell. Visits to view the home are welcomed. Four care plans were sampled for service users. Evidence was seen on file of a pre admission assessment. All relevant social contact information had been recorded. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 9 The home is not purpose built and the accommodation is restricted in places, however, the care needs of the service user group in residence were being met. The home prepares contractual documentation and includes the information about free nursing care, enduring power of attorney and a form asking for information ‘in the event of death’, seeking for example details of any arrangements that have been made. The contract would be given to the service user or whoever is appointed to deal with their affairs. The homes maximum rate at the time of the inspection was confirmed as £515 /week. Contractual arrangements for two more recently admitted service users were sampled. These were satisfactory. The RNCC was seen to be claimed and then be re reimbursed to the service user. Ten service user comment cards were returned to CSCI. These indicated that 7 service users liked living at the home and 2 said sometimes. Thirteen relatives comment cards were returned to CSCI 7 indicated that they are satisfied with the overall care provided, 1 said no. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Service users have planned care and receive nursing and community professional health care input as required. Service users are treated respectfully and with care and sensitivity. EVIDENCE: Four care plans were sampled. The care plans were selected to look at service user input to the care planning and specialist input into the health care needs of the service users. Pre admission assessment details were held with the care plan and informed the care planning. Where a service user was frail there were good accounts of the care input required and given. There was evidence on file of recent referral of a service user to a hospital consultant specialist via the GP. Input by health care specialists allied to healthcare, such as the optician were seen to be recorded in the care plans. One example was seen where the Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 11 Manager and the district nurse work closely together to manage a skin condition. One bed rail consent form was seen in a plan that had not been completed by the service user. This was discussed with the admitting nurse and was described as having been an oversight and was to be dealt with that evening. Care is reviewed regularly; a monthly record was completed on all care plans seen. Medications management was seen. Each chart has photographic identification. Medication Administration Records (MAR’s) were completed with exception of three gaps detected for the administration of eye treatment. Blood sugar monitoring and pulse records are recorded on the MAR’s. The disposal of medication had been arranged with a named waste collection company. It is now to be arranged under the supplying pharmacy Boots, waste collection contract. The home has a range of nursing equipment, patient hoists and pressure relieving aids. Not all beds are adjustable height. Ten service user comment cards were returned to CSCI. These indicated that seven service users felt they are well cared for and two said sometimes. Nine said staff treat them well. Eight said that their privacy was respected. Feedback from visiting healthcare professionals was very positive. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 Service users have access to activities at the home. Contact with relatives and friends is encouraged. Service users are able to exercise choice in their lives. The catering is satisfactory. EVIDENCE: The home offers a range of activities and has dedicated staff time to focus on this. Soft background music was heard playing in the lounge during the day. Family and friends are welcome to visit and two visitors were seen and spoken with at this inspection. Both expressed their satisfaction with the care and service offered to their relative/friend. The kitchen was seen and the cook was spoken with, the meals are home made. Lunch was served in the dining room to three service users; others had a tray and remained in their armchairs in the lounges or their rooms for lunch. Lasagne was served with potatoes, carrots, caraway cabbage and gravy was available. An alternative meal can be requested. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 13 There was a choice of dessert and drinks were served with the meal. A selection of 5 sandwich fillings was offered for tea. The hot option was macaroni cheese. A ‘cream tea ‘was available with fresh scones, jam and cream. Plus there was a choice of fruit flan, fresh fruit salad and/or ice cream. Ten service user comment cards were returned to CSCI. Asked if ‘they wish to be more involved in decision making at the home’, seven responses were made. One said yes and 6 said no. Asked if ‘the home provides suitable activities’, six said yes and one said sometimes. Of the food six said they liked the food, three responded ‘sometimes’. Thirteen relatives comment cards were returned to CSCI, these indicated that all are welcomed into the home. Nine responded all saying they could visit in private. Seven said they are kept informed of important matters affecting their relative or friend, three said no. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 There have been no formal complaints made to the home since the last inspection. Staff recruitment checks demonstrated deficits in one staff recruitment process last year. EVIDENCE: The pre-inspection questionnaire indicated that no complaints had been made to the home since the last inspection. The complaints policy displayed in the homes entrance hall was identified as out of date, the manager checked and was due to replace this with their more updated version. One service user confirmed they would be able to raise any concerns with the Manager. Staff recruitment records were sampled and inspected. Three staff files were seen, two were satisfactory. One dating from last autumn did not have a POVA First or CRB on file until five weeks after the person commenced working at the home. There were not two references obtained until 6 weeks after commencing working at the home. All the information was now on file but this was not safe practice at the time. This was an isolated example and reasons were given for this error. All other recruitment was satisfactory. Two files for latest recruits demonstrated that POVA First was being taken up before the staff were able to commence working at the home. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 15 Ten service user comment cards were returned to CSCI. Nine responding that they ‘felt safe at the home’. Asked if ‘they knew who to speak with if unhappy’, five said yes and two said no. Thirteen relatives comment cards were returned, six responded that they are aware of the homes complaints procedure, four responded no. Six indicated that they had made a complaint, five said no. Six indicated they are made aware of forthcoming inspections, four said no. Six said they had access to the inspection report, three responded no. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is kept clean and tidy. Although not purpose built this small home has been adapted and is equipped to meet the general nursing care needs of older people. The home provides a comfortable homely environment and bedrooms can be personalised. EVIDENCE: A tour of the premises was made and the home was found to be clean and tidy. A malodour was detected in the entrance hall on arrival; this was not present later in the day. There was also some malodour detected in one bedroom, this was discussed with the manager, more effort must be made to minimise this. The home is not purpose built and some corridors are narrow. The home has been adapted to accommodate elderly persons requiring general nursing care. Appropriate aids have been sited throughout the home. Grab rails and ramps are available and a small shaft lift gives access to the first floor. A call bell system is installed throughout the home. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 17 The home has a conservatory lounge/dining area with a dining room and a smaller lounge off this room. There is also a lounge area situated on the first floor. The home is pleasant and comfortable with domestic style furnishings and lighting, the home has a ‘homely’ feel. The home has two assisted baths and one ‘walk-in’ shower, which is accessible to wheelchair users. All bedrooms are fitted with a wash hand basin as a minimum. Eleven bedrooms have toilet facilities; curtains are used to screen en-suite toilets in some bedrooms. Appropriate staff hand washing facilities are available in communal toilet and bathing facilities and bedrooms. Window restrictors were seen to be in place on all first floor windows seen at this inspection. The home has a rural outlook and a small pleasant garden area that can be accessed from the conservatory lounge. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 There were sufficient staff in number at the time of the inspection and on the duty rota copies sent to CSCI. EVIDENCE: The home is actively recruiting new staff. Copies of duty rotas were sent to CSCI and worked rotas were seen. There has been agency staff used to supplement the staff team. These rotas demonstrated a sufficient staff number on duty. (The home adheres as a guide, to the minimum nursing and care staff numbers as set by Somerset Health Authority pre 2002.) There are also a domestic/laundry staff, which includes bed makers. There is a separate catering staff team. Staff receive training to carry out their duties. Staff training is promoted b the owner manager. The homes induction plan booklet was seen and appears comprehensive, a competence column for signing when it is recognised that a staff has reached this level of capability is recommended. Staff recruitment practice was sampled and analysed. One out of three recruitment files although now complete, demonstrated incomplete recruitment practice. No POVA First had been obtained prior to the employee commencing Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 19 working at the home and references were not received until after the start date. Recent practice however was confirmed as thorough and sound, this must remain so. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,37,38 The home is well managed. The Registered Manager is respected by staff, relatives and by service users. Records inspected indicated that safety checks are up to date. EVIDENCE: The Registered Provider/Manager, Ms Sarah Joyce is a Registered Nurse (RGN & RMN). Ms Joyce also holds a recognised qualification in specialist care of the elderly (ENB 298). The Registered Provider/Manager has many years nursing experience and is committed to the care of the service users at the home. Ms Joyce has previously confirmed her commitment to completing NVQ Level 4 Registered Managers Award. Ms Joyce was described by service users as ‘a good trooper’ Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 21 and ‘very kind’. One service user said they would be happy to raise any concerns with the Manager. Service users confirmed that the Manager is helpful. The home also employs a bookkeeper and an administrator to assist with the management and administration of the home. The home had its certificate of registration displayed and their employers liability insurance. From the pre-inspection questionnaire: Fire testing records were seen. The fire alarm system was serviced in August 2005. Fire extinguishers were serviced in October 2005. The emergency lighting was also checked in October 2005. The central heating was checked 10.06.05. PAT testing was carried out in June 2006. The passenger lift was confirmed as serviced on November 2005. Hoists for patient handling were serviced 15.09.05. Accident records are maintained and are audited to detect patterns of behaviour precipitating to falls etc. New manual handling slings have been purchased, it was recommended that an inventory be made and all equipment clearly numbered/labelled. Good staff manual handling practice was seen at this inspection. One poorly positioned bed rail was brought to the attention of the Manager for urgent attention at the time of the inspection. This was attended to. Fire training has been held at regular intervals, the trainer had identified five staff as needing updating, two were only just due, and all had been sent a reminder. One staff member was identified that requires updating as a priority. One bathroom door was found to be sticking and in need of attention to make it close fully and easily. The records were examined for money held in safekeeping for service users personal spending. These records were satisfactory. All records were appropriately stored and securely held at the home. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 X 3 2 Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP29OP18 Regulation 19(b)(i) Requirement POVA First must be obtained prior to a new recruit starting work and their full CRB check being returned. Two satisfactory references must be obtained before a new recruit commences working at the home. All staff must have regular fire training. Timescale for action 11/04/06 19(c) 2 OP38 23(4)(e) 18/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 Refer to Standard OP9 OP19 OP22 Good Practice Recommendations Medication administration records for instilled eye drops should be completed at each application or a reason given for the omission. One bathroom door that was sticking must be repaired to ensure that it closes fully and easily. An inventory of manual handling equipment and aids should be made, this is recommended at this inspection. DS0000003265.V273220.R01.S.doc Version 5.0 Page 24 Holywell Nursing Home 4 5 OP26 OP16 Attempts to minimise odour and improve odour control should be made. The complaints procedure should be updated and re circulated to service users and their families. Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holywell Nursing Home DS0000003265.V273220.R01.S.doc Version 5.0 Page 26 - 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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