Inspection on 19/08/05 for Holywell Nursing Home

This inspection was carried out on 19th August 2005.

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

The inspector 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 Nursing Home 14/11/07

Holywell Nursing Home 19/09/06

Holywell Nursing Home 14/02/06

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 Unannounced 19 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holywell Nursing Home Address Brent Street Brent Knoll Somerset TA9 4BB 01278 760601 01278 760912 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ms Sarah Elizabeth Joyce Ms Sarah Elizabeth Joyce Care Home with nursing 25 Category(ies) of Old age (25) registration, with number of places Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Two places for persons of either sex, age 40-59 years, who require nursing care by reason of physical disablement, convalescent or respite care. 3. Up to three places for personal care. Date of last inspection 19 January 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 condtions). 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 D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector; the Registered Manager was available throughout the inspection day, to assist with the process. There was one outstanding requirement from the last inspection, January 2005, action has been taken and this was discussed. A recommendation for action is now made. There were 22 service users in residence, 2 persons were booked to come into the home during the coming weeks. A tour of the premises was made; Service Users and their visitors were seen and spoken with both in communal areas of the home and in the privacy of their own rooms. Afternoon activities were observed. Staff were spoken with, they were helpful and contributed to the inspection process. The homes administrator provided financial and contracting information for the inspection. The catering staff were spoken with and the kitchen was seen, lunch was seen served in the dining room/lounge. This was a positive inspection where a good level of care was observed. What the service does well: Holywell is a small friendly home. There is a core of experienced and enthusiastic staff. The Registered Manager provides a good level of management input and support; service users, staff and families visiting confirmed this. The home has good links with the community health care services. The care and ill health management is of a good standard. Service users were observed to be treated kindly and with respect. Those who were ill or very frail were observed to be well cared for. Staff are encouraged to update their knowledge and skills through access to training. Care staff have achieved NVQ 2 and 3 qualifications with in-house support. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,NMS 6 does not apply. There is sufficient pre-admission information available for service users to make an informed decision about the care and service offered at the home. Administration is well managed and contracts are issued to service users. EVIDENCE: The home has a Service User Guide and a Statement of Purpose. Two more recent admissions financial records were sampled. Contracts for privately funded care were seen. The Registered Nurse Care Contribution (RNCC) had been assessed by the community nurse and funding agreed. Information such as Power of Attorney was recorded. The contracts and invoicing were satisfactory. The Registered Manager or a senior nurse undertakes pre-admission assessments for new service users. Four care plans were sampled, the preadmission information seen included medications information, health histories, Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 9 summaries of care, discharge letters from other service providers and hospitals. All relevant social information had been recorded. 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 seen to be met. Visits to view the home are welcomed. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans were satisfactory and information is held in sufficient detail. Care of service users and those who are very frail is satisfactory. Service users are treated kindly and with respect. EVIDENCE: Service users were spoken with and daily life at the home was observed throughout the inspection day. Service users confirmed that they are treated with respect. Care was observed to be given in a kind and dignified manner. Four-service user care plans were sampled, these were chosen to case track pre-admission information, chronic disease management and wound pressure sore care. The care plans were satisfactory and recorded all aspects of care given at the home. Appropriate measures were in place to promote healing and to prevent the development of pressure sores. Visits by professions allied to care were recorded such as Chiropodist. GP appropriate risk assessments were recorded for manual handling, nutrition, pain and falls. There was evidence of the community nurses and the homes nurses working together to manage wound care. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 11 Medications management was seen. Each chart had photographic identification. The systems for receiving medicine have been fine tuned to leave no room for error, following an incident where medication had gone missing between the pharmacy and the home, it having not been accounted for at the time of delivery to the home. The manager has thoroughly investigated the matter with the allied Boots Pharmacy. CSCI and their Pharmacist were also fully notified of the incident. One record on the MAR chart was brought to the attention of the Nurse on duty and the Manager with regard to the recording of insulin doses changes. The deficit was rectified at the time, the dose changes were confirmed and were countersigned on the MAR chart. Prescribed pots of cream were seen that did not have an opened on date, this is recommended. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. Activities are supported with specific activity staff time. There are activities held at the home for service users to join in with if they wish. Friends and families are welcomed into the home. Service users are encouraged to maintain as much independence in their lives as they are able. The catering at the home is good, home baking and cooking with a good level of service seen at lunchtime. EVIDENCE: The home offers a range of activities and has a dedicated staff to deliver this aspect of care. Appropriate soft background music was heard playing in the lounge at times during the day. Families and friends are welcomed at the home and may visit whenever they wish. Two visitors were seen at lunchtime assisting their relative with their food. Staff also provided one to one assistance as required and in a sensitive way at lunchtime. One service user has use of a buggy to get out into the village and was pleased to have the freedom and be able to get out and about independently. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 13 The kitchen was seen and the cook and her assistant were spoken with. Kitchen records were up to date. An inspection by the Environmental Health Officer was reported to have been satisfactory. Staff were aware of and catered for service users special diets such as diabetic diets and for particular ‘likes and dislikes’. Lunch was fishcakes and parsley sauce, potatoes and peas; there was also a selection of sweets. An alternative is available. Afternoon Tea was served with home baked cakes and High Tea was from a choice of Jacket potatoes, salad, sandwiches, plus cakes or puddings. Service users were complimentary about the food offered at the home; one person felt they ‘had put on weight’. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Service users are protected from harm by the homes recruitment policies and procedures. EVIDENCE: Staff files were sampled, recruitment practice was satisfactory and offered protection to service users. The home has whistle blowing and POVA information displayed on the staff notice board. The home has not received any complaints since the last inspection. One service user confirmed that she had made the choice to vote by post this year. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 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. Slight odour was detected in two bedrooms. 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. The home has a spacious conservatory lounge area with a dining room and a smaller lounge off this room. There is also a lounge area situated on the first Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 16 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. The home has a rural outlook and a small pleasant garden area that can be accessed from the conservatory lounge. The windows and door to the garden was opened during the afternoon and the service users were enjoying the fresh air. Windows above first floor are restricted in opening and one restrictor was found to be broken, this was brought to the attention of the Manager for repair at the time of the inspection. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 There was sufficient staff on duty at the time of this inspection. The home continues to adhere to its previous regulatory minimum Health Authority staffing notice. Staff are appropriately recruited. Training is encouraged to ensure service users are in safe hands. EVIDENCE: Staff from all departments, nurse, carers, kitchen staff, maintenance, administration, activities, domestic and support workers were seen on duty. There was sufficient staff on duty to meet all aspects of care and service at the home. There were reported to be no carer vacancies at the home, RN’s are being recruited to cover three vacancies. Staff spoken with confirmed that they have received training for manual handling, fire protection and food hygiene. Staff confirmed also that they have meetings and new staff confirmed that their inductions were thorough. Study days are offered to staff and speakers are invited to the home. Staff were aware of the Protection of Vulnerable Adults from abuse but had not received specific ‘POVA’ training, this is recommended at this inspection. Staff recruitment was not examined in detail at this inspection, at the inspection in January 2005, a good standard of recruitment practice was seen, CRB disclosures had been obtained and POVA First checks were recorded. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,37,38 The home is well managed; the Registered Manager was described as a ‘good trooper’ and ‘a wonderful person’ by a service user and as ‘very good’ by staff. Records inspected indicated that attention to the health and safety of service users is considered at all times. Safety checks were up to date. Good practice is supported by the homes policies and procedures. EVIDENCE: The Registered Provider/Manager is Ms Sarah Joyce who is a Registered Nurse (RGN & RMN). Sarah 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 confirmed her commitment to completing NVQ Level 4 Registered Managers Award. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 19 Service users and staff confirmed that the Manager is approachable and helpful. Financial procedures are managed well by the homes administrator, one outstanding account requires attention and this was discussed and is ‘in hand’. All pocket monies held by the home are checked regularly, receipts are kept and accounts are signed. The home has policies and procedures in place to protect services users and staff from harm. Records for the servicing of equipment were checked: Annual servicing of the fire alarm, emergency lighting was carried out on 19.08.05, weekly alarm tests and fire door checks are carried out. The alarm was routinely tested during the inspection. Fire extinguishers are checked annually and were serviced on 8th and 9th March 2005. Staff fire training was held on 17.08.05 and is carried out on a regular basis. Bed rails are numbered and are checked on a monthly basis; one bed rail was identified for adjustment at this inspection and was to be attended to immediately. Wheelchairs are cleaned and checked on a monthly basis and a log is maintained. Hoists both mobile and bath hoists were serviced in March 2005. Radiators and hot surfaces are guarded for protection from accidental burning. Above ground floor windows are restricted in opening, one broken restrictor was identified for attention and the Manager confirmed that this had been repaired during the inspection. A review must be made to ensure the window restrictors are of a type that is strong enough to be safe. The hot water at bath outlets is checked monthly; the last test was on 01.08.05 and was reported as satisfactory. Accident records are maintained and are audited; the last audit was in June 2005. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x 3 2 3 3 2 Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 21 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 Regulation Requirement Timescale for action 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 OP 9 OP 38 OP35 Good Practice Recommendations Prescribed creams should be labelled with an opening date to ensure that they are replaced at the recommened time. Window restrictors should be reviewed to ensure the method used is stong enough to provides safety. One account held should be reconciled as soon as possible. Contact with the next of kin/social services must be retried. Holywell Nursing Home D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - D02 S3265 Holywell V227327 190805 Stage 4.doc Version 1.40 Page 23 - 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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