Inspection on 19/09/06 for Holywell Nursing Home

This inspection was carried out on 19th September 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 14/02/06

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 Stephen Humphreys Key Unannounced Inspection 09:30 19 September 2006 th 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.V303319.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 Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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.V303319.R01.S.doc Version 5.2 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 14th February 2006 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 passenger 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 residents 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 en-suite 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.V303319.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Holywell nursing home using the Commission for Social Care Inspection Inspecting for Better Lives methodology. The methodology used at this inspection will result in the service being given a rating of, excellent, good, adequate or poor. The frequency of inspections will be determined by the rating. This inspection was a key inspection at which all the core national minimum standards were assessed. The inspection was unannounced and carried out over one day from 09:30am until 16:45 by one inspector. The inspection methodology included speaking in detail with staff, residents, the registered manager and a relative. A tour of the premises was made to assess the environment. Statutory records were assessed including care plans and staff files. Maintenance records were also viewed. On this occasion the financial records could not be accessed because the finance officer was not in the home. What the service does well: What has improved since the last inspection? Redecoration and upkeep of the premises has continued, both internally and externally. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 6 The registered manager has bought new ‘Kings Fund’ beds and bedside furniture. Local staff recruitment has improved and the recruitment procedure carried out includes a POVA First check. The registered manager has introduced a special banding for health care assistants to promote personal development 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.V303319.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 Nursing Home DS0000003265.V303319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 The quality in this outcome group is good. Prospective residents and their relatives are provided with detailed information about the home and the services available in the statement of purpose and service user guide. EVIDENCE: Information for prospective residents in the form of the statement of purpose and service user guide is available in the home, displayed near the front entrance and also given to prospective residents. A copy of the statement of purpose and other information is also placed on display in each of the resident’s bedrooms. Unfortunately only one relative was spoken to during this visit, however they confirmed that they had received and read the statement of purpose and service user guide. The service user survey results also indicated that information on the home had been received and was enough for service users to make an informed choice about entering Holywell nursing home. The statement of purpose was last reviewed and updated in July 2006. The care home fees range from £525 - £550 perweek Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 9 Four contracts were reviewed during the inspection. The terms and conditions were understandable and reasonable. The resident or their representative had signed the contract. Each contract contained all the guidance terms stated in the national minimum standards. The contracts include 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 registered manager carries out a pre-admission assessment using the activities of daily living model of care to assess if the prospective residents care needs can be met at Holywell. Visits to view the home are welcomed. Six care plans were reviewed as part of the case tracking exercise. Evidence was seen on file of a pre admission assessment. All relevant social contact information had been recorded. The inspector was able to observe residents receiving care as part of the case tracking and also talk to residents. All of the care delivered was documented clearly in the care plans and observed practices included lifting and moving, assisting residents with their meals and wound care was all carried out safely and sensitively. The care staff observed are commended for their sensitivity, explaining to the resident all that they where doing. The care staff are complemented on their relationship with the residents, no carer walked past a resident without an acknowledgement, and a smile. Residents spoken too said ‘the staff are all wonderful’, other comments such as ‘it’s a family home’ were received. One relative confirmed that they had visited the care home before making a decision. The majority of residents said they were not able to visit due to them being in hospital. Relatives mostly carry out pre-admission visits. Holywell Nursing Home DS0000003265.V303319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome group is good. Residents can be assured their individual care needs will be met and they will be treated with dignity and respect at all times. EVIDENCE: Six care plans were selected for the case tracking exercise. The care plans were very detailed and contained all the necessary information to enable the residents care needs to be met. Input to the plan of care includes residents and other visiting professionals. Pre admission assessment details were held with the care plan and informed the care planning. Three of the residents had complex care needs. There were good accounts of the care input required and given. There was evidence on file of recent referral of a resident 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 registered manager and the district nurse work closely together to manage a skin condition. Carers said that matron attends courses on wound care and Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 11 other clinical practices and then implements what she has learnt into the care of the residents. Consent forms for bedrails were included in the care plan. Care is reviewed regularly in all care plans seen. The receipt, storage, administration and disposal of medicines was reviewed. Each chart has photographic identification. Medication Administration Records (MAR’s) were completed with no gaps or omissions. Controlled drugs were checked and found to be correct. The disposal of medication had been arranged with a named waste collection company. The home has a range of nursing equipment, patient hoists and pressure relieving aids. Ten service user surveys were returned to the Commission for Social Care Inspection seven residents responded that they are well cared for and two said sometimes. All residents spoken too on the day said staff treat them respectfully at all times, this was also observed by the inspector. Comment cards received from visiting healthcare professionals was very positive. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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): 12,13,15 The quality in this outcome group is good. Residents can be assured of contact with relatives and local community is encouraged. Wholesome nutritious meals are served. EVIDENCE: Dedicated staff offer a range of activities at various times of the day. The activities programme id displayed in the lounge. Soft background music designed to induce relaxation was heard playing in the lounge during the day. Family and friends are welcome to visit at any reasonable time. Visitors were seen coming and going during the day but only was spoken with at this inspection. Satisfaction with the care and service offered to their relative was expressed. A tour of the kitchen was made and meal discussed with the cook. The cook prepares the menus from the residents likes / dislikes, that are recorded in the care plan. There is generally only one main dish at lunchtime with a selection of deserts. The meals appeared nutritious and the portions were ample. The inspector observed the lunch being served and three residents being assisted to eat their lunch. All residents said the meals the very good. The residents survey results confirmed the resident’s comments. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 13 Lunch was served in the dining room to one resident; others had a tray and remained in their armchairs in the lounges or their rooms for lunch. Lasagne was served with potatoes, green beans and cauliflower was available. An alternative meal can be requested. 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 available. Snacks are also available through out the day with carers encouraging and providing drinks to all residents. Water and squash were sited near to all residents. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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 The quality in this outcome group is good. Residents can be assured that they will be protected from harm through robust recruitment procedures and staff training in vulnerable adult issues. EVIDENCE: There have been no formal complaints made to the home since the last inspection. 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 up to date. One service user confirmed they would be able to raise any concerns with the registered manager others said they would tell relatives. Staff recruitment records were sampled and inspected. Three staff files were seen, all were satisfactory. All had a POVA First and CRB disclosure record on file dated before the person commenced working at the home. There were two references obtained. This procedure has improved from the last inspection. Six of the service user survey respondents indicated they knew who to make a complaint to and three said they thought they did. The relative spoken to said they were very happy with the service delivery and they were aware of how to make concerns known. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 15 Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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): 19,26 The quality in this outcome group is adequate. The environment is safe and well maintained. The rooms are warm and decoration is on going. EVIDENCE: 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. A tour of the premises was made and the home was found to be clean and tidy. The home is not purpose built and some corridors are narrow. The registered manager said that work is on-going at every opportunity to widen doorways and make the internal structures suite the equipment used today. The home has been adapted to accommodate elderly persons requiring general nursing care. Appropriate aids have been sited throughout the home. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 17 Grab rails and ramps are installed and a small passenger lift gives access to the first floor. A call bell system is installed throughout the home. 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. There are 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.V303319.R01.S.doc Version 5.2 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): 27,28,29,30 The quality in this outcome group is good. Residents can be assured that the staff are trained and experienced in caring for the older person. EVIDENCE: The registered manager is actively recruiting new staff. She is pleased with the upturn in locally recruited 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. There is also domestic/laundry staff, which includes bed makers. There is a separate catering staff team. The registered manager encourages all her staff in their personal development and provides regular opportunities for them to attend relevant NVQ and clinical training courses. The inspector reviewed the staff files and training records including inductiontraining booklet. All the senior carers are NVQ trained to either level two or three. All statutory training has been completed including Manual handling, Food hygiene, fire drills, health & safety and COSHH. Some of the carers have attended a first aid course. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 19 Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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): 31,33,36.38 The quality in this outcome group is adequate. Residents can be assured that the home is run with their best interests in mind however the registered manager needs to introduce quality monitoring systems into the home. EVIDENCE: The Registered Manager is respected by staff, relatives and by residents. 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 residents at the home. The registered person employs a bookkeeper and an administrator to assist with the management and administration of the home. Residents said ‘the Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 21 matron is good at her job’. Carers said ‘matron values us and provides us with a sense of importance and responsibility’. The registered manager carries out satisfaction surveys and makes these surveys available at the main entrance to the home. A suggestion box is also placed at the main entrance. Apart from this and accident audits there is no other quality assurance systems in place. To improve the quality system the registered manager should show how the outcomes from the survey’s and audits are introduced into the running of the home. The registered manager carries out annual staff appraisals. It is accepted that this is a small home and the registered manager is visible and in the home daily in constant touch with residents and relatives. Regular staff meetings are held and staff feel that they are valued and can make suggestions however there is a need for a formal quality assurance system and formal supervision to be initiated. This was discussed with the registered manager. These will be followed up at a later inspection. The certificate of registration is displayed along with the employers liability insurance on the wall by the main entrance. The fire logbook was checked along with the hot water temperature records. Accident records are maintained and are audited to detect patterns of behaviour precipitating to falls. Good staff manual handling practice was seen at this inspection. Fire training has been held at regular intervals as required. All records were appropriately stored and securely held at the home. Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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 3 3 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 X X 2 X 3 Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 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 OP33 Regulation 24 Requirement The registered manager must introduce a formal system of quality assurance monitoring in all service delivery areas. The registered manager must introduce formal supervision for all staff groups. Timescale for action 31/12/06 2. OP36 18 (2)(a) 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holywell Nursing Home DS0000003265.V303319.R01.S.doc Version 5.2 Page 24 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.V303319.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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