Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 16/01/06 for Little Holland Hall Nursing Home

Also see our care home review for Little Holland Hall Nursing Home for more information

This inspection was carried out on 16th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The inspector was most impressed by the staff working in the home. Interaction seen and heard between staff and service users was very good. Staff were observed being polite, respectful and helpful. The home had a relaxed atmosphere which was commented on by service users, relatives and staff. Calls for assistance from service users were seen to be acted on quickly and staff displayed a "nothing is too much trouble" dedicated manner.

What has improved since the last inspection?

Rewriting of long term service users` care plans had been undertaken. Problems with medication administration record sheets had largely been sorted out in conjunction with staff, GPs and the dispensing pharmacy.

What the care home could do better:

The monthly reviews of service users` care plans were seen not always to be up to date and action to correct this needed to be taken.Formal recorded supervision sessions with staff were not taking place six times a year, as outlined in the National Minimum Standards for Older People. Discussion with service users and observation indicated that a number of bedrooms would benefit from having additional chairs for use by visitors/relatives.

CARE HOMES FOR OLDER PEOPLE Little Holland Hall Nursing Home Frinton Road Holland On Sea Essex CO15 5SS Lead Inspector Steve Boyd Unannounced Inspection 09:30 16 January 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 Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 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. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Little Holland Hall Nursing Home Address Frinton Road Holland On Sea Essex CO15 5SS 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) 01255 813402 01255 813962 Ellerash Limited Mr Barry Healy Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability (41), Physical disability of places over 65 years of age (41), Terminally ill (3) Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) Persons of either sex aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 8 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) The total number of service users accommodated must not exceed 41 persons 7th July 2005 Date of last inspection Brief Description of the Service: Little Holland Hall is situated in Holland on Sea, North Essex. It is part of a larger complex that includes sheltered housing, warden controlled flats and privately owned homes for older people. Near to the nursing home, on the same site, there is a two storey listed building. The Little Holland Hall complex is owned by Ellerash Ltd which is part of the Care UK group, a national care organisation. This nursing home has 41 single rooms divided between two floors. All of the rooms have en suite facilities. The home offers nursing care for up to 41 older people. Within this number, three beds are also registered for service users who are terminally ill, or require general palliative care. The home is not registered for dementia care. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on one day in January 2006. The inspector spoke with three service users in private and a number of others in communal areas. Two relatives were spoken with in private. Seven staff, including nurses, care assistants and ancillary staff were spoken with. The manager, Mr Healy, was also spoken with and was present throughout the inspection. A number of policies and records were looked at through the inspection and a general tour of the building also took place. Sixteen National Minimum Standards were assessed, fourteen of which were met in full and two were partially met. Overall, a good standard of care was being provided to service users in a relaxed and friendly environment. What the service does well: What has improved since the last inspection? What they could do better: The monthly reviews of service users’ care plans were seen not always to be up to date and action to correct this needed to be taken. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 6 Formal recorded supervision sessions with staff were not taking place six times a year, as outlined in the National Minimum Standards for Older People. Discussion with service users and observation indicated that a number of bedrooms would benefit from having additional chairs for use by visitors/relatives. 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. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 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 Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 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): 3. Service users have an assessment of need before moving into the home and are assured their needs can be catered for. EVIDENCE: An assessment of need was seen to have been completed on one new service user. The service user confirmed that this had taken place and also said that she was being helped to settle well into the home. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 9 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, 10 and 11. Individual care plans for service users were available, although not all were reviewed in a timely fashion. Service users were clearly treated with respect and sensitivity. EVIDENCE: Care plans were seen for a number of service users during the course of inspection. All the service users were seen to have assessments based on the activities of daily living and goals were set based on identified needs. Reviews of individual plans were seen to take place but not always on a monthly basis as outlined in the National Minimum Standards for Older People. The manager, Mr Healy, was made aware of this issue to progress with nursing staff. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 10 From discussion with service users and observation of interaction between staff and service users on the day of the inspection, it was clear that service users are treated with respect and core values such as privacy and dignity are maintained. For example, staff were seen to knock on service users’ bedroom doors and wait for a response before entering. The home had a policy on how to deal with the sensitive issues of death and dying. A number of letters were seen from relatives expressing gratitude on the way their loved ones had been cared for in the home prior to their death and the way the home had treated them as relatives in their time of loss. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 11 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 and 14. Service users’ lifestyles within the home met their preferences and needs. They are able to maintain contact with family/friends/others and can exercise and control as much as their abilities allow. EVIDENCE: The home employs an activities worker and an activities programme is available that includes such things as bingo, board games, quizzes, arts and crafts and trips out. Service users also follow individual interests such as reading and watching television. Service users are encouraged to keep contact with family and friends and a number of relatives were seen to be visiting at the time of inspection. Relatives spoken with confirmed that they could visit at times convenient to them and their relatives, and that staff always treated them well. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 12 During the inspection service users were seen to be offered choice in a number of different ways. For example, the inspector heard an interaction between a member of staff and a service user regarding whether they would like a cup of tea or coffee or other drink in their bedroom. The service user was offered a choice of milk and sugar, whether they wished to have a biscuit, whether they would like their door opened or closed and their bedroom light on or off. This was all carried out in a polite and attentive manner. In discussion with service users, one described themselves as being “well looked after” and another that the “nursing care is very good”. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 13 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 and 18. Service users, their relatives and friends can be confident their complaints will be listened to and acted upon. The home takes the protection of service users from abuse seriously. EVIDENCE: Only one complaint had been made regarding the home since the previous inspection. This had just come to light and had been dealt with appropriately over the weekend prior to the inspection taking place. An appropriate complaints procedure is available and is given to new service users as part of an “information welcome pack”. A policy and procedure is available on the protection of vulnerable adults from abuse. Staff have received training on the protection of vulnerable adults. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 14 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): No Standards were considered at this inspection. EVIDENCE: Although the environment was not a focus of this inspection, communal areas and individual rooms seen during the inspection appeared well decorated and were clean and tidy. More storage space, if it could be provided, would be beneficial due to the volume of wheelchairs, walking frames, etc. Some service users commented that additional chairs for visitors/relatives in their bedrooms would be welcomed. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 15 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 and 30. Service users’ needs are met by qualified, trained and competent staff who are recruited in a professional and safe manner. EVIDENCE: Staffing levels allow for a minimum of two nursing and five care staff on duty during the day and one nurse and three care staff during the night time period. Staff are supported by the manager, Mr Healy, his deputy, Ms Dale, and an administrator. Other staff include kitchen, laundry and maintenance personnel. Service users spoke highly of the staff who care for them. Each staff member has an individual training record. Staff confirmed that they have training opportunities within the home, including National Vocational Qualifications for care assistants. Since the previous inspection, training has included fire safety, health and safety, moving and handling and protection of vulnerable adults. In discussion with staff and looking at staff records, it was clear that they are recruited in an appropriate manner. Application forms are completed, interviews undertaken, references and Criminal Record Bureau checks pursued and appropriate photo identity expected to be provided by staff. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 16 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): 36 and 38. Staff supervision needs to be formalised on a more regular basis. The health, safety and welfare of service users and staff are given high priority. EVIDENCE: Supervision documents seen during the inspection indicated that formal supervision has been irregular since the previous inspection. The manager was advised that the expectation is for six formal sessions per year for care staff. Staff confirmed they can approach the manager, deputy and senior staff at any time and it was clear that informal supervision takes place. Safety certificates were available for electricity, gas, lift, various mechanical aids used in the home and legionalla during the inspection. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 17 Training for staff on health and safety issues had taken place over the past months and the home had a number of trained first aiders. During the course of inspection no obvious safety hazards were seen, although the lack of storage space meant that wheelchairs, walking frames, etc. were often stored in areas such as bathrooms. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 18 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X 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 X X X X X 2 X 3 Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 19 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 Regulation 15(2)(b) Requirement The registered person must ensure that service users’ care plans are reviewed in line with National Minimum Standard timescales of once a month. The registered person must ensure that care staff receive regular formal supervision in line with timescales set out in National Minimum Standards Timescale for action 28/02/06 2. OP36 18(2) 28/02/06 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. Refer to Standard OP22 Good Practice Recommendations An occupational therapy assessment of the whole home should be carried out within the home. Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Little Holland Hall Nursing Home DS0000015325.V275190.R02.S.doc Version 5.1 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!