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Inspection on 07/07/05 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 7th July 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.

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

What has improved since the last inspection?

The general morale in the home had improved since the last inspection, which ahd also been noticed by the residents who spoke to the inspector. The manager had been registered with Commission for Social Care Inspection.

What the care home could do better:

The care plans for the long-term residents must be thoroughly reviewed and should be rewritten, to reflect current care. A general occupational therapy assessment of the whole home should be considered to review the need for any further adaptations that would improve the lives of the residents.

CARE HOMES FOR OLDER PEOPLE Little Holland Hall Nursing Home Frinton Road Holland on Sea Essex CO15 5SS Lead Inspector Lysette Butler Unannounced Thursday 7th July 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. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Little Holland Hall Nursing Home Address Frinton Road Holland on Sea Essex CO15 5SS 01255 813402 01255 813962 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) Ellerash Limited Mr Barry Healy Care Home 41 Category(ies) of Oldd 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 I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) 2 Persons of either sex aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 8 persons) 3 Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) 4 Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) 5 Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) 6 The total number of service users accommodated must not exceed 41 persons Date of last inspection 9/12/04 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 I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took seven and half-hours on one day during July 2005. Twenty-three of the thirty-eight National Minimum Standards were inspected during this visit. It was found that many of the standards had been met or partially met. The overall care and well being of the residents was very good; staff and residents were welcoming and happy to speak to the inspector. During this visit the inspector spoke to eight residents; six relatives/ visitors; seven staff members including the administrator; the maintenance man; two housekeeping staff; one of the activities coordinators; one Registered Nurse and two care assistants. The inspector also spent time with the registered manager and his deputy. Residents and their relatives all expressed satisfaction with the care they received and with the quality of the food offered. What the service does well: 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. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 6 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 Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 7 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 & 6 The information supplied to prospective residents and their families enables them to make the right choice of home. EVIDENCE: The Statement of Purpose and Service User Guide have both been reviewed within the last six months, however no changes were required. All residents are issued with a contract and a statement of terms & conditions on admission to the home. Both documents have been reviewed since the last inspection. The level of qualifications obtained by the staff within the home enabled them to meet the needs of the different residents. The deputy manager carried out most of the preadmission needs assessments. She was very clear on who was suitable for the home and who was not. Care UK documentation is used for all assessments. The original assessments are kept in the resident’s care file. The assessment is used as the basis of the full admission assessment and compilation of their care plan. The training offered to the staff is tailored to the needs of their job description and the needs of the residents. Staff were welcoming and happy to cooperate with the inspector throughout this visit. Residents and visitors spoken to all said that the staff were “wonderful – helpful and friendly”. “They really know how to talk to us.” Prospective residents are always offered a trial visit and all are accepted on an initial one-month trial period. If prospective residents go to the home for a trial visit this is documented as part of the initial assessment documentation. This home does not accept emergency admissions. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 8 Intermediate care is not offered at this home. Although respite is offered if a bed is available. On arrival at the home a respite resident was being discharged home, which was in another home in Cambridgeshire. The husband had requested a bed for his wife so that they could have a holiday ‘by the sea’. The home had also arranged a room for the husband on the site. The husband was very complimentary about the home and the organisation of the holiday. “We have had a lovely week – we have been able to go to the beach everyday. The staff have been so accommodating and caring to both of us.” Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 &10 Health, personal and nursing care is good in this home. Care plans are user friendly and detailed, but need more frequent review. Privacy & dignity is observed throughout the home. EVIDENCE: Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 10 All indicators examined during this inspection suggested that the service users’ health and personal care needs were well catered for. Three care plans were reviewed during this inspection. Overall the care plans in this home were detailed and reviewed regularly. Some changes made were in the evaluations rather than on the action plan itself. Two of the plans reviewed were of residents who had been at the home for a number of years; they had both been regularly reviewed but had not been rewritten for a considerable number of years. The newer residents care plan was much better constructed and demonstrated evidence of changes being made to the action plan as the residents’ condition deteriorated. Two of the care plans were signed by the resident and the staff were in the process of getting all signed by either the residents, or their relatives. The mental health status of each resident was reviewed every three months. Pressure area care was good and equipment for the prevention of sores was observed in use throughout the home. Residents were given access to all medical professionals needed, or requested. The residents were all registered with a number of different local GP’s. A list of every resident’s GP is kept in the front of the medication administration records file, for easy reference. At the time of this inspection all residents looked clean, tidy and in age appropriate clothing. Nails and hair were all clean. One relative told the inspector, “Personal care is excellent. Mum is really well looked after. She really likes it here.” A resident said, “Staff are so kind I can do whatever I want when I want to.” The staff demonstrated good links with local specialist nurses, especially the tissue viability nurse, who would attend the home when asked and would give advice over the telephone if necessary. Medication procedures were good. The Registered Nurses administer all medications. There were high levels of medications prescribed due to the high dependency of most of the residents at the time of this inspection. The inspector and deputy manager discussed the problem of discontinued medications still appearing on the medication administration records. This is a problem generated by the either the GP surgeries or the dispensing pharmacist. The manager was going to tackle this problem following this inspection as it made the forms rather confusing for some of the residents. All observed interactions between staff and service users, demonstrated a commitment to protect the privacy and dignity of the service users. Observed interactions were very good and practices concerning personal care were good. Some of the residents had their own telephones but there was also two pay phones in the home, which can be ‘plugged’ into the phone sockets in the residents rooms if they wish to use them in private. Residents were all in age appropriate, well-laundered clothes. Service users and relatives stated that staff were friendly, approachable and helpful. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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 standard(s) 15 Food is varied, of good quality and presented well at this home. EVIDENCE: All the residents and visitors spoken to during this visit said that the food was very good and there was a lot of choice. The lunchtime period was relaxed and care assistants were helping residents to eat in a very respectful way. On admission residents were consulted about their nutritional and dietary likes/dislikes. At the time of this inspection there were three residents who were diabetic in the home. Snacks and drinks were available on request at all times of day and night. Some visitors regularly had meals with their relatives. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 12 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) EVIDENCE: None of these standards were reviewed at this visit. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 13 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 environment of this home is good, light and airy. The home had a pleasant atmosphere for the residents to live in. EVIDENCE: Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 14 There had been no change to the fabric of the building since the last inspection. The home was very clean, bright and open. The grounds were well kept and accessible for all residents, a lift conveys residents upstairs. The surroundings are very rural and there is a nice view from each room. There is a large lake to the rear of the building that is not directly accessible by the residents. The maintenance person had an area under the stairs at the front of the building that was acting as his ‘office’ at the time of this inspection. There had been further redecoration in various parts of the home, in light, muted colours; residents spoken to thought it had been done nicely and to their ‘tastes’. The maintenance person was very busy and told the inspector that he spent most of the summer in the grounds and the winter maintaining the interior of the home. Individual rooms were redecorated between residents. The front entrance and open area at the top of the stairs are used as sitting areas for the residents to compliment the main communal areas. There were residents sitting in these areas throughout this visit. One resident said “I like seeing everyone walk past and the staff often stop and chat, I can read my book and just watch the world go by.” Staff were observed to check on residents frequently in all the communal areas in the home. Residents are encouraged to bring in their own items of furniture and personal items. Some of the residents in this home also had their own duvets and bed coverings out of choice. All residents had nursing beds. Both sluices and all bathrooms/ensuite viewed were clean and tidy. Hoists had been serviced regularly and staff were observed using them appropriately. The maintenance person carries out all routine checks and day-to-day repair work needed. At the time of this inspection he was mending resident call bells. Although there were a number of adaptations throughout the home it would still benefit from an Occupational Therapist assessment of the home. This home does not have any CCTV. Decoration, furnishing and lighting throughout is homely. The day of this visit was a very wet humid day, but the housekeeping and care staff had made sure that the home was fresh and cool. There were no unpleasant odours throughout the home at any time during this visit. The general cleanliness of the home was excellent. All staff attended hand washing and infection control training sessions. The laundry, which is in a separate building, was clean and tidy; all equipment was serviced regularly and met the requirements of the national minimum standards. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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 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) EVIDENCE: None of these standards were reviewed during this visit. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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 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. The overall management and administration of this home is good ensuring the residents are safety. EVIDENCE: The overall ethos of care in this home was very good. Staff spoken to felt that the manager and his deputy were approachable and supportive. The residents said they saw the manager daily and that there were always staff around to talk to and to help them as needed. Visitors felt welcomed and said that the staff worked as a team to look after their relatives safely. One visitor spoken to had a meal every day with their relative. The manager had been registered with the local office of the Commission for Social Care Inspection since the last inspection. The manager is a experienced registered nurse who has been a care home manager for a number of years, having worked in a number of Care UK homes. Care UK have a quality assurance programme that is guided by clinical governance. Internal auditors carry out an audit yearly and a quality improvement plan is agreed following the audit. Resident meetings are arranged as needed; the last one had been in the previous May and only three residents had attended. The manager tries to get Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 17 to see all residents separately on a daily basis to discuss any problems. Residents and visitors confirmed that he was frequently around the home and, along with the staff, is approachable. All insurances, servicing and certificates that were checked during this inspection were up to date. There was no evidence of financial difficulties on the home. The procedures and documentation concerning service users’ money were good and easy to follow. Four residents monies were checked and they were correct. The manager and administrator were not appointee for any of the residents. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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 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 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 3 3 3 x x x Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2b-c) Schedule 3(1b) Requirement Regular reassessment and rewriting of long term residents care plans must be undertaken to reflect current care being given. Timescale for action 31st October 2005 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. Refer to Standard 9 22 Good Practice Recommendations Medication administration records should be rationalised to remove discontinued medications and prevent mistakes in administration occuring. Occupational Therapy assessment of the whole home should be carried out. Little Holland Hall Nursing Home I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 I56-I05 S15325 Little Holland Hall V235836 050705 Stage 4.doc Version 1.40 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. 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