CARE HOMES FOR OLDER PEOPLE
The Hollies Nursing & Residential Home Church Street Clayton-le-moors Accrington Lancashire BB5 5HT Lead Inspector
Mrs Janet Proctor Unannounced Inspection 09:30 2nd & 14 December 2005
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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 The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Hollies Nursing & Residential Home Address Church Street Clayton-le-moors Accrington Lancashire BB5 5HT 01254 381519 01254 395477 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) The Hollies Nursing & Residential Home Limited Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (2), Physical disability of places over 65 years of age (36) The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Within the overall total of 42 a max of 36 service users requiring nursing care who fall in the category of PD (E) Within the overall total of 42 a max of 32 service users requiring personal care of the category OP Within the overall total of 42 a maximum of 2 service users requiring personal care who fall into the category PD Staffing for service users requiring nursing care will be in accordance will be in accordance with the Notice issued on 4 November 1996. The registered provider shall at all times, employ a suitably qualified and experienced person who is registered with the National Care Standards Commision as manager of The Hollies Nursing and Residential Home. 18th August 2005 Date of last inspection Brief Description of the Service: The Hollies provides 24 hour nursing and personal care for up to 42 people. The registered providers are The Hollies Nursing & Residential Home Ltd. The day-to day management of the home is undertaken by one of the registered persons and there is a Registered Nurse who takes responsibility for the care management of the residents. The home is situated in Clayton-Le-Moors close to local amenities including a park. The home is a large detached property with gardens, which are easily accessible to all service users. A parking area is available for use by visitors and staff. Accommodation is provided in single or twin-bedded rooms. There are no en-suite rooms but toilet and bathroom facilities are within easy reach of all rooms. A passenger and stair lift facilitates access to all areas of the home. Communal lounges and dining rooms are located on the ground floor.The home is situated in Clayton-Le-Moors close to local amenities including a park. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one and a half days on the 2nd & 14th December 2005. The previous inspection was done on 19th July 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk. No additional visit had been made since the previous inspection. On the day of the inspection there were 34 residents at the home. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to 5 residents, one of the registered persons, the Care Manager, 3 staff members and 1 visitor. Nine questionnaires were returned from relatives/visitors. Wherever possible the views of residents were obtained about their life at the home. Due to memory and communication difficulties, some of the residents were unable to engage in conversation or make comment about their experience of living in the home. Detailed notes were taken, which have been retained as evidence of the inspection findings. The issues below are based on the standards assessed on this inspection. What the service does well:
Staff at The Hollies ensured that residents had a thorough assessment of their needs before admission. They then wrote a plan of care that identified the personal and health care needs. The care given to residents was in a friendly and professional manner. There was a good rapport evident between residents and the staff. Residents said, “The staff are very nice. You get on better with some than others, but they all look after you”, and “I’ve settled in well and I’m happy here. Everybody’s very nice, the people who live here and the staff. They take good care of us”. A visitor said, “I think they’re well looked after. My mum’s always happy when I come”. A comment on one of the questionnaires returned said “ Everything is taken care of in the best possible way and (my mother) is content with all they do for her.” All of the questionnaires said that they were satisfied with the overall care provided. In addition to the usual staff numbers there were extra on duty over the lunchtime and teatime period. This meant that all residents received enough attention during the mealtimes. The Registered Nurses also had an overlap of one hour so that they could give each other full information on resident’s conditions. All except one resident spoken to said that they felt there were enough staff on duty. The medications in the home were well managed. The records of these were complete and accurate. This promoted and safeguarded the health of
The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 6 residents. One of the Registered Nurses also worked 10 hours where she was not included in the staffing numbers. This was so that she could manage the medications in the home. Staff spoken to said that they felt well supported by the management team of the home. Recently employed members of staff said that they “had been made to feel welcome and part of the staff team”. All staff spoken to described the management team as being approachable. They said that they would have no hesitation in going to them with any problems. Staff said that they received training so that they could do their job properly and well. What has improved since the last inspection? What they could do better:
The plan of care should be amended to show any changes in a resident’s moving and handling needs. This is so that staff always use the right method and equipment. The plans of care should also include details on how to reduce the risk of pressure sores. This is so that staff give the correct care to a resident who is at risk. The procedure for the disposal of medications should be reviewed before the new system starts. This is so that staff know what to do when medications are no longer needed in the home. The staff should also sign and witness any handwritten additions to the Medication Administration Recording charts. This is to ensure that the details are accurate. The temperature of the drug storage room should be reduced if it goes over a certain temperature. This is so that the medicines do not spoil. When the arrangements for Protection of Vulnerable Adults and dementia care training have been completed all members of staff should attend this. This is so that they receive additional skills and knowledge. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 7 The registered person who does the day-to-day management of the home must make an application for Registered Manager to the Commission. This is so that the Commission can be satisfied that she has the qualities and qualifications to undertake her responsibilities at the home. The results of residents’ surveys should be made available to residents and their visitors. This is so that they can see that the information from the surveys has been read. They can also make comparisons between the results of surveys and see what areas have improved. 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. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 8 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 The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 9 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 Residents received a full assessment prior to moving into The Hollies with the result that their needs were known and met. EVIDENCE: Three resident’s files were examined. These showed that it was usual practice for the care manager to visit and assess prospective residents before offering them a place at the home. One file also contained copies of assessments completed by health and social care professionals. Following the assessment prospective residents received a letter confirming that their needs could be met at the home The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Resident’s healthcare needs were identified and met. The medications were well managed and ensured that residents were safeguarded. EVIDENCE: The individual care plans of 3 residents were inspected. These identified the personal care needs of each resident and, apart from one, had been written on the point of admission. The plans stated whether the resident needed prompting, assistance or full help. Staff spoken to said that they read the care plans. Care plans were reviewed monthly. There was little evidence in these plans that residents or their relatives had been involved in the care planning process. Eight of the questionnaires returned said that they were kept aware of important matters affecting their relative/friend. Appropriate assessments for prevention of falls, prevention of pressure sores, nutrition, and moving and handling needs were undertaken. Directions were given to staff on how to meet these needs. One of the plans said that a resident needed a hoist and sling for moving and handling needs. Staff spoken to said that the resident now walked short distances with the help of two carers. One of the care plans contained insufficient information to staff about how to prevent the formation of pressure sores. The presence of any wounds
The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 11 was noted in the plan of care and a dressing plan prepared. There was no evidence of wound assessment being done, although charts were available for this. Residents were registered with a GP of their choice and other professionals and specialists were contacted for advice when necessary. There were policies and procedures for all aspects of medication management. The method of disposing of the medications was on the point of being changed so that procedure needed to be updated. There were records for all aspects of the process of ordering prescriptions up to the medications being received at the home. The medications were stored in a separate, clean, room that locked. The temperature of this room had exceeded 25 º on some instances. There were adequate cupboards for the storage of the medications. There was little excess stock kept. The Controlled Drugs were stored and recorded properly and the balance was correct. No resident administered their own medication, this was done by the Registered Nurse on duty. Each resident had a Medication Administration Recording chart that listed their medicines, when they were to be given, and who had given them. These were completed accurately. Handwritten additions to the MAR charts were not always signed and witnessed. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed on this inspection. They had all been looked at on the inspection on 19th July 2005 and no requirements and recommendations were made. EVIDENCE: The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 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): 18 The procedures at the home ensured that residents were protected from abuse. Training for staff is needed to ensure that they are able to recognise and react correctly to any instances. EVIDENCE: There was a Whistle blowing procedure and an appropriate procedure for staff to follow should they suspect or witness an incident of abuse. These issues were discussed with staff during the Induction period. The Care Manager had recently completed a course so that she could start to give Protection of Vulnerable Adults training to staff. A video with an assessment question and answer sheet had also been purchased to compliment the training. Therefore, training on Protection of Vulnerable Adults was being arranged for staff but had not yet been finalised. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 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): None of these standards were assessed on this inspection. They were all looked at on 19th July 2005 and no requirements or recommendations were made. EVIDENCE: The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 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, 29 and 30 The numbers, skill mix and competencies of staff on duty met residents’ needs. The recruitment procedures were thorough and ensured the protection of residents at the home. EVIDENCE: There was a duty rota showing the names and grades of staff and what hours they worked. The number of staff rostered for duty was sufficient for the number of residents living at the home. One resident said that she felt that the staff were, “Always rush, rush, rush. They’re all too busy”. However, there was no evidence that this was the case. There was a Registered Nurse on duty 24 hours per day. There was at least one member of Domestic staff on duty each day and there were an additional 20 cleaning hours allocated for carpet cleaning. There was a Cook and a Kitchen Assistant on duty each day. There was an overlap period of one hour over lunchtime and teatime when the number of carers on duty was increased. There was also an overlap of one hour between 5.00 pm and 6.00 pm for the Registered Nurses on duty. This enabled them to give a thorough report on the residents’ conditions. Staff spoken to said that they were satisfied with the number of staff on duty. The recruitment procedures included completion of an application form, a faceto-face interview, obtaining of references and a POVA First and CRB check. The files for 3 new employees were checked. These showed that the procedures had been followed and all relevant details had been obtained. All files had proof of identity, including a photograph.
The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 16 All new employees received an Induction programme that covered: fire safety; moving and handling; health and safety; management issues; and working practices. A recently employed member of care staff confirmed that she had done the Induction programme and that she had worked under supervision when she first started. A recently employed Registered Nurse was still shadowing another until she felt confident working in the home. In-house training was also done. Arrangements were in the process of being made for training on the care of residents with dementia. This had not yet been finalised. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 17 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, 35 and 38 Residents lived in a home that was well run. The use of surveys and meetings enabled residents to give their views and ensured that the home was run in their best interests. The procedures for managing residents’ finances ensured that these were safeguarded. The health and safety of residents and staff was promoted by the wearing of appropriate footwear. EVIDENCE: The day-today administrative management of the home was done by one of the registered persons. She had many years experience of running a care home and was currently doing the NVQ level 4 Manager’s Award. An application for Registered Manager needs to be made to the Commission to formalise this arrangement. A designated Registered Nurse took responsibility for care issues. There was a job description for Manager and the responsibilities on this were divided out between the registered person and the care manager.
The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 18 The home had the Investors in People award and had recently been audited by them and had this renewed. They used surveys as a means of getting the views of residents. These were done about every three months and completed forms were seen. The forms covered questions about: care; attitude of staff; visitors; privacy and dignity; activities; food; their bedroom; and anything they particularly liked or disliked about the home. The information from the surveys was not available to residents or others. Residents meetings were also held. The last one of these was in September 2005 when residents talked about the trips they would like to do before Christmas. Staff meetings were held for Registered Nurses and the Cooks. Carer meetings were not held as a routine, but arrangements were being made to address this. The arrangements for handling residents’ money were safe. They ensured that these were kept in a safe manner and that there were records to demonstrate what money had been deposited and withdrawn. The registered person who managed the home was appointee for one resident. Money was held in a safe for some residents. The balance of money held for three residents picked at random was checked. This was found to be correct with the balances recorded. Receipts were given for nay money or valuables handed over for safekeeping. At the time of this unannounced inspection all staff were seen to be wearing appropriate footwear. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 19 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 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action 1. OP31 8 An application for registered 14/01/05 manager needs to be made to the Commission. 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. 4. 5. Refer to Standard OP7 OP8 OP8 OP8 OP9 Good Practice Recommendations There should be evidence that residents or their representatives have been consulted about the plan of care. Detailed information about the strategies used to prevent the formation of pressure sores need to be included if a resident was identified as being at risk. The moving and handling details in the plan of care should updated as the condition of a resident means that these change. An assessment should be done of any wounds so that there is a measure of whether they are improving or not. The procedure for the disposal of medications should be reviewed so that the new system is documented. Records should be kept of all medicines returned. All handwritten entries to the Medication Administration Recording charts should be signed and witnessed.
DS0000022498.V269437.R01.S.doc Version 5.0 Page 21 The Hollies Nursing & Residential Home 6. 7 8. 9. OP9 OP16 OP30 OP33 Arrangements should be made to reduce the temperature of the drug storage room if the temperature exceeds 25 º C. Formal training for staff in Protection Of Vulnerable Adults should be undertaken by all staff. Training in dementia care should be arranged. The information from resident surveys should be made available to residents, visitors and other interested parties. The Hollies Nursing & Residential Home DS0000022498.V269437.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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