Care Home: Halliwell Nursing Home

What the care home does well The home has consistently high standards in keeping the home clean and well presented. This is especially difficult during this time of building work, and the housekeeping staff are to be commended.Residents are confident that staff will answer their bells quickly, and will assist them as needed. The staff are mindful of preserving their privacy and dignity. The home has a very enthusiastic activities co-ordinator, who is highly committed, and uses every opportunity to find things for residents to enjoy. She is assisted by a committee of the "Friends of Halliwell", who take their part in helping to organise events, and in spending time with residents on an individual basis. The food is well prepared, home cooked, and provides a good variety. Dining tables are attractively laid with clean tablecloths and fresh flowers, enhancing the daily dining experience. Staffing levels, recruitment and training are well managed, providing the home with a competent and well-trained staff team. What has improved since the last inspection? The manager has enrolled the home with "Care Aware", who will provide an advocacy service, and offer their support to new residents and enquirers. The home has introduced the "Liverpool Care Pathway" for residents who need end of life care. This is a specific programme, which is set up to ensure that residents` wishes are followed, and to provide consistency of care across all health care professionals delivering care at the end of life. The activities co-ordinator has developed an e-mail service for residents who have family members living abroad. She will keep relatives informed as to events that take place in the home, and pass on their e-mailed letters to the residents. Catering services are now provided by in-house staff, instead of the previous arrangements for outside catering. This ensures better rapport with residents, and a higher commitment to meeting their dietary preferences and requirements. The home has developed the complaints procedure, by putting the data on to a CD disk, for the benefit of anyone with impaired vision. There have been ongoing improvements with refurbishment in the home, including redecoration of several bedrooms, communal areas, and corridors. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Halliwell Nursing Home Kingswood Road Tunbridge Wells Kent TN2 4UN Lead Inspector Mrs Susan Hall Unannounced Inspection 29th July 2008 09:10 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 Halliwell Nursing Home DS0000064706.V367470.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. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halliwell Nursing Home Address Kingswood Road Tunbridge Wells Kent TN2 4UN 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) 01892 525909 01892 516470 dee.serls@efhl.co.uk Elizabeth Finn Homes Ltd Mrs Gillian Pollok Forsyth Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time the service may admit service users under 65 years of age. 1st August 2006 Date of last inspection Brief Description of the Service: Halliwell Nursing Home is a purpose built home with three floors, dating from the 1970s and with later additions. It is owned by Elizabeth Finn Homes Ltd., who are care providers with another ten care homes spread across England. Their web site contains details of the other homes. The philosophy of the company is to “provide the highest standards of care within convivial surroundings.” Halliwell is situated in a residential area of Tunbridge Wells, near to the famous Pantiles area. The home overlooks Dunorlan Park, and has views across the countryside. It has its own extensive grounds, covering an area of six acres. There is easy access to public transport including a main line station. The home can be easily reached by car, and there is sufficient parking for staff and visitors at the front of the house. Accommodation is in single rooms on two floors. All rooms have en suite toilet facilities and wash basins. Some rooms have patio doors on to a courtyard area. There are two passenger lifts providing access between floors. The home is currently in the process of going through an extensive building and refurbishment programme. This is being carried out with the minimum of disruption to residents possible. Current fees are set at £1,055.00 per week. Some residents may be entitled to receive financial support from the local authority or primary care trust because of their individual financial or health circumstances. These are assessed on an individual basis. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of excellent, 3 stars. This was a key inspection, which includes assessing all key national minimum standards. Many other standards were also assessed, so as to give a comprehensive view of the home. The inspection process involved assessing all information received about the home since the last inspection – such as letters, phone calls, and formal notifications; sending out survey forms to residents, health professionals and staff – for which seven were received back; and a visit to the home which lasted for seven hours. The visit was carried out by one inspector, and included viewing the facilities; reading documentation such as care plans, staff files and maintenance files; and chatting with three residents, one visitor, and ten staff. The home was spotlessly clean in all areas, and well presented, in spite of the ongoing building work. Residents stated that the inevitable disruption has been kept to a minimum, and a recent residents’ forum meeting concluded that there was “not too much interference” from noise and additional dust. The company are building an additional unit for fourteen residential beds, as well as carrying out internal refurbishment for many areas. The work is being carefully done in different phases, and the builders have a notice board to provide details for residents and visitors about the next stages of the work. There is less access to the grounds at present, and some residents have expressed disappointment with this. However, the home still has several courtyard and patio areas available, which are attractively presented with suitable garden furniture and flower tubs/baskets. Staff were seen carrying out their duties calmly and with respect. Residents stated on the day, and in survey forms, that the staff are “most attentive”, and “caring and helpful”. A relative stated that “the staff are excellent, and I am confident that my relative is in good hands”. What the service does well: The home has consistently high standards in keeping the home clean and well presented. This is especially difficult during this time of building work, and the housekeeping staff are to be commended. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 6 Residents are confident that staff will answer their bells quickly, and will assist them as needed. The staff are mindful of preserving their privacy and dignity. The home has a very enthusiastic activities co-ordinator, who is highly committed, and uses every opportunity to find things for residents to enjoy. She is assisted by a committee of the “Friends of Halliwell”, who take their part in helping to organise events, and in spending time with residents on an individual basis. The food is well prepared, home cooked, and provides a good variety. Dining tables are attractively laid with clean tablecloths and fresh flowers, enhancing the daily dining experience. Staffing levels, recruitment and training are well managed, providing the home with a competent and well-trained staff team. What has improved since the last inspection? What they could do better: Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 7 Personal healthcare is well delivered, but some of the documentation could be further improved. This includes: • Showing how decisions made about the use of bed rails are discussed with the resident/next of kin, pointing out the risks associated with using bed rails. Clearly demonstrating how decisions regarding care are made in line with the Mental Capacity Act 2005, especially for residents who have limited capacity due to cognitive impairment associated with illness or old age. Ensuring that consent forms include the printed name, signature, and date of the people who sign these. Ensuring that all residents have a completed property list showing any items of furniture or sentimental value which belong to them. • • • Medication management needs to show that all nurses have a proper understanding of their accountability and responsibilities in administering medication according to the Royal Pharmaceutical Society guidelines, and in line with the NMC (Nursing and Midwifery Council) codes of practice. This includes ensuring that each drug administered is appropriately signed for; and ensuring that any hand written entries are signed for by two nurses/ appropriate staff. The complaints procedure on display in the front entrance hall, and included in the welcome packs should include timescales, showing when complainants will receive a response. 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 summary of this inspection report can be made available in other formats on request. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 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 Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (Standard 6 does not apply in this home). Quality in this outcome area is good. The home provides prospective residents with clear and detailed information, enabling them to make a choice about coming into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and the service users’ guide are very well produced, and are on display in the entrance area. They provide clear details of the home and management, including the management structure. Each resident is given a copy of these as part of the “Welcome Pack” on admission to the home. A separate colour brochure is provided for people who are making enquiries about the home. All residents have a pre-admission assessment, which is carried out by a trained nurse. We (i.e. CSCI) examined three pre-admission assessments. They show the person’s medical history and diagnosis; their usual general Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 10 health; social preferences; mental state; and medication records. They are designed so as to assess all aspects of the person’s needs. Those viewed had been completed satisfactorily. Each resident (or their representative) is provided with a detailed contract, which includes terms and conditions of residency. This documentation can be provided in large print on request. The contract shows if the resident is for respite/long stay/convalescent care; and a breakdown of the fees – showing what is and is not included. For example, the fees include full board and twenty-four hour nursing care; but do not include hairdressing, chiropody, newspapers, transport, phone charges, toiletries, physiotherapy, or dry cleaning. Required notice periods are included as forty-eight hours if the home cannot meet the needs; or for the home – if the resident’s behaviour is unacceptable or detrimental to other residents. There is very clear data about insurance. All admissions are for an initial trial period, with an assessment at the end of this time to determine the suitability of the placement. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is good. Residents are confident that they will receive good standards of care, and that their health needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans are set out in individual folders, and are stored in residents’ own rooms. The storage is discussed at admission, and the resident’s agreement is obtained for the care plan to be stored in their room. This provides them with access to the plan whenever they wish, and full involvement in the setting up of care plans, and how the care is to be delivered. It may also give access to other visitors/relatives to the care plan, which could undermine confidentiality. These matters are therefore discussed thoroughly as part of the admission process. We viewed three care plans as part of the inspection process. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 12 Care plans not only include a photograph of the resident, but also of the named nurse, night named nurse, and key worker. This is a thoughtful touch to help new residents to quickly become familiar with key staff. Care plans follow all of the “Roper’s” activities of daily living – such as communication, eating and drinking, personal hygiene, mobility, activities, and sleeping. The home uses a computerised system, so all care plans are typed, and show the name and date of the person who has written or updated the care plan. Each plan is accompanied by appropriate charts and risk assessments. For example, communication care plans show if the resident has hearing/sight/speech problems; if they can understand information, and if they can make their needs known. Eating and drinking care plans include a nutritional assessment; and personal hygiene care plans include risk assessments for use of bathing hoist if indicated, and the risk of developing pressure ulcers. Wound care is sufficiently detailed, with additional reports entered directly on to the computer system, and filed separately. Photographs of wounds are taken at each dressing change, as an additional method for demonstrating the progress of healing. The clinical care manager stated that verbal consent is obtained for taking any photographs. Written consent may be more appropriate. Most risk assessments show sufficient details, for example: the type of mattress in place for providing pressure relief; or that bed rails are to be used to prevent falls. However, risk assessments in regards to the use of bed rails do not show that the residents (or their representatives) are fully informed about the risks of using bed rails, such as entrapment, and these documents could be further clarified. Moving and handling risk assessments show when a hoist is needed, and the accompanying care plans indicate the type of hoist, and the size of the sling to be used. Care plans demonstrate that referrals are made to other health care professionals as needed, such as GPs, speech and language therapist, dietician, and physiotherapist. The home has developed use of the “Liverpool Care Pathway” during the past year. This is a format for agreeing and arranging for specific details in regards to end of life care, between all health professionals involved. The home has a good relationship with the local Hospice, and have some residents for longer term care referred from there. Wishes in regards to death and dying are discussed sensitively between the resident and other parties, so that there is clarity about following their choices. The home records if a decision is made in the event of emergencies – i.e. if the resident would wish to be resuscitated or not. Three forms were viewed. One of these had been signed by a doctor and a nurse, but the names were not printed, and signatures may not be easily recognisable. Another form showed Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 13 clearly that a resident, their next of kin, the GP and a nurse had discussed this matter together, but only the GP had signed the form. The resuscitation forms do not show how the Mental Capacity Act has been applied, but the clinical care manager said that this evidence is kept in separate written files. The resuscitation forms could include this evidence for further clarity. Daily reports are written by the nursing staff, and there are good systems in place to ensure that care staff keep them informed of any changes observed. Medication storage was inspected on the First Floor (Elizabeth unit), and Medication Administration Records (MAR charts) were inspected for both floors. The clinical rooms are being re-located to other rooms in due course, as part of the refurbishment programme. The current rooms provide satisfactory storage areas. There is a good system in place for daily checks for: the drugs fridge and room temperatures; checks for controlled drugs; and medical equipment such as the suction machine. One nurse on each floor is responsible for overseeing the ordering of medication for that floor; but whichever nurse is on duty is responsible for checking in drugs as they are delivered. The home uses a monitored dosage system (blister packed). Storage was satisfactory except for one external cream being stored next to tablet medication. Homely remedies are kept in the home in accordance with a signed list agreed with the visiting medical officer, (who is the GP for many residents). There are good records kept of these for auditing purposes. There were many signatures missing on the MAR charts from the previous night shift. This had already been identified and pointed out by the day nurse to the clinical care manager, and was being addressed. However, there were a number of signatures missing at other times as well, and on both floors. This does not demonstrate good practice in giving medication, and correctly signing immediately after for each item administered. The home has a policy that all handwritten entries should be signed for by two nurses, but several entries had only been signed for by one nurse. There is a requirement to ensure that all nurses are reminded of their responsibility and accountability in regards to administering and recording medication accurately. Some residents wish to manage their own medication, and this is allowed after a risk assessment has been completed, and demonstrates that they are able to manage their own medication safely and effectively. Nursing and care staff were observed to be carrying out care sensitively, and respectfully. A health professional stated in a survey that all staff are “good, positive, and understand residents’ needs; and it is the most caring home I have visited in many years of working in them. All staff I have come into contact with have exceptional skills.” Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is excellent. Residents’ benefit from a wide variety of group and individual activities. Food is well managed and is of good quality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs a full time social care co-ordinator, who is extremely motivated, and ensures that there is a wide variety of ongoing activities and clubs for residents to join in with as they wish. There are group activities such as music and movement, flower arranging, scrabble, cream teas, coffee mornings, and bingo. Clubs include a bi-weekly music club for listening to light classical music; a monthly poetry club, and a craft club. The home has a small shop, which is open every Thursday morning, and this also includes a venue for residents to do crosswords together, and have coffee or a glass of sherry. Library books can be changed on a weekly basis, and this is very helpful for individual residents who like to read a lot. The home has visits from an aromatherapist, and three hairdressers. A new beauty salon has nearly been completed, and will provide a very pleasant and Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 15 well-designed area for hairdressing, manicures and other beauty treatments. This includes soft lighting, mirrors, hot and cold drinks etc. Residents can have therapies in their own room if they prefer to do so. Activities are clearly displayed on notice boards, and each resident is provided with a copy of the daily “Halliwell Times”. This is the home’s newspaper, and details any items of interest each day. The home has a group of people who are the “Friends of Halliwell”, and who assist the activities co-ordinator with events and outings. They have regular meetings to identify changes, and to discuss new ideas. They also accompany residents for appointments or for outings. The home has a minibus, and three staff are insured to drive this. It can take three to four residents in wheelchairs, and is ideal for taking residents out to shops, hospital appointments, or theatre visits etc. Fashion sales are held in the home four times per year, (enabling residents to choose and buy their own clothes); and there are special events such as Opera nights, birthday teas, and invited entertainers. Visitors are welcomed into the home at any time, in accordance with the residents’ wishes. The day before the inspection visit, a hot air balloon had landed just outside the grounds, and the co-ordinator had taken some photographs of this as it was landing. She had turned this into a competition for residents to come up with the best caption for the photos. This demonstrates how innovative she is, and able to notice and use any opportunity for residents’ enjoyment. The home enables residents to take part in religious observances. There is a monthly Sunday service, when residents are invited to take part e.g. giving a reading or a prayer. There is also a monthly communion service. Residents are able to bring in their own possessions/small items of furniture, to personalise their own rooms. These items are not recorded, and it is recommended that a property list is held for each resident to ensure there is no confusion. The food is prepared in a kitchen on the ground floor. This is a temporary venue, as there will be a new kitchen as part of the building alterations in due course. A hotel services manager oversees all of the catering, housekeeping and laundry. The kitchen has a main cooking area and a separate washing up area. The home was given a gold hygiene award for the kitchen at the last environmental health visit. There is always a chef on duty from 07.00 – 18.00, and the chefs work alongside each other for three days a week, so there is lots of opportunity to discuss changes in menus. Nursing and care staff carry out basic food hygiene training, and are familiar with the important details for assisting people with their meals, such as ensuring they are sitting up comfortably etc. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 16 Residents have a choice of three courses for lunch and dinner, and there is plenty of choice at breakfast. Mid-morning coffee, afternoon tea and cakes, and evening drinks are served, and snacks can be requested at any time. Each floor has a satellite kitchen, which is kept stocked with items for snacks and drinks. Residents have a printed menu each day, and are reminded of the choices available. Residents said that the food is excellent, well-presented and using fresh ingredients. All of the food is home cooked. The catering service is now provided in house – as opposed to previously being by outside caterers. This provides a higher level of commitment for ensuring that individual wishes and dietary requirements are met. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents know that their concerns and complaints will be taken seriously, and will be properly addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is on display in the front entrance hall, and is included in the service users’ guide, and in the welcome pack for each room. The procedure does not include timescales, and these need to be added in. The policy states that responses will be made within twenty days, but people reading the procedure do not have this information. The complaints policy is sensitively prepared in a CD version, as well as in larger print. The home had received two complaints during the past year. The correspondence in the complaints log showed that these complaints had been taken seriously, and had been properly investigated by the manager. Residents feel confident that they will be listened to, and said they would speak to the nurse on duty or the manager if they had any concerns. All staff are trained in the recognition and awareness of abuse. The training is incorporated in the induction training, and is then updated on a yearly basis. The staff training matrix confirmed that all staff are being kept up to date with this, and are aware of the action to take for any suspicion of abuse. They are Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 18 required to read and understand the whistle-blowing policy, and have had training in the Mental Capacity Act 2005 – in respect of determining if individual residents have the capacity to understand specific information, and to make their own decisions. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19-22, & 24-26 Quality in this outcome area is good. The home is going through an extensive programme of new building and refurbishment. It is being well maintained throughout this process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently in the middle of extensive alterations and new building work. This is being done very sensitively and with due consideration for health and safety measures. Some residents said the building work is causing a lot of dust, and is obviously noisy at times, but that the cleaning staff work very hard to keep everywhere dust free. The building was immaculately clean in all areas, and the housekeeping staff are commended for their vigilance and hard work in this respect. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 20 The builders are now providing a weekly update to enable residents and relatives to keep up with the changes, and these are displayed on a notice board in the entrance hall. The work includes new building for sixteen residential beds, and new landscaping of the gardens. There will be many pleasant areas in which to walk and sit, and the home has excellent views over nearby Dunorlan Park, and the surrounding countryside. The management team have worked hard to ensure that there is sufficient outdoor space for residents to sit in the meantime, as there are a number of patio and courtyard areas available. These contain attractive garden furniture, and plenty of flowers in borders, tubs etc. The home employs two maintenance men, and one specifically oversees the gardens as well as taking part in ongoing decorating and repair work. There is a planned ongoing maintenance programme, as well as responding to any repairs needed. The home has a good quality nurse call system, which shows where the bell is coming from, and how long it takes before a response is made. There are a variety of communal areas, with a mixture of lounges, sitting areas and dining rooms. The main dining room was closed for alterations, and a room on each floor had been set up for dining instead. The residents appreciated the intimacy of these rooms, and the beautifully laid tables with fresh flowers. Accommodation is provided on two floors – “Constance” and “Elizabeth” after the founders. All rooms are for single use and have en-suite toilet facilities. Each room has an adjustable bed, and an appropriate mattress/pressurerelieving mattress for the individual needs of each resident. The home has a suitable number of shared toilet and bathroom/shower facilities. There are different types of assisted baths, so that they meet the needs of different people. Some of the shower facilities are being refurbished. The home is well equipped with other items such as grab rails and hoisting facilities; and there are sluice facilities on each floor. All radiators have low surface temperatures for safety; and hot water outlets have individual thermostats. The maintenance men check these temperatures, and the manager audits these records on a monthly basis. The home has a large laundry on the ground floor, which has separate dirty and clean areas for the effective management of infection control. There are designated laundry staff on duty each day. The laundry has two commercial washing machines and tumble dryers. Residents said that the laundry is well managed, and they get their clothes returned promptly. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. The home has a competent, caring and efficient staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has two nurses on duty throughout the twenty-four hour period. This provides one nurse for each floor, and the opportunity to work together and discuss any issues that arise. In the mornings there are eight care staff (four for each floor) and a total of five in the afternoons and evenings. This means that there are always two groups of care staff who can assist residents in pairs, and one additional carer. There are three carers on duty at night. Care staff who have completed NVQ 3 training are employed as nursing assistants, carrying more responsibility, and working directly to assist the nurses. In addition to nursing and care staff, there are housekeeping staff each day, a chef and food services’ assistants, laundry, maintenance and administration staff. The kitchen, housekeeping and laundry services are now provided inhouse (previously contracted out). This has promoted improvements, and a greater commitment to the care of the residents. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 22 The home is currently lower in numbers than usual, as some bedrooms have been taken out of commission during the refurbishment and building work. There were thirty-one residents on the day of the inspection. Numbers will be increased to sixty-six residents eventually, and staffing numbers will be increased accordingly. The home currently has 16 out of 30 care staff trained to NVQ levels 2or 3, making this a percentage of 53.3 , which is a good ratio. The home encourages and supports staff in carrying out this training. Recruitment procedures are well managed, We read three staff files and they included all required checks – i.e. photograph and proof of ID, POVA first and Criminal Record Bureau (CRB) checks; two written references; training records; and a health declaration. The home checks Nursing and Midwifery Council (NMC) records for nursing staff, and retains an interview record. The induction programme has been further developed during the past year, and is more detailed. All staff carry out mandatory training in fire awareness, manual handling, first aid, health and safety, infection control, and POVA. Ongoing training is provided in house and with some external courses. Staff files included training in person centred care, COSHH, Mental Capacity Act, and medication as well as other mandatory training. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33 & 35-38 Quality in this outcome area is excellent. The manager leads a strong staff team, and provides effective overall management for the smooth running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a trained nurse, has many years of experience, and is familiar with the illnesses associated with older people. She leads a team of management staff, who have responsibilities within their areas such as clinical care and housekeeping. There is a weekly management meeting to discuss changes and events from the previous week. The heads of departments have delegated authority within their roles, and oversee one to one supervision of staff within their area. The manager is also involved in the home’s business Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 24 plan and budgeting, and works with senior management in the company for strategic financial and operational planning. The home has regular staff meetings for different groups of staff, as well as one to one supervision. This provides all staff with the opportunity to provide feedback and to express new ideas or concerns. CSCI staff survey forms, and chats with staff, indicated that staff generally feel well supported by the management, and feel valued in the home. The manager promotes awareness of the importance of professional behaviour, and staff act accordingly. The home has good systems in place for measuring quality assurance. This is obtained via daily feedback from residents; from chats with residents and visitors; from the home’s own satisfaction surveys (which are audited and published); from residents meetings and coffee mornings; and via a comprehensive auditing system. Monthly regulation 26 visits are carried out by a senior manager in the company, or by a manager of another home. Resident satisfaction surveys ask questions about every aspect of life in the home, such as the quality of the reception, food, cleanliness, care, activities, bath/shower facilities, care planning and call bell responses. Any areas of concern that are highlighted, are addressed by the management. The home does not take any part in managing residents’ personal finances. If unable to manage these for themselves, they will have a representative or appointee of their choice. The manager can assist with details for obtaining advocacy if required, and the “Friends of Halliwell” may also assist in this process. Records were seen to be well maintained, and kept up to date. There are backup systems for the care details on the computer system, and printed details of care plans are always retained on file. The computer system is password protected. Mandatory training in fire prevention and health and safety are carried out reliably. There is a health and safety management team who discuss these issues together. Quality audit reviews (mostly monthly) are carried out by the manager for items such as checks for water temperatures, bed rail checks, window restrictors, fire drills and PAT testing. There are risk assessments in place for items such as use of stepladder. Servicing records confirm that checks (e.g. hoists, lifts, gas, electricity) are carried out as required. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 25 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 4 X 3 3 4 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 4 4 X 3 3 3 3 Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13 (2) Requirement To ensure that all nurses administer medication in accordance with the guidelines laid down by the Royal Pharmaceutical Society, and the Nursing and Midwifery Council: • All medication must be appropriately signed for immediately after administration. • Handwritten entries on Medication Administration Records (MAR charts) should be signed by two nurses. Timescale for action 31/08/08 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 OP8 Good Practice Recommendations • To show clearly in care planning documentation how residents and next of kin are informed about the risks associated with using bed rails – such as DS0000064706.V367470.R01.S.doc Version 5.2 Page 27 Halliwell Nursing Home • • entrapment. For documentation to show clearly how the Mental Capacity Act 2005 is applied in decision-making for any residents who have some cognitive impairment. To ensure any consent forms/resuscitation forms are clearly signed, and include the printed name of the persons signing, and dates of signing. 2 3 OP14 OP16 To complete a property form for each resident on admission. To ensure that the complaints procedure includes timescales for a response to be made to complainants, wherever the procedure is displayed. Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Halliwell Nursing Home DS0000064706.V367470.R01.S.doc Version 5.2 Page 29 - 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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