Care Home: Halwill Manor Nursing Home

What the care home does well People tell us that Halwill Manor is "homely" and they are made "very welcome" from their very first day living at the home. The team spend time getting to know people, so that they know what needs a person has right from day one. This ensures that the team can meet people`s needs. Every person has care plan that is discussed with them and/or their relative around what care they want from the team. The team of staff are said to be "kind and caring" and are very experienced in caring for older people. Relatives are very satisfied with the care and also say that their relations are happy living there. People are treated with respect. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. The also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager. Families and friends tells us that they are made "very welcome". When choosing the home with their relation, many have said that it was "recommended" to them. There is a good choice of appetising and well-balanced meals at Halwill Manor. People say that the choice is good and meals are "lovely" and we saw that they enjoyed them. The home is large and is a comfortable place to live. People who use wheelchairs or walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is always clean and reasonably well maintained. Staff have done a lot of training and have a lot of experience in caring for older people. What has improved since the last inspection? Everyone is now clear that bullying behaviour is totally unacceptable. People are confident that this will be stamped out if it ever occurs again.People have had more opportunity to comment about the quality of the service. Guidance written by the Commission is being used as a benchmark to help improve the quality of service for people living at Halwill Manor. The team have assessed people and know exactly what nutritional needs. This has ensured that people get the right foods to keep them healthy. People living are involved in planning and reviewing their care to ensure that it meets their needs. Tablets are given out safely and follow Halwill Manor`s policies and procedures. This ensures that people are given the right medicine at the right time. The team have looked at their practice and improved it by using Department of Health guidance about infection control. Therefore people are better protected against the risk of spread of infection.New wheelchairs have been bought and checks are done of all of the equipment used. This has ensured that equipment used when caring for people is fit for the purpose and in full working order. What the care home could do better: Peoples` mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Halwill Manor. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. In particular, the use of keypads or mats linked to the call bell system need to be carefully considered and agreed by all stakeholders. The team have bought an assessment pack to assess the recreational needs of people, particularly those with dementia or communication difficulties. This should now be done so that activities are person centred and pitched at a level that is suitable for the individual. Financial practice must be reviewed because one aspect of it is against the law. The provider must ensure that people`s personal money is not be paid into an account that is used by them in connection with the carrying on or management of the care home. This is so that people`s rights and financial interests are safeguaded by being kept separate from the business. We have made a legal requirement about this. CARE HOMES FOR OLDER PEOPLE Halwill Manor Nursing Home Halwill Beaworthy North Devon EX21 5UH Lead Inspector Susan Taylor Unannounced Inspection 16:30 31 July & 1st August 2008 st 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 Halwill Manor Nursing Home DS0000026717.V366490.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. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halwill Manor Nursing Home Address Halwill Beaworthy North Devon EX21 5UH 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) 01409 221233 01409 221265 Mrs Jacqueline I Mirjah Clare Grace James Care Home 25 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (25) Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Dementia, over 65 years of age (Code DE(E)) - maximum 13 places Mental disorder, excluding learning disability or dementia, over 65 years of age (Code MD(E)) - maximum 13 places The maximum number of service users who can be accommodated is 25. 31st July 2007 2. Date of last inspection Brief Description of the Service: Halwill Manor is a privately owned care home registered to provide care for 25 patients. It is located in the heart of Halwill and has strong links with the local community. Halwill Manor is set back off the road and is situated in large and accessible grounds. Parking is provided and access to the home is level. The house is old and large, it has been adapted to suit the needs of people with mobility problems and care needs. There is a lift to help those with limited mobility access all floors. On the ground floor there is a large lounge and dining room; a smaller sitting area is adjacent to the main lounge off which are two offices. Two kitchens, a laundry, sluice room, staff rest room and some patient rooms are also on the ground floor. Home cooked meals are cooked on site. Activities and entertainment are arranged for patients. The atmosphere at Halwill Manor is relaxed and friendly yet professional. A qualified nurse is on duty to oversee the patients nursing needs 24 hours a day. The staff work hard to provide a homely environment whilst also striving to deliver quality care to Patients. The fees range from £375 - £600 per week and exclude the cost of hairdressing (£6.00), toiletries (varies) and newspapers (variable). Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 5 Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was a key inspection of Halwill Manor under the Inspecting for better lives arrangements. We were at the home with people for 9.5 hours over two days. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care of three people and met some of their relatives. We also spoke to six people that live in the home about their experiences there. We sent surveys to all of the people living in the home and received 8 back. The comments of these people and our observations are in the report. As at July 2008, the fees ranged between £375 and £600 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People described living at Halwill Manor as being “wonderful” and there are “lovely, very kind caring staff”. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Everyone is now clear that bullying behaviour is totally unacceptable. People are confident that this will be stamped out if it ever occurs again. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 8 People have had more opportunity to comment about the quality of the service. Guidance written by the Commission is being used as a benchmark to help improve the quality of service for people living at Halwill Manor. The team have assessed people and know exactly what nutritional needs. This has ensured that people get the right foods to keep them healthy. People living are involved in planning and reviewing their care to ensure that it meets their needs. Tablets are given out safely and follow Halwill Manor’s policies and procedures. This ensures that people are given the right medicine at the right time. The team have looked at their practice and improved it by using Department of Health guidance about infection control. Therefore people are better protected against the risk of spread of infection. New wheelchairs have been bought and checks are done of all of the equipment used. This has ensured that equipment used when caring for people is fit for the purpose and in full working order. What they could do better: Peoples’ mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Halwill Manor. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. In particular, the use of keypads or mats linked to the call bell system need to be carefully considered and agreed by all stakeholders. The team have bought an assessment pack to assess the recreational needs of people, particularly those with dementia or communication difficulties. This should now be done so that activities are person centred and pitched at a level that is suitable for the individual. Financial practice must be reviewed because one aspect of it is against the law. The provider must ensure that people’s personal money is not be paid into an account that is used by them in connection with the carrying on or management of the care home. This is so that people’s rights and financial interests are safeguaded by being kept separate from the business. We have made a legal requirement about this. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 9 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. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 10 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 Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 11 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): 3&6 Quality in this outcome area is good. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three care files for people living in the home. Important information had been obtained about people prior to them moving in to the home. Nursing staff told us that the manager or provider assessed people prior to admission to ensure that their needs could be met at the home. Comprehensive assessments were seen in all three files, which also identified risks that people might have with regard to tissue viability, falls, manual Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 12 handling, continence and mental health issues. Since the last inspection, nutritional needs had been assessed and the information used help plan the care people need. Assessments had been regularly reviewed with the individual’s and/or their next of kin. In one file, nursing staff had completed a mental health risk assessment highlighting that the person was at risk of harming himself or herself by wandering, particularly at night. A pressure mat was highlighted as measures to reduce the stated risks from occurring. The person’s mental capacity had not been assessed. Such measures might be considered to be forms of restraint without careful assessment and agreement from all stakeholders, including the individual’s advocate. We discussed this with the manager who is aware of requirements in the Mental Capacity Act 2005 for ongoing assessment of an individuals capacity at an exact moment about a particular decision/issue. They verified that policies and procedures covering this aspect of care were in the process of development. These will also incorporate the local authority procedures that come into effect in April 2009. The manager told us that the home does not offer intermediate care. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 13 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): 7,8,9 & 10 Quality in this outcome area is good. Individuals’ personal, social and health care needs are well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at four care files and tracked the outcomes for those people. Desired outcomes were clearly stated, providing achievable goals for the individual. The care files examined also gave a comprehensive overview of the health needs of the individual’s concerned. The home has a professional relationship with the general practitioner with whom all the people living in the home are registered with. We saw correspondence demonstrating that there are good links with the mental health and social services teams. Each person had a nominated key worker whose responsibility it is to ensure that the care plans are current and the identified needs met. One area where we felt the Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 14 information was less robust was in recording individuals’ personal preferences, routines and social activities and evidencing their/or their advocate’s involvement in the review process. We discussed this as part of our feedback at the end of the inspection, and said that plans could be made more person centred by including preferred daily routines for individuals for example, explicit information about a person’s bedtime routine to include what time they like to retire and get up, what they wear, what they do (cleaning teeth and having a wash) and if they like to have a drink, the light on or off. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. We observed care being given to the people, whose files we looked at. We particularly looked at the decision making process followed regarding bedsides that a person who was being cared for had on their bed. The person was unable to tell us this information so we looked at their records, which were explicit about why bedsides were being used. Nursing staff had carefully considered the risks and had outlined measures to ensure that bedsides were used in a safe way for the person concerned. We saw ‘bumper cushions’ in place on the bedrails. Similarly, a high risk of development of pressure ulcers had been highlighted for the individual and we looked at ‘turning charts’ and saw pressure-relieving equipment in place on the person’s chair and bed. The person’s relatives showed us the manual handling chart in their relation’s room and told us “the staff follow it to the letter” and “turn her regularly”. Additionally, daily records in the person’s file demonstrated that they did not have any pressure sores; therefore the care they were receiving was effective. We tracked care of an individual with a range of health and social care needs including diabetes. Advice had been sought from the diabetic nurse specialist. The person told us that they were well cared for. Their care plan outlined how their health is monitored, the type of diet they need and medication they are prescribed. Additionally, we saw that risk assessments covered the individual’s nutritional needs and extent of their capability to self administer their medication. At lunchtime we saw that they were given a meal that was suitable for them, reduced sugar and low fat. The person told us that their weight was regular monitored and we saw a record of this in their file. Daily records documented when the person had attended the eye clinic at the local hospital for regular screening, and correspondence about this was also examined. Therefore, the care this person was receiving was good and ensured that their health was properly monitored. We tracked the care of a person with dementia, who was being treated for an infection as detailed in their care plan. Daily records demonstrated that the GP and Community Psychiatric nurse visited this person regularly. Antibiotics and pain relief that had been prescribed by the GP was given as prescribed. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 15 Continence advice had also been sought from a specialist practitioner. Training records verified that care staff were in the process of doing a dementia awareness course. We spent time observing the person whose care we were tracking and how staff interacted with them. Staff engaged with the person continuously at the right speed and demonstrated genuine warmth and attention, which the person appeared to respond to and enjoy. Four relatives that we met said that they were “very satisfied” with the care their relation receives, with other comments like “her quality of life has greatly improved” since moving into Halwill Manor. Additional comments were “the staff give excellent care, it [Halwill Manor] was recommended to us”. And a person being given care said ‘’they always knock before they come in’’. Two surgeries dispense medicines to people. One of the qualified nurses is responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we looked at how prescribed medicines were given to people. Records accurately reflected medication having been given as prescribed by the GP. All medication was kept in a secure place; controlled drugs were stored in accordance with legislation(Misuse of Drugs Safe Custody Regulations 1973). We observed medication being given to people after lunch and during the evening meal. At lunchtime, safe procedures were followed. Records were completed appropriately after each person had taken their medication. Care staff told us that medicines are only adminstered by qualified nursing staff. The provider and manager told us that following the last inspection; staff had been reminded to follow the home’s procedure. Therefore, the risk of people being given the wrong medication had diminished. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 16 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): 12,13,14 & 15 Quality in this outcome area is good. Routines and activities are flexible for people. Improvements are being made, which will further enhance this for people with dementia and specialist communication needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spent the evening of the first day of inspection in discussion with people in the lounge after their evening meal. The purpose of this was to find out how people spent their time and what activities and outings were available for them. We received a mixed response in surveys about the level of activities available to people. 25 of people responding felt that there are ‘always’ activities, whilst 50 felt this was less so. Their comments included there is ‘organ music and jigsaws’. A relation wrote ‘mother could not participate’ as there Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 17 was nothing suitable for her to do. During the evening we observed that the atmosphere was very homely, with people seated in the lounge some watching television and others in conversation with staff. People were offered a choice of drinks and several chose a glass of sherry and were given this. One person said that they wanted to go shopping and staff offered to do this a couple of days later to Launceston. The person was satisfied with this response. Over the course of two days we also met four relatives who told us that they are “made very welcome” and “everyone is very kind right down to the cook and cleaners”. They also told us that activities, food and links with the community are “very good”. We observed how staff interacted with the people living at the home, particularly those with limited communication or dementia. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Training records verified that staff was in the process of doing the ‘Dementia Awareness’ course. Staff told us that the course had given them more ideas about activities for people with dementia. The manager told us that they had begun to assess people’s abilities so that activities for them would be much more person centered. She showed us that she had purchased the ‘Pool Activity level instrument’ resource pack. Therefore, we are confident that this aspect of the service will improve further for people with dementia and ensure that activities are pitched at the right capability and interest level for them. Lunch was served during the inspection, which was well balanced and appetising. We saw at least three different choices being served. The cook had creatively incorporated plenty of fruit and vegetables into all courses and sought informal feedback from people throughout the meal. People we spoke to made comments like “the food is wonderful”. We saw people getting help where needed, in a sensitive and discreet way. Other people were given support and encouragement to do as much for themselves as they were able to and equipment such as plate guards helped them do this. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 18 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. The arrangements at Halwill Manor ensure that people are both protected and able to voice their concerns. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw the complaint procedure displayed on the notice board. Additionally the procedure was summarised in the ‘service users guide’. Surveys received from 8 people living at the home tell us that they all know who to speak to if they should have any concerns. Additionally, people indicated that they are confident that if they did have a concern it would be dealt with in a timely and appropriate way. At the last inspection, we reported that some people had told us that they felt bullied by a particular individual also living at the home. The provider and manager quickly acted on this and sought advice from the person’s GP and community psychiatric nurse. We read the individual’s care file and saw a record of this. The person’s care plan had been reviewed with them and clearly stated that any form of bullying behaviour would not be tolerated. We Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 19 concluded that this was a positive outcome for the individual concerned, which is clear about boundaries, and the rest of the people living in the home. People made comments like “I feel at home” and “the staff are good to me”. The home had a whistle blowing policy, which all of the staff we spoke to understand. Kind and caring interactions were observed throughout the evening and second day of inspection between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated a high level of skill in engaging those individuals. A relative told us “I can’t fault the place”. All of the staff we met had attended recognised training about safeguarding people. Additionally, 90 of care staff had either completed or were in the process of completing the national vocational qualification in care, of which a component module is about abuse and adult protection. Information sent to the Commission hightlighted that no referrals had been made to POVA (Protection of Vulnerable Adults List). No referrals had been made to the local authority to safeguard the interests of a person living in the home. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 20 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 & 26 Quality in this outcome area is good. People living at Halwill Manor live in a safe, comfortable and clean environment. Improvements to practice have protected people from the risk of cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spent the first evening of the inspection, touring the home meeting people in their bedrooms and main communal areas. We met a family and their relation who said that they had been “encouraged to make the room homely” with whatever furniture and personal effects they wished to. Bedrooms were clean, individualised and comfortably furnished. All of the rooms we looked at Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 21 had radiator guards fitted, which ensures the safety of people living there. Fire exits were clear and accessible. People living in the home told us that there is always a housekeeper on duty during the day. All of the wcs and bathrooms had locks on the doors, which people could use to maintain their privacy. Communal areas were comfortable and homely. There was a roaring fire in the lounge, which was made safe for people to sit in front of with a guard in place. We were shown maintenance certificates for the assisted baths, electrical installation, central heating and fire alarm systems. Information sent to us by the provider verified that 26 staff had received training about the prevention of infection and management of infection control. Additionally, since the last inspection the manager and provider had used Department of Health guidance ‘Essential steps’ to audit the home. They had produced an improvement plan and were working on it. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. We saw staff practicing good hand washing techniques immediately after giving care to each person. The laundry was clean and well organised. Staff understood health and safety principles when dealing with soiled linen and told us that they used a ‘no touch technique’. Sluices were clean and fully operational. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 22 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): 27,28, 29 & 30 Quality in this outcome area is good. The staff group are experienced and sufficiently trained and supported to ensure the needs of the people who live at the home are well met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives told us that the staffs responds “quickly” if their relation has to use the call bell. People we met said they “never have to wait” if they need to be taken to the toilet or want to go to bed. We examined duty rosters for July 2008. Most days there were five or six staff on duty in the morning, four or five in the afternoon and through the evening. Additionally every day there was a cook and two domestics working eight till 2:30 p.m. We were at the home until late evening on the first day and then all day the second day. Over that period we concluded that there were sufficient staff on duty because people’s needs were promptly met. There is a diverse staff team at Halwill Manor, with a gender mix that matches the people living there. A sample of staff files were looked at (4) and relevant Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 23 checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. Training records show that staff has training in all key areas of health and safety, as well as some specialist areas such as working with people with Dementia. Staff spoken to said that they were offered regular training updates, including opportunities to complete NVQ (National Vocational Qualifications) in care. Information sent to us by the provider tells us that 90 of staff have or are working towards an NVQ2 or above. Five staff we spoke to verified that the have regular supervision and appraisals. A recent supervision session had been recorded on all files examined. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 24 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, 36 & 38 Quality in this outcome area is good. The home is well managed and run in the best interests of the people who live there. Financial practices do not entirely safeguard people’s money and must be reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is experienced and holds the Registered Managers Award and NVQ Level 4 in Care Management. Additionally, she is a registered nurse and has maintained her professional Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 25 registration with the NMC. She told us that she used the internet extensively, in particular the Commission’s professional website, to keep up to update thus ensuring that the care delivered is best practice. Additionally, she told us that they were using KLORA and the AQAA (Annual Quality Assurance Assessment) as a framework for improving the service for people that live there. Staff we spoke to felt that communication was always very good, their comments included “we are always encouraged to do training” and “this is a very professionally run home” and “a lot has improved”. The Commission asked for, and received, the AQAA (Annual Quality Assurance Assessment) document. The information provided gave us a brief overall picture of what the service had done in the last year. However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. We were shown records, which demonstrated that external and internal audits are carried out for quality assurance purposes. Additionally, all of the requirements and recommendations made in the last inspection report was met. As a result of this people living in the home have benefited from better planned nutrition that specifically meets their needs; been better protected from potential abusive behaviour and the risk of infection; and once assessed will have person centred activities that are designed specifically to meet their needs. We looked at 4 staff files, which contained a written record of supervision with the individual concerned. The manager told us that the frequency of supervision had been improved. This was also borne out when we spoke to 4 staff that told us they felt well supported by the manager and provider. Records show that staff receive training in all areas of health and safety and follow an induction programme to help them understand their role. We looked at records showing how money is managed on behalf of two people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. One of the two people has their allowance paid into the home’s account named ‘Mrs Mirjah T/a Halwill Manor’ because they do not have an account in their own name. We were shown the paying in book with deposits and payments made and a spreadsheet denoting this. We spoke to the provider who also confirmed that the home’s account was being used in this way. We concluded that people’s money is well managed, however, the regulations stipulate that this must not be paid into an account is used by the registered person in connection with the carrying on or management of the care home. This is so that being kept separate from the business safeguards people’s rights and financial interests. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 26 The manager told us that the records were regularly audited and we spoke to the person responsible for this. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities were used to safeguard money. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told us that the alarm was checked every week. An engineer had checked the hoists twice in the last 12 months. First aid equipment was clearly labelled. We saw staff following good manual handling practice when moving people from wheelchairs to chairs in the dining room at lunchtime and in the evening. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 3 x 3 Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 28 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 OP35 Regulation 20(1)(b) Requirement The provider must ensure that people’s personal money is not be paid into an account that is used by the registered person in connection with the carrying on or management of the care home. This is so that people’s rights and financial interests are safeguaded by being kept separate from the business. Timescale for action 30/11/08 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 OP3 Good Practice Recommendations Peoples’ mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Halwill Manor. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. In particular, use of keypads or mats linked to the call bell DS0000026717.V366490.R01.S.doc Version 5.2 Page 29 Halwill Manor Nursing Home 2. OP12 system need to be carefully considered and agreed by all stakeholders. The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities should then be person centred and pitched at a level that is suitable for the individual. Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Halwill Manor Nursing Home DS0000026717.V366490.R01.S.doc Version 5.2 Page 31 - 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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