Care Home: Holbeche House Nursing Home

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What the care home does well There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre-admission assessments are completed, so that the home and people who are considering living in the home are confident that their individual needs can be met appropriately. Information was readily available in a variety of formats, so that it was accessible to people visiting, providing them with information about the services and facilities to assist them with making a decision about moving it. The arrangements for handling people`s personal finances were good ensuring their money was protected. There were adequate numbers of staff on duty at the time of inspection to ensure people`s needs were met. The home was clean, well maintained and homely providing people with a pleasant environment to live. There is a separate staff team on the nursing and dementia unit providing greater consistency of care. The recruitment of staff was satisfactory ensuring people living in the home are safeguarded when new staff are employed. What has improved since the last inspection? Some flooring has been replaced, furniture was being steam cleaned and redecoration was in progress, improving the environment for people living in the home.Holbeche House Nursing HomeDS0000058391.V378106.R01.S.docVersion 5.2The interim manager had held staff meetings with all staff groups and staff supervision had commenced, so systems had been put in place to support staff effectively. Staff stated morale was starting to improve. The interim manager is in the process of developing the activities programme to ensure people have opportunities of stimulation and social contact. The interim manager had identified shortfalls in staff training and had arranged for training to take place. This will ensure staff have the knowledge and skills to meet people`s needs. Changes have been made to the dining arrangements in the dementia unit with a view to providing a more effective approach and this is being reviewed on an on going basis. What the care home could do better: The interim manager stated she would like to produce the service user guide in picture format to make it more accessible to people. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes demonstrating people`s needs are met effectively. Daily records should clearly give details of people physical, psychological and social well being in addition to any concerns, so their conditions can be monitored effectively. Communication systems should be reviewed and action taken to ensure staff are made aware of peoples needs, so peoples needs are met effectively. There must be a more proactive approach to any concerns or risks identified with appropriate follow up and referral to health professionals as appropriate, to ensure people`s well being is maintained. Staff must ensure there is consistency with risk assessments and understand the link between them and the care planning systems, to ensure risks are reduced and peoples needs met effectively. The medication systems need to be more robust for receiving, administration and recording of medication to ensure people receive the medication prescribed for them The interim manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure and so forth to ensure people`s well being and complications prevented.Holbeche House Nursing HomeDS0000058391.V378106.R01.S.doc Version 5.2 The interim manger is planning to implement "Niggles books" on each unit, so staff can record any concerns or informal complaints raised. This will ensure a proactive approach to complaints with continuous improvements in the home. A review of the meals should be undertaken and appropriate action to ensure people receive meals that meets their needs and preferences. It is recommended that the arrangements for smoking be reviewed, so people living in the home have a suitable place to smoke if they wish. The recommendations for servicing of the gas equipment should be undertaken to ensure the safety of people living in the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Holbeche House Nursing Home Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA Lead Inspector Ann Farrell Key Unannounced Inspection 13th October 2009 07:30 DS0000058391.V378106.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holbeche House Nursing Home Address Wolverhampton Road Wall Heath Kingswinford West Midlands DY6 7DA 01384 288924 01384 296733 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) www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd Vacant Care Home 49 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (22), Physical disability (8) of places Holbeche House Nursing Home DS0000058391.V378106.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 8 Dementia (DE) 27 Old age, not falling within any other category (OP) 22 The maximum number of service users who can be accommodated is: 49 12th March 2009 2. Date of last inspection Brief Description of the Service: Holbeche House Care Centre is a large Jacobean style Grade Two listed building set in extensive grounds. The home has undergone a major refurbishment programme to provide accommodation for up to forty-nine people who require care. The home provides accommodation on two floors; the first floor can be accessed by a passenger lift. The home has two lounges, two dining rooms and one lounge/dining room. The home has a separately staffed Dementia Care unit, which provides accommodation for up to twenty-two with dementia. There is one double bedroom and all other bedrooms are single occupancy with many having en-suite facilities. There are extensive grounds and beautiful gardens for people to enjoy when the weather permits. The fees range between £348 and £750 per month for people to live there. The information did not include details of the Registered Nurse Care Contribution (RNCC) and extra costs. Up to date information about costs should be discussed at the time of making and enquiry. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 12th March 2009 when they were given a one star rating. Concerns were raised with us about the quality of service being provided by the home, so a key inspection was undertaken. It was obvious from the findings of this inspection action had been taken by the organisation to address the concerns. An operations manager had taken over the day to day control of the home and had started to implement a number of changes. They are currently advertising for a new manager to take over control of the home. This inspection found there were still some areas that need to be addressed to ensure good outcomes for people living in the home and they can be found in the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 13th October 2010. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies plus concerns raised. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager, was forwarded to the home and they were in the process of completing it when we undertook the inspection. The inspection was undertaken over two days by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involved discovering their experiences of living at the home by Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 6 meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection five people who live in the home and five staff were spoken with, in order to gain comments. What the service does well: There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre-admission assessments are completed, so that the home and people who are considering living in the home are confident that their individual needs can be met appropriately. Information was readily available in a variety of formats, so that it was accessible to people visiting, providing them with information about the services and facilities to assist them with making a decision about moving it. The arrangements for handling peoples personal finances were good ensuring their money was protected. There were adequate numbers of staff on duty at the time of inspection to ensure peoples needs were met. The home was clean, well maintained and homely providing people with a pleasant environment to live. There is a separate staff team on the nursing and dementia unit providing greater consistency of care. The recruitment of staff was satisfactory ensuring people living in the home are safeguarded when new staff are employed. What has improved since the last inspection? Some flooring has been replaced, furniture was being steam cleaned and redecoration was in progress, improving the environment for people living in the home. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 7 The interim manager had held staff meetings with all staff groups and staff supervision had commenced, so systems had been put in place to support staff effectively. Staff stated morale was starting to improve. The interim manager is in the process of developing the activities programme to ensure people have opportunities of stimulation and social contact. The interim manager had identified shortfalls in staff training and had arranged for training to take place. This will ensure staff have the knowledge and skills to meet peoples needs. Changes have been made to the dining arrangements in the dementia unit with a view to providing a more effective approach and this is being reviewed on an on going basis. What they could do better: The interim manager stated she would like to produce the service user guide in picture format to make it more accessible to people. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes demonstrating peoples needs are met effectively. Daily records should clearly give details of people physical, psychological and social well being in addition to any concerns, so their conditions can be monitored effectively. Communication systems should be reviewed and action taken to ensure staff are made aware of peoples needs, so peoples needs are met effectively. There must be a more proactive approach to any concerns or risks identified with appropriate follow up and referral to health professionals as appropriate, to ensure peoples well being is maintained. Staff must ensure there is consistency with risk assessments and understand the link between them and the care planning systems, to ensure risks are reduced and peoples needs met effectively. The medication systems need to be more robust for receiving, administration and recording of medication to ensure people receive the medication prescribed for them The interim manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure and so forth to ensure peoples well being and complications prevented. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.2 Page 8 The interim manger is planning to implement Niggles books on each unit, so staff can record any concerns or informal complaints raised. This will ensure a proactive approach to complaints with continuous improvements in the home. A review of the meals should be undertaken and appropriate action to ensure people receive meals that meets their needs and preferences. It is recommended that the arrangements for smoking be reviewed, so people living in the home have a suitable place to smoke if they wish. The recommendations for servicing of the gas equipment should be undertaken to ensure the safety of people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 9 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 Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for people moving into the home to assist them in making a decision about moving into the home. An assessment is completed prior to admission, so staff can determine if peoples needs can be met upon moving into the home. EVIDENCE: The home had a service user guide available in the reception area on entering the home. Alternative formats such as large print and audio cassette were also available. The manager stated she was going to develop one in picture format, so that it is accessible to everyone. These documents provide people with information about the services and facilities to assist them in making a decision about moving into the home. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 11 The home provides residential and nursing care for people who require long term, respite care and dementia care. The nurse stated a senior member of staff goes out to assess people before they move into the home to determine if the home is able to meet their needs. One file was looked at for a person who had recently moved into the home. The assessment was satisfactory and a letter had been sent to them advising the home could meet their needs. This process gives people the confidence that their needs will be met when they move into the home. People can visit the home before moving in so they can have lunch, view the facilities, meet staff and other people who live there in order to sample what it would be like to live there. On discussion with one person they stated they did not visit the home as they were in hospital, but confirmed an assessment had been undertaken before they moved in to the home. There is a trial period of one month following admission to the home and a review is held at the end of a month, which was evidenced in records. This provides further opportunity to discuss whether the person would like to continue living there and if their care needs are being met or any changes are required. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for planning peoples care and meeting health care needs of people require further development to ensure everyones needs are met effectively. The medication system needs further development to ensure people receive the medication prescribed for them. EVIDENCE: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, tissue viability, nutrition and falls. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 13 to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Generally it was found there were copious pieces of paper making up the care plans, but some lacked detail, in some cases they did not cover all aspects of the intervention, statements were vague, they were repetitive and had not been updated when changes had occurred. Therefore, they did not provide staff with the information required to meet peoples needs. Generally the planning of care was inconsistent and, therefore, we could not be certain that each person had plans of care that were up to date, accurate and addressed thier needs. Records were available to demonstrate people were weighed on a regular basis. It was noted two people had lost weight and staff were recording their diet and fluid intake. The records were poorly maintained in respect of people who were nutritionally at risk and there was no evidence that nutritional supplements were given on a regular basis. On discussion with staff it was stated they received a bulk order of supplements such as fortisip, callogen, maxijul and foticreme and they were not prescribed for individuals. Staff also stated some people living in the home did not like them. It was found the supplements were not stored in the fridge in order to make them more palatable and they were not administered in a consistent manner. Staff had not explored alternatives to the supplements and we were told by the catering staff they did not fortify any of the meals. Another person was identified at risk nutritionally and the risk assessment indicated dietetic advice should be sought, but there was no evidence this had occurred. Therefore, we could not be assured that peoples nutritional needs were being met effectively. Where fluid intake was being recorded for some people on a daily basis it was noted that one persons fluid intake had been poor over a period of time, but there was no evidence that any action had been taken to address the issue in any way. Poor fluid intake puts people at risk of developing dehydration. Systems need to be put in place to ensure monitoring of fluid intake and where it is not sufficient appropriate action taken. Two people were on special diets, but on discussion with the kitchen staff and care staff they were not aware of these special diets. The nutrition risk assessment for one person stated they could not eat solids and staff were observed to offer the person an egg sandwich or egg on toast. This does raise questions about the communication systems in the home. The management will need to review the communication systems in the home and ensure all staff are fully aware of everyones individual needs, so their well being is maintained. Some risk assessments gave conflicting information e.g. one stated the person could mobilize with a Zimmer frame and two staff and the other indicated they were chair bound. This could cause considerable confusion when trying to Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 14 meet peoples needs. Action needs to be taken to ensure nurses are fully aware of the risk assessment process, how they link together and how they feed into the care planning system to ensure a consistent approach to care. One persons risk assessment indicated their condition had worsened on 10th September and they were at a risk of developing pressure sores. However, no care plan had been drawn up to address the issue, no pressure relieving equipment was in place and on discussion with staff there were no systems in place to ensure pressure was relieved on a regular basis to reduce the risk. This is concerning as staff had obviously reviewed the risk and had not taken any action when the tool indicated there was an increased risk. There was evidence of pressure relieving equipment in place in some cases and staff were monitoring the equipment to ensure it was working effectively. One person had communication problems and a communication aid was available to assist the person, so they could make themselves understood by staff. Feedback from people living in the home was generally positive; The staff are good; they come fairly quickly if I call them. I am lucky to be here Staff are very good; what ever they can do for you they will. The home has a retained General Practitioner (GP) who visits once a week and everyone living in the home was registered with them. People have the option of retaining their own GP. on admission to the Home (if the GP was in agreement). People had access to other health and Social Care professionals and records demonstrated visits were undertaken by social workers, chiropodist, optician and speech and language therapist. This ensures aspects of peoples health care needs are being met. Records did not demonstrate if checks in respect of chronic diseases such as diabetes, high blood pressure, asthma, etc. had taken place. The manager will need to follow this up with the GP surgery to ensure peoples well being is maintained and complications prevented. When reviewing some of the daily records written by staff it was noted that one area of concern was raised and it was twenty days before the person was reviewed by the GP. In another case a person was seen by a speech and language therapist, but records did not indicate that there had been any concerns prior to the referral. Daily record should indicate the physical, psychological and social care of people plus any concerns, so they can be followed up in a timely manner and peoples condition monitored effectively. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in a locked room in locked cupboards with the exception of destroyed medication Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 15 and this will need to be addressed. On inspection of the medication for the current month, audits were found to be correct for the medication that was in blisters. However, a number of the medications audited in boxes were not correct or could not be audited. Therefore, it could not be guaranteed that everyone received the medication they were prescribed. Also it was noted that Promazine was prescribed when required (PRN), but there was no care plan or instructions for staff about when it should be administered. On inspection of records it was noted that reasons were not given for its administration in some cases, in another case it stated the person was wandering and in another case staff stated it was given at night to help the person sleep in addition to night sedation. This is not appropriate and a review of this medication should be undertaken and protocols written up for all PRN medication The manager stated they do not use homely remedies. On discussion with the manager and nurse they were not able to confirm robust systems for checking medication into the home from the pharmacist or when people were admitted from their own home. Staff recorded the temperature of the fridge and medication room regularly to ensure they were within safe limits and this was satisfactory ensuring medication was stored appropriately. Staff were observed to assist people in a sensitive manner when undertaking interventions. People were well supported by staff in respect of personal care and choosing clothing appropriate for the time of year which reflected their individual culture, gender and personal preferences. The home is divided into two units and there was two lounges/dining rooms on the nursing unit and a separate lounge in dinging room on the dementia unit. In addition, there was seating the reception area, so people had a choice of areas to sit and meet visitors. Bedroom doors had locks in place and lockable facilities were available in bedrooms to store valuables/medication if required, so enhancing the arrangements for privacy. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home were flexible, so people were able to maintain important relationships. Staff are in the process of developing the activity programme to ensure there is a range of activities suitable to maintain peoples well being. The arrangements in respect of meals need to be reviewed to ensure they meet peoples dietary needs and preferences. EVIDENCE: There was no evidence of any rigid rules or routines in the home at the time of inspection. People who live in the home can go outside on their own or with friends and family as they choose, depending on their abilities. On discussion with people living in the home they stated they could get up/go to bed when they wanted. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 17 An activities co-ordinator had recently been employed on a full time basis and a monthly newsletter was being produced to keep people informed about events in the home. The manager and activities co-ordinator were in the process of developing a four weekly activities plan for people. On the day of inspection a cake making session was in progress. Activities to date have included exercises to music, entertainers had visited and there had been pic niks outside during the summer. Birthdays are celebrated, cocktails are provided weekly, newspapers are brought into the home for people to read and one person goes out to a day centre three times a week, There is a television in each lounge plus music in lounges and dining rooms and a Wii console is also available for use. The activities co-ordinator is in the process of completing life stories with people plus a Halloween and bonfire party are in the process of being arranged. The home has two cats who wander around and there is a fish tank, which one of the people living in the home is becoming involved with. Feedback from people indicated they did get bored at times and would appreciate more stimulation. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met. Feedback from people included; I get up and go to bed when I want There was a four week rotating menu based on the organisations nutmeg system, which was designed to provide the correct components for a healthy diet. The menu demonstrated a variety of foods/meals with a choice at each meal time, but over 50 of the foods were processed foods. If people did not like the main meal there was also a choice of jacket potato, omelette, salad or sandwiches. However, one person told us they did not want the main choices one day and she was offered potatoes and gravy as an alternative. Drinks and snacks were available between meals. Comments received about the meals were varied and included; The food is quite good I am not keen on the food, it’s the same thing over and over again and they don’t put any salt in the vegetables. The food is OK. Sometimes the food is cold. They cant cook. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 18 The dining rooms were very pleasantly presented with small tables, with table cloth, napkins, condiments and cutlery. The meals were served from heated trolleys by the kitchen staff and care staff served and assisted people with their meals. Lunch was observed on the dementia unit and staff were very busy moving from one person to another to assist them. Due to the needs of the people staff were unable to observe everyone effectively. This was discussed with the interim manager who stated they had only recently changed the dining arrangements, so that everyone had their meals in the dining room. She stated she would review the system to ensure people have a more relaxed and pleasant dining experience. As identified in the health and personal care section there were some concerns with the nutritional intake of people who were nutritionally at risk. The manager of the home stated she had already arranged for a senior catering manager from the organisation to visit the home in order to review the catering arrangements. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for dealing with concerns and complaints were satisfactory to ensure people were listened to and their comments acted upon. Training is being arranged for staff to ensure they have the knowledge to ensure people are supported appropriately and protected from harm. EVIDENCE: A complaints procedure was available in reception and in the service user guide. The manager had a record of the formal complaints they had received and they had all been responded to in writing indicating the action taken to address the shortfalls. The manager stated she was also going to introduce a niggles book on each unit, so staff could record any concerns or informal complaints to ensure a proactive approach to any issues raised. On discussion with people living in the home they were generally content and did not complain. However, they stated they were not aware of the complaints procedure. This was discussed with the manager and she stated a meeting with people who live in the home and relatives had been arranged for 6th November and it would be discussed at the meeting. We received two complaints about the home, one of which the organisation were aware of. On arrival for the key inspection the operations manger was Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 20 acting as an interim manager and was in the process of addressing the issues, which was very positive. Records indicated that 76 of staff had undertaken training in respect of safeguarding, but there was no evidence of training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards. The manager stated she was aware of the deficiencies and she had arranged training for staff in all three areas in the near future. This will ensure staff are aware of their responsibilities in respect of supporting people who lack capacity to make decisions and safeguarding them from harm. The home has a satisfactory recruitment system; ensuring people are safeguarded by the employment of new staff. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and comfortable environment that meets their needs. EVIDENCE: Holbeche House Nursing Home is a large detached listed building that is set in extensive grounds set in a peaceful country setting. It is situated on a main road and is five minutes by car from the local village. It provides care and accommodation for up to 49 older people. There is a parking area to the front and side of the building with level access to the building for wheelchair users and seating outside for use when the weather permits. Internally it is divided into two units; one for people requiring nursing care and one for people who require dementia care. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 22 On entering the home there is a large very peasant reception area with seating for people if they wish to use it. A partial tour of the home was undertaken and it was found to be warm, clean, and maintained to a good standard. The atmosphere was calm, relaxed and friendly and there were no unpleasant odours. Each unit had a lounge and dining room and new flooring had recently been provided in some of the corridors and communal areas of the dementia unit. Also steam cleaning and re-decoration were in the process of being undertaken during the inspection, enhancing the environment for people who live in the home. There was no call bell in one of the dining rooms and the manger actioned it during the course of the inspection. There were no facilities for people who smoke and currently they have to go outside. The manager stated she would have to look at this when considering the future of the home. Bathrooms and toilets were strategically placed around the home and were provided with liquid soap and paper towels for infection control purposes. Two of the assisted bathing facilities in bathrooms were not working properly and the manager had arranged for their repair, so people could have a choice of bathing facility situated close to thier bedroom. All bedrooms were single and twenty nine had en-suite facilities consisting of a toilet and wash hand basin. A call bell facility was available in each bedroom, so people could call for assistance if required. Bedroom doors had locks and lockable facilities were available in bedrooms, so people could store medication/ valuables to enhance privacy. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, toilet seats etc. The main kitchen was clean, well organised and adequately equipped for its purpose. Temperatures of fridges and freezers were being recorded on a regular basis to ensure food was stored at the correct temperature. It was noted that the milk fridge was not at the recommended temperature. When this was raised with the manager she arranged for it to be addressed. The laundry was adequate and had processes to prevent cross infection. Laundry equipment was adequate to allow sluice and pre-wash cycles. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was adequate staff on duty to meet peoples needs. The recruitment of new staff was satisfactory ensuring people are safeguarded. Further training had been organised for staff to provide them with the skills and knowledge to meet peoples needs effectively. EVIDENCE: On the day of inspection the interim manager was on duty plus one nurse and three care staff on each unit. The duty rota indicated these levels were maintained during the day and there was one nurse and two care staff on each unit overnight. This appeared satisfactory to meet the current needs and dependency of people living in the home. Ancillary staff such as domestic, laundry, catering, administration, and maintenance staff support care staff. The staff files for two newly appointed staff were inspected. The recruitment process was found to be satisfactory and Protection of Vulnerable Adults (POVA) first checks were obtained before people commenced work on the home. The organisations head office then contacts the home with the Criminal Record Bureau Check (CRB) result. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 24 Newly appointed staff undertake induction training. This provides them with the knowledge initially to meet peoples needs. There was a rolling programme of in house staff training. The interim manager stated she was aware there were some shortfalls in the training and she had made arrangements for the training to take place in the near future. It was recommended that consideration should be given to training in respect of clinical conditions also to enhance staffs understanding of peoples condition. The information provided indicated fourteen care staff had completed National Vocational Qualification (NVQ) level 2 in care and four had completed NVQ level 3 in care. Training provides staff with the appropriate skills and knowledge to care for people living in the home. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current management arrangements are enabling systems to be developed, so that outcomes for people are improved. EVIDENCE: Over the previous months there has been a period of unrest in the home associated with low staff morale and complaints. The organisation took this seriously and the operations manager took over day to day control of the home and had been working hard to address the shortfalls. This arrangement currently provides strong leadership and direction in the home. The post of manager had been advertised and she stated there had been plans made to Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 26 change the management structure with the appointment of separate unit manger for each of the units in addition to the home manager. This would ensure ownership in each area and lead to improved outcomes for people living in the home. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The home does not act as appointee/agent for people in the home, but assists with personal allowances. Individual records were maintained for people where the home held money on thier behalf and receipts were given for all deposits and withdrawals. Balances of monies checked were found to be correct. This should ensure that people’s monies are held safely. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. The manger was completing it at the time of inspection. The organisation has a quality assurance process that consists of a range of audits and an annual satisfaction survey. There had been a recent staff survey and feedback had been received from people living in the home in May 2009. The manager stated some of the issues raised by people living in the home were in respect of the laundry and activities. As a result of the feedback a labelling machine had been purchased for the laundry and they were developing the range of activities. On discussion with some staff they stated staff meetings and supervision did not occur on a regular basis. Since the operations manger took control of the home there had been a general staff meeting and separate meetings with night staff and those working on the dementia unit. She stated staff meetings would take place on a monthly basis initially. Formal supervision sessions had also commenced with staff and when unit managers are appointed they will take responsibility for supervision of their own staff group. This will provide staff the support they require to undertake their role effectively. A meeting with people who live in the home and their relatives had been arranged for 6th November and cheese and wine will also be available. The manager stated she would like to develop a support group for relatives and arrange specialist speakers to attend meetings, so people are provided with information about conditions such as dementia and they feel supported. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and in full working order. These were found to the satisfactory, but the gas safety certificate stated the gas equipment needed servicing. Checks were completed on the fire system regularly ensuring people would be safe in the event of a fire. Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 27 Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 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 2 X 3 X 3 X X 2 Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 29 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 OP8 Regulation 13(4) Requirement Where someone is identified as being at risk robust systems must be put in pace to ensure action is taken to reduce the risk and they are followed up appropriately. Robust systems must be in place for the correct administration and recording of medication. To ensure everyone receives the medication prescribed for them. Systems must be in place for checking medication into the home. So the home has the correct type and amount of medication available to administer to people. All medication must be stored in locked cupboards within locked rooms. To ensure the safe storage of medication. Protocols should be written up for PRN medication so staff have DS0000058391.V378106.R01.S.doc Timescale for action 13/11/09 2 OP9 13(2) 13/11/09 3 OP9 13(2) 13/11/09 4 OP9 13(2) 13/11/09 5 OP9 13(2) 13/11/09 Holbeche House Nursing Home Version 5.3 Page 30 6 OP9 13(2) 7 OP31 18(1) instructions about the appropriate use of it. A review of medication should be undertaken where promazine is being used in conjunction with night sedation to enhance sleeping to ensure appropriate medication is given. A registered manager must be appointed to the home to provide leadership and stability so outcomes for people are improved. 13/11/09 13/01/10 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 OP7 Good Practice Recommendations All care plans should be updated and outline in detail the action required by staff to meet peoples needs, so care is individualised and peoples needs are met in a consistent and person centred manner. Records must clearly indicate follow up of concerns and when changes occur in treatments/care etc, so that peoples conditions can be monitored effectively. Daily records should include information about peoples health, social and psychological welfare plus any concerns, so care can be followed up in a timely manner and peoples condition monitored effectively. It is recommended that food charts are reviewed for people who are nutritionally at risk in order to provide a comprehensive record of food intake, so peoples food intake can be monitored effectively. It is recommended that systems for monitoring and follow up in respect of fluid records are reviewed to ensure action is taken where people are not receiving a sufficient fluid intake. DS0000058391.V378106.R01.S.doc Version 5.3 Page 31 2 OP7 3 OP7 4 OP8 5 OP8 Holbeche House Nursing Home 6 OP8 Undertake a review of the communication systems in the home and take action to ensure all staff are fully aware of peoples needs and the support they require, so peoples needs are met effectively. The manager should liaise with the GP practice about monitoring of chronic diseases to ensure peoples well being is maintained. It is recommended the gas equipment is serviced as indicated on the gas safety certificate, to ensure the safety of people living in the home. 7 OP8 8 OP38 Holbeche House Nursing Home DS0000058391.V378106.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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