Care Home: Holcombe Hall Nursing Home

What the care home does well Mr. Warr has worked hard to meet the requirements made following the March key inspection of the home and he has kept the Commission informed about improvements. He has good understanding of the needs of people in his care.People who use the service receive a high standard of personal and health care at Holcombe Hall. What the care home could do better: Information about the service must be in a format suitable for the people who will use it and must include all that is required. It is important that they, or their representative, has this information. Progress has been made toward meeting this requirment and the timescale for compliance has therefore been extended. It must be recorded if people have made an Advanced Decision to refuse treatment, whether there are arrangements regarding Lasting Power of Attorney or an Independent Advocate. This provides the legal safeguard for people who are unable to make decisions on their own welfare. Progress has been made toward meeting this requirment. Staff providing care to people must be conversant with a person`s care plan, including any deprivation of liberty decision, otherwise they cannot deliver care in the way it is wanted or needed. People`s privacy and dignity must be upheld. To this end all toilet, bathroom and bedroom doors must must be fitted with locks suited to people`s capabilities and accessible to staff in emergencies. This is a repeat requirement as to date the manager`s research into how to achieve compliance has not led to any action being taken. Following consultation with people, or their representative, the home must provide a more regular and varied programme of leisure and social activities and opportunity for stimulation. Consideration must be given the the specific needs of people with dementia. This previous requirement is not met to a satisfactory standard at the home. Adaptation to the home environment, so as to help people with dementia find their way around easier and so increase/maintain their independence, should continue. The Home should be more domestic in nature. The decor and furnishings should be reviewed. There should be communal space where people can meet visitors in private. Where there are staffing shortfalls there must be arrangements in place to meet those short falls so that the needs of individuals at the home can be met at all times. Staff must be properly supervised, both as part of the management process and on a continuous basis. Although this requirement is not yet met arrangements have been put in place to achieve this and so the timescale for compliance has been extended. Random inspection report Care homes for older people Name: Address: Holcombe Hall Nursing Home Holcombe Drive Holcombe Dawlish Devon EX7 0JW one star adequate service 29/03/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Sutcliffe Date: 2 0 0 7 2 0 1 0 Information about the care home Name of care home: Address: Holcombe Hall Nursing Home Holcombe Drive Holcombe Dawlish Devon EX7 0JW 01626862330 01626888977 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr William Stanley Warr Type of registration: Number of places registered: Conditions of registration: Category(ies) : Holcombe Hall Nursing Home Ltd care home 29 Number of places (if applicable): Under 65 Over 65 29 29 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 0 0 The maximum number of service users who can be accommodated is 29. The registered person may provide the following category of service only: Care home with nursing only - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - (Code DE(E)) Mental disorder, excluding learning disability or dementia (Code MD(E)) Date of last inspection 2 9 0 3 2 0 1 0 Care Homes for Older People Page 2 of 13 Brief description of the care home Holcombe Hall Nursing Home is a care home with nursing that is registered for 29 people of either gender. It can provide nursing care within the categories Mental Disorder or Dementia. The Registered Manager is a Registered Mental Nurse with many years experience in the National Health Service and the Independent Health Care Sector. As nursing is provided there a Registered Nurse on duty at all times. The home is situated between Teignmouth and Dawlish in an area called Holcombe. It has its own driveway and small parking area off a quiet residential road, Holcombe Drive, just off the A379. The House is situated in three acres of land, and has scenic views across Babbacombe Bay. The accommodation is provided on 2 floors that are accessed by stairs or a passenger lift. There are two levels off the second floor that have further bedrooms that the lift does not reach. People who live in the home, that are able can climb stairs, use these rooms. The communal accommodation is all on the ground floor and comprises of two (interjoined) lounges and a very large dining room, each with sea views. There is an accessible, private garden to the rear of the property with magnificent sea views also. The majority of bedrooms are shared and none have en-suite facilities although all have a wash hand basin. All rooms are within close proximity to adapted bathing/toilet facilities. The weekly fees are currently between £535 and £675 a week. There are additional charges for services such as hairdressing and chiropody. The cost will be provided upon request. 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 . Care Homes for Older People Page 3 of 13 What we found: We made an unannounced visit to Holcombe Hall Nursing Home and spent seven (7) hours at the home. During the visit we spent time talking to people who use the service, observing what happened in the lounge and dining room, we looked closely at the care of the last person admitted, toured the home, spoke in detail with four staff and the manager Mr Warr. The reason for the visit was to look at progress made on the seventeen (17) requirements we made during a key inspection 29th March 2010 and to follow up on concerns we had following that inspection. Those concerns were passed to Devon County Council safeguarding team. The results from the safeguarding process were fed back to Mr. Soy Sebastian, the person responsible for Holcombe Hall on behalf of the organization and Mr. William Warr, the registered manager. That process is now closed. Previously we found that information about the service was not in a format suitable for the people who will use it and did not include all that is required to help people make a decisions as to whether the home is suitable for them. That information has been reviewed, some has been updated but some change is not completed. We have therefore extended the timescale to complete this work. During our visit we looked closely at the care of the last person admitted to the home. This involved meeting them, looking at records pertaining to their admission and care and talking to the manager and staff about what care is provided. We saw that their needs had been assessed and recorded. From this a plan, of how their care was to be delivered, had been produced within a reasonable timescale. Where restrictions on their liberty had been considered necessary, for their safety, the home had taken the correct steps to ensure this would be done lawfully. Records of this were good. However, the staff we asked were unaware of it. Staff providing care to people should be conversant with a persons care plan and any deprivation of liberty decision, as they are legally bound to comply with it. We found that there is not always not always clear information as to whether people have made advanced decisions to refuse treatment or whether Lasting Power of Attorney or advocacy arrangements are in place to provide legal safeguards for any person who lacks the ability to make decisions on their own welfare. However, the tools the home uses to assess peoples needs is currently under review. During the March inspection we had several concerns which related to privacy and dignity of people using the service. Personal care was being completed in the lounge; this has now stopped. Personal care was being delivered where other people could observe; this has now stopped. People were being given clothes protectors whether or not this was part of planned care and/or with their consent; this has now stopped. One persons room was being used for ironing of peoples clothes and those clothes were being hung along the corridor making it unusable for people; this has now stopped. Staff were assisted more than one person at a time to eat. It was impersonal and undignified; this has now stopped. Records containing personal information about people were kept in the lounge where they could be viewed by people who do not have a right to see them; this has now Care Homes for Older People Page 4 of 13 stopped. However, there are still no locks on toilet, bathroom or bedroom doors. We are aware that the most suitable form of lock is still being researched and so will extend the timescale for compliance. We looked to see if a more regular and varied programme of leisure and social activities is now available for people, whether they are consulted and if the specific needs of people with dementia are being addressed. Currently people can attend music for health sessions, choirs have come to entertain people and each afternoon a member of staff is alloted time for activities, including taking people into the garden. The current arrangements remain insufficiently to prevent boredom and promote a meaningful life for people based, on their individual interests and needs. At our previous inspection we found that dining at the home was an institutional process, which involved a food trolley brought into the dining room, people being given a plated meal and then the trolley was removed. Now meal times have been reviewed and some people remain in the lounge for their lunch. A new and much more varied menu is being tried, which appears much more appetizing. (Mr Warr told us he still intends to take advice on the nutritional value of the food provided.) We saw a desert trolley being taken to people so they can then choose their desert from seeing the options, which is helpful for people with memory impairment. The dining room remains fairly bare, with little adornment, and not a pleasing room in which to enjoy a meal. During the key inspection in March we watched what we considered to be abusive practice during a lunch time. A care assistant was forcing food into the mouth of a woman in a manner which was both dangerous and undignified. When we informed Mr. Warr that staff was removed and we felt assured that the situation was safe. However, when we received an Improvement Plan from Mr. Warr, and followed this with a telephone conversation for clarity, it was clear that the member of staff was still in the position where she had direct contact with people who use the service. We then made an immediate referral to Devon County Council safeguarding team. At the time of this report that safeguarding process is completed. We asked Mr Warr how arrangements at the home now ensure vulnerable people in his care are protected from staff who may be unsuitable to work with vulnerable people. He was able to show us an example of where a person had been refused employment because he felt they were unsuitable. We were also shown records of disciplinary action taken against the staff whose practice had been abusive. Staff confirmed, as they did in March, that Mr. Warr would not allow poor practice at the home. Staff told us that they have received training in how to protect vulnerable adults from abuse and each was correct in how they should respond if they have concerns. At the previous inspection we saw that there was no adapatation of the environment to help people who have the condition of dementia. At this visit we saw what had been done toward achieving this, for example, signs to guide people to the lavatory. Mr. Warr is aware of current good practice guidance on environments for people with dementia and we anticipate continued improvement. Care Homes for Older People Page 5 of 13 We toured the building with Mr. Warr and discussed safety. We have no concerns based on what we saw: wardrobes are now secure and could not fall if pulled and hand rails were secure, not loose as previously. The staff member responsible for maintenance showed his regime for checking safety within the home and risk is now better assessed and managed. However, the environment continues to look warn and outdated and lacks homely features. Neither is there any communal space where people can meet their visitors in private, as was requested by family visiting in March. Previous concerns relating to staff use of chemicals in the laundry are now dealt with as there is a new automated system in place. Staff management of soiled laundry is improved and staff told us that they have the protective equipment they require. Staff have recently received training in the safe use of chemicals. We had previous concerns about the number of staff available to care for people. Staff were managing to meet peoples needs, in part, because people were collected together most of the day time. At this inspection we asked four staff: Are there enough staff to meet the individual needs of people at the home? One said yes. One said no, not when people do not arrive for work. One said most of the time and the last said Usually, but a few days last week there were only four, instead of five care assistants and that is not enough for us to manage. Staff told us that the change of arrangements at lunch time is an improvement. However, there must be arrangements in place to meet any staffing shortfalls that occur. At the inspection visit in March we found that staff were not receiving formal supervision of their work, as part of the management process and on a continuous basis. We saw on this occasion that, although staff are still not receiving this supervision, arrangements are being put in place to do so. We looked at the recruitment records of four staff recently employed. On this occasion we found that the checks, necessary to ensure that only staff who are suitable to work with vulnerable adults are employed to do so, were more complete that previously. We saw that open references, rather than in response to a personal request, are still being accepted, which is not best practice, but Mr. Warr had refused employment to a person found to be unsuitable/unsafe for care work at the home. In March Mr. Warr did not have sufficient time to manage the home effectively as he was frequently rostered to work as a nurse on duty. His is now alloted more management and administration time. Although we know that the organisations representative (known as the Responsible Individual) Mr. Soy Sebastian, visits the home at least monthly and often weekly, he was not producing a written report on the conduct of the care home following his visit. We are now receiving those reports as required. What the care home does well: Mr. Warr has worked hard to meet the requirements made following the March key inspection of the home and he has kept the Commission informed about improvements. He has good understanding of the needs of people in his care. Care Homes for Older People Page 6 of 13 People who use the service receive a high standard of personal and health care at Holcombe Hall. What they could do better: 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 set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 5 The Service User Guide must 30/06/2010 include all of the information required and be in a format suitable for people who use the service. So that people are fully informed what the home has to offer and have a reference of it. 2 1 4 The Statement of Purpose must include all of the information required and be in a format suitable for people who use the service. So that people are fully informed what the service can offer. 30/06/2010 3 8 12 Care and support must be 31/05/2010 planned and delivered taking into account the Code of Practice and principles underlying the Mental Capacity Act 2005. So that people who are unable to make decisions on their own behalf are protected in law. 4 12 16 People must have the 30/04/2010 opportunity to engage in meaningful activities that are of interest to them and Page 8 of 13 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action within their capabilities, on a regular basis. To prevent boredom and promote a meaningful life. 5 24 12 Doors to peoples private accommodation, and all bathrooms and toilets, must be fitted with locks suited to peoples capabilities and acessible to staff in emergencies. So that people have some private space available to them. 6 36 18 Staff must be appropriately supervised. This should include regular formal supervision. So that aspects of practice and standards of care can be monitored. 31/05/2010 31/08/2010 Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The Service User Guide must 31/08/2010 include all of the information required and be in a format suitable for people who use the service. So that people are fully informed what the home has to offer and have a reference of it. 2 3 14 It must be recorded if people 31/08/2010 have made an Advanced Decision to refuse treatment, whether there are arrangements regarding Lasting Power of Attorney or an Independent Advocate. This provides the legal safeguards for people who do not have mental capacity to make decisions on their own welfare. 3 7 15 Staff providing care to people 30/09/2010 must be conversant with a persons care plan, including any deprivation of liberty decision. Page 10 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that they cannot deliver care in the way it is wanted or needed. 4 10 12 All toilet, bathroom and bedroom doors must be fitted with locks suited to peoples capabilities and accessible to staff in emergencies. To provider privacy and promote dignity. 5 12 16 Following consultation with 30/09/2010 people, or their representative, the home must provide a more regular and varied programme of leisure and social activities and opportunity for stimulation. To prevent boredom and give meaning to life. 6 27 18 Where there are staffing shortfalls there must be arrangements in place to meet those short falls. So that peoples individual needs will be met even if staff do not arrive as expected. 7 36 18 Staff must receive formal supervision of their work. So that any needs they have to improve their standard of work are identified and managed. Care Homes for Older People Page 11 of 13 30/09/2010 31/08/2010 31/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 The Home should be more domestic in nature. The decor and furnishings should be reviewed and an ongoing programme of improvement put in place. Adaptation to the home environment, so as to help people with dementia find their way around easier and so increase/maintain their independence, should continue. 2 22 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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