Care Home: Hollybank Nursing Home

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What the care home does well The residents looked clean and well cared for. The residents told us that they liked the food and they had plenty to eat. More activities are now being provided for the residents. What the care home could do better: Most of the requirements from the last inspection remain outstanding. These were issues in relation to: Care plans and assessments that still do not give enough information about the current and changing needs of the residents. Medication management remains unsafe. The staff need to be suitably trained so that they have the skills and knowledge to care for the residents safely. Improvements must be made to the environment so that the residents can live in a pleasant and safe environment. Random inspection report Care homes for older people Name: Address: Hollybank Nursing Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN zero star poor service 20/01/2010 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: Grace Tarney Date: 2 8 0 4 2 0 1 0 Information about the care home Name of care home: Address: Hollybank Nursing Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN 01617235756 01617249693 hollybankdualreg@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Halliday Type of registration: Number of places registered: Conditions of registration: Category(ies) : QNS Residential Limited care home 49 Number of places (if applicable): Under 65 Over 65 0 49 dementia old age, not falling within any other category Conditions of registration: 10 0 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: Old age, not falling within any other category - Code OP. Dementia - Code DE (10). The maximum number of service users who can be accommodated is: 49 Date of last inspection Brief description of the care home Hollybank is operated by QNS Residential Limited. The home provides 24-hour care for up to 30 older people. The property is on Bolton Road Radcliffe and is about one mile Care Homes for Older People Page 2 of 14 2 0 0 1 2 0 1 0 Brief description of the care home from the town centre. There is a bus stop on the main road close to the home and there are shops nearby. The accommodation is provided on two levels with a lift giving access to the first floor. The home has fourteen single bedrooms and eight rooms that are shared. There are two lounges and there is a separate dining room. Toilets and bathrooms are provided on both floors. The home has a garden area with seating that can easily be reached from the conservatory. A Service User Guide that describes the homes services is readily available in the home and the staff give other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report, the homes Statement of Purpose and copies of the homes policies and procedures are also displayed in the home. At the time of this inspection the weekly charge for accommodation and services range from 380:00 pounds with a top up fee of 10 :00 pounds. Additional charges being made for hairdressing and chiropody services. Care Homes for Older People Page 3 of 14 What we found: The reason for this inspection visit was check that the requirements made in the Statutory Requirement Notice, dated February 2010 and the requirements made following our inspection visit on 20th January 2010 had been complied with and they were no longer in breach of the regulations. A Statutory Requirement Notice is a legal notice, which is served on the provider when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach. It also gives the date by which this must be done. We then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements in this notice were made to make sure that residents health was not at risk from poor medication practices. The Statutory Requirement Notice made the following eight requirements that had to be complied with by the 19th March 2010: 1. Put in place effective arrangements at the home to ensure that all service users have a sufficient supply of medication to ensure that they receive prescribed medication entirely in accordance with the directions of the prescriber. 2. Make arrangements to ensure that all medication is administered as directed by the prescriber to the service user it was prescribed, labelled and supplied for. 3. Make arrangements to ensure that all medication administration records are completed contemporaneously, clearly and accurately to show that all medicines are administered to service users correctly and can be accounted for. 4. Put in place effective arrangements at the home to ensure that any omissions or variations in the administration of prescribed medication and reasons for these are clearly and legibly and promptly recorded. 5. Put in place effective arrangements at the home to ensure that all medication is administered to service users in exact accordance with the prescribers instructions. 6. Put in place effective arrangements to ensure records of all medication received into the home are accurately completed. 7. Put in place effective arrangements to ensure records of all medication for disposal are accurately completed. 8. Put in place effective systems for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. During the inspection we spoke to the homes acting manager and a manager working on behalf of Bury Social services about medication practices. They told us they had found many instances of poor medication practice and they were of the opinion that the Statutory Requirement Notice was unmet. We also spoke to two members of staff who Care Homes for Older People Page 4 of 14 had responsibility for administering medicines. Full detailed feedback was given to the acting manager at the end of the inspection. The pharmacist inspector looked at medication together with records about medicines for twelve residents. We found that none of the requirements in the Statutory Requirement Notice had been met and the residents health and wellbeing was still at significant risk of harm. We found that the home had failed make sure that all residents had a sufficient supply of medication. Five residents could not be given some of their medication either because it had run out or staff had just recorded it was unavailable to give. We looked at the quantities of medication available in the home on the day of inspection for specific residents, together with the records of receipt, administration and disposal. We found that not all medication could be accounted for and that it was probable that medication such as analgesia and laxatives had been shared between residents rather than administering from their own supply. The records about medication were very poor and confusing. Sometimes the records showed that residents had been given more medication than prescribed because the same medication had been signed for twice on the same day. Some records could not show what medication had been given because the staff failed to sign the administration records. We found that the records were not always signed when medication was given and on the day of inspection we found that medication was signed as given but the medication remained in the medication room. The records about non administration, receipt and disposal were also inaccurate. It was difficult to tell which records could be relied upon to show accurately what medication had been given to residents or if medication could be accounted for. There were numerous incidents where medication had not always been given to residents as prescribed by the doctor. The acting manager had found that one resident had been prescribed two antibiotics and staff had given half the prescribed dose of one and quarter the dose of the other antibiotic. Failure to administer medication as prescribed could lead to serious risk of harm to residents health. We also found failures in the safe keeping of medication. Some medication was not stored securely, other medication was not stored at the correct temperature. We were also told that medication was not disposed of according to current legislation. During the inspection we took evidence of the failure to meet the requirements and the breaches of regulation under Code B of the Police and Criminal Evidence Act. Following the last inspection of 20/01/2010 requirements were also made in relation to the following: Inadequate preadmission assessments. A detailed assessment needs to be completed to ensure that the home staff can meet the needs of the individual. There had been no new admissions to the home. The current document in use for pre admission assessments did not contain enough information to allow a detailed assessment of an individuals needs. This requirement had not been met. Care Homes for Older People Page 5 of 14 There was a requirement to ensure that all the residents have a detailed care plan showing how their needs are to be met. This requirement was not met. The acting manager told us that the majority of the care plans had not been updated. We were told by the acting manager that she had asked the care staff who had been at the home for a long time and knew the residents, to write out an assessment of the residents needs. We saw evidence that this had been done when we looked at one of the care plans. Not all the information required however, had been documented. The record was incomplete. The assessment was also not signed and not dated. It is important to sign and date assessments so that there is a very clear record to show what the needs of a resident are at any specific time. We saw that the acting manager had brought in new care plan documents to improve the documentation within the home. The care plan that we looked at had been updated since the last inspection of 20/01/2010 and there had been some improvements. We did see however that important information about the resident had not been added to the care plan. There was no information to show that this resident had a pressure sore and that the district nurses were visiting this resident to address this nursing need. There was also no evidence to show how the staff had to care for the resident to reduce the risk of any further pressure damage. There was also conflicting information in the care plan about one aspect of this residents care needs. We did visit this resident in her bedroom and saw that she was being cared for very well. The correct type of equipment was in place to make sure that her care needs were being met. Another requirement was to make sure that staff were trained so that they have the skills to meet the needs of the residents. The acting manager told us that this requirement had not been met. The requirement to ensure that there was a system in place for reviewing the quality of care provided at the home had not been met. The acting manager told us that a quality assurance system had not been put in place. Following the last inspection a recommendation was made in relation to the environment The recommendation was to continue with the refurbishment of the home to make sure that the residents live in comfortable and pleasant surroundings. We looked around the home to see if any improvements had been made. We found that the following things needed putting right: Several of the bedrooms doors were very wide and there was very little space between the door handle and the lintel. This could make opening/closing the door properly difficult for the residents. Some of the bedrooms had a toilet situated in the corner of the room. They were not ensuite. We felt this was totally undignified. We saw that 1 of these toilets did not have any screening. Several bedrooms were in need of redecoration. Several bedrooms had carpets that were in need of replacement as they were either badly stained or rucked, causing a trip hazard. The furniture in several bedrooms was badly marked and in need of replacement. The majority of the bedrooms were without a call bell lead. Staff handwashing facilities such as liquid soap and paper towels were not available in the majority of the bedrooms. To reduce the risk of cross infection, this facility should be in place wherever personal care is being delivered. Several of the toilets and bathrooms were without aids and adaptations. These are necessary to help reduce the risk of any accidents and to aid independence. Not all the toilets and bathrooms had a lock on the door that was working. Care Homes for Older People Page 6 of 14 Several of the toilets and bathrooms were in need of redecoration. The radiators in the dining room, a bathroom and a bedroom were unguarded. This could be a health and safety risk to the residents. There was a trip hazard in one of the lounges. We were told that this was due to a tree stump coming through the foundations. What the care home does well: 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 14 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 3 14 A detailed pre admission 31/03/2010 assessment is to be completed to ensure the home can meet the needs of the individual. To enable staff to offer the care needed on admission. 2 4 18 You must ensure that staff are suitably trained to care for people who require specialist care, for example residents with dementia. To ensure that staff are able to provide the appropriate care needed. 30/04/2010 3 7 15 You must ensure that all residents have a detailed care plan as to how their needs are to be met. To enable staff to provide the individual care needed. 31/03/2010 4 9 13 Effective arrangements must 19/03/2010 be put in place at the home to ensure that all medication is administered to residents in exact accordance with the prescribers direction. Because receiving medicines at the wrong dose, wrong Care Homes for Older People Page 8 of 14 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 time or not at all can seriously affect their health and wellbeing. 5 9 13 There must be effective systems in place to ensure that staff that handle medicines are trained in medicines handling and are competent to do so safely. To help make sure that people who live in the home are kept safe. 6 9 13 There must be effective information recorded to enable staff to administer medication safely and know how to store medication safely. To prevent residents health from being harmed by the misuse of medication. 7 9 13 Effective arrangements must 19/03/2010 be in place at the home to ensure that all medication records regarding, receipt, administration and disposal are completed accurately. So that medicines can be fully accounted for to prevent mishandling. Records must show that medicines are being given correctly and peoples health is not at risk from harm. 8 9 13 That a record is maintained of all medicines destroyed/returned to the 28/02/2009 19/03/2010 19/03/2010 Care Homes for Older People Page 9 of 14 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 chemist. To ensure an accurate account of all medicines is maintained to ensure they are being safely managed. 9 9 13 There must be an effective auditing process in place to ensure that managers are confident that medicines are being handled safely. To help make sure that people who live at the home are kept safe. 10 16 13 Arrangements are made to ensure that safeguarding training is provided to those staff who have not been provided with such training since the last inspection. To ensure that residents are cared for and supported safely by staff who are appropriately trained in safeguarding issues. 11 18 13 You must make sure that 31/03/2010 measures are in place to prevent residents being harmed of suffering abuse or being place at risk of harm or neglect. To make sure that residents are safe and their health and well being is maintained at all times. 12 27 18 You must ensure that all staff 31/03/2010 have the skills to meet the Page 10 of 14 19/03/2010 28/02/2009 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 needs of the residents. To make sure that the individual care needs of the residents are met. 13 30 18 You must ensure that all staff 31/03/2010 receive training that is appropriate to the work they are to perform. To ensure that residents are in safe hands at all times and their care needs are met. 14 30 18 That arrangements are made 28/02/2009 to ensure that staff are provided with ongoing relevant training. To ensure that residents are cared for/supported properly by competent staff. 15 31 9 You must ensure that 31/03/2010 residents live in a home which is run and managed by a person who is fit to be in charge and is able to discharge her responsibilties fully. To make sure that the home is run in the best interests of the residents. 16 33 24 That a system is established and maintained that evaluates the quality of the service provided at the care home. To help ensure the home is run in the best interests of Care Homes for Older People Page 11 of 14 28/02/2009 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 residents. 17 33 24 You must ensure that there is a system for reviewing at appropriate intervals the quality of care provided at the home. To ensure that the home is run in the best interests of the residents, 18 38 13 You must ensure that that unnecessary risk to the health and safety of residents are identified and eliminated. To ensure that residents live in avsafe and secure environment. 19 38 13 That arrangements are made 28/02/2009 to ensure pipework and radiators are guarded or have guaranteed low srface temperature surfaces. to minimise unnecessary risks to the health and safety of residents. 31/03/2010 31/03/2010 Care Homes for Older People Page 12 of 14 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 19 23 The premises must be kept in a good state of repair, kept clean and well decorated. A plan of how and when this will be achieved must be forwarded to the Commission. To ensure that the residents live in a clean, safe and pleasant environment. 30/06/2010 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 Care Homes for Older People Page 13 of 14 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. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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