Care Home: Hollymere House General Nursing Home

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What the care home does well People`s needs are assessed before they go to live at Hollymere House to make sure that this is the right home for them. The people we spoke with were very satisfied with the health and personal care that they receive and we observed that staff had a positive, caring and respectful attitude. Medicines are well managed and records showed that people receive what has been prescribed for them by their doctor. Social activities are provided for the people who wish to join in and people can choose whether they wish to spend their time in one of the lounges or in their own room. There are good records to show that complaints are taken seriously. Staff have received training so that they are able to make sure that residents are protected from abuse. Good recruitment procedures are followed to make sure that the home does not employ anyone who would be unsafe to work with vulnerable people. Training is provided to ensure that staff know how to work safely. People are given opportunities to express their views in meetings and through satisfaction surveys and there are internal audits to monitor the quality of the service. Regular checks of the building and equipment are made to ensure that the health and safety of staff and residents is protected. What has improved since the last inspection? A new manager has been registered since our last visit to the home and she is supported by a general manager. The grounds and gardens have been improved, and there is a pleasant outdoor sitting area for the people who live at the home to enjoy. The ventilation of the first floor has been improved so that it doesn`t get too hot and stuffy. What the care home could do better: Assessments done before people come to live at the home should be more detailed so that staff have good information about the person`s care needs. The assessments should always be signed and dated so that we know when they were done and by whom. There is room for improvement in the care plans so that they are more `personcentred` and reflect the social and emotional needs of the individual and how the staff can meet these needs. Make sure that the kitchen always has enough staff with the necessary skills to ensure that a consistent standard of meals is provided. Replace window panes that have `blown`. Provide good bathing and shower facilities on both floors of the home. Improve the lighting around the nurses stations to help the staff doing paperwork. Consider providing an extra member of staff between 8pm and 10pm to help people settle for the night. Key inspection report Care homes for older people Name: Address: Hollymere House General Nursing Home Crewe Road Haslington Crewe Cheshire CW1 5QZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 1 7 0 9 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 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. 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 Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Hollymere House General Nursing Home Crewe Road Haslington Crewe Cheshire CW1 5QZ 01270501861 01270585043 hollymerehouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Ann Bearpark Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 The maximum number of service users who can be accomodated are: 48 Date of last inspection Brief description of the care home Hollymere House is a modern two-storey property that was purpose built as a care home for older people. It is set in its own grounds, that are shared with the neighbouring Primrose House nursing home. The homes are in the Haslington area of Crewe, close to local amenities and within easy reach of Crewe town centre. The Care Homes for Older People Page 4 of 23 Over 65 48 0 Brief description of the care home homes are owned by Southern Cross Healthcare Ltd. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors visited Hollymere House unannounced on 17 September 2009 as part of this inspection. During the visit one of the inspectors spoke with residents, staff and a visitor. We walked round the building to see all the communal areas and some of the bedrooms. We checked records kept at the home and spent time talking with the general manager and the operations manager. We also looked at any information that we had received about Hollymere House since our last inspection there in 2007. Before the inspection the manager was asked to complete a questionnaire to give us up to date information about the service and survey forms were sent out for staff to give us their views. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: Assessments done before people come to live at the home should be more detailed so that staff have good information about the persons care needs. The assessments should always be signed and dated so that we know when they were done and by whom. There is room for improvement in the care plans so that they are more personcentred and reflect the social and emotional needs of the individual and how the staff can meet these needs. Make sure that the kitchen always has enough staff with the necessary skills to ensure that a consistent standard of meals is provided. Replace window panes that have blown. Provide good bathing and shower facilities on both floors of the home. Care Homes for Older People Page 7 of 23 Improve the lighting around the nurses stations to help the staff doing paperwork. Consider providing an extra member of staff between 8pm and 10pm to help people settle for the night. 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. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they come to live at Hollymere House to find out if it will be the right home for them. Evidence: When we visited Hollymere House we found that information about the home was available in the entrance area for people to look at. There was also a copy of the homes Service User Guide in each bedroom for residents and their visitors to read. We found evidence in the care plans we looked at to show that peoples needs had been assessed before they came to live at the home. However, we considered that some of the assessments were very brief and could be more detailed so that staff have more information about new residents. Not all of the assessments had been signed or dated. On the day we visited one of the nurses had gone out to assess someone who was interested in coming to live at the home. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 health and personal care needs of the people living at the home are met and medicines are well managed. Evidence: Each of the people living at the home has a care plan. The care plans contained quite good assessments of peoples health and personal care needs and of any risks to their health and safety. All except one of the care plans we looked at had been kept up to date with monthly reviews. There were also records of regular reviews involving the resident and their family. We found little information about peoples social and emotional needs or about their personal preferences and choices about how they like things to be done. All of the people we spoke with were positive about the care provided and we received comments including the girls are marvelous, they treat me with respect. One person told us that she does not want male carers for personal care and this is respected. We observed that the staff had a very positive and caring attitude towards residents. Care Homes for Older People Page 11 of 23 Evidence: We were able to speak with a GP who visits the home every week. She spends about two hours there each week and sees any residents as needed. She considered that the homes staff communicate well with her, but thought that some of the nurses could do further training which would enable them to give additional treatments such as flu vaccinations. We also saw records which showed that people living at the home had visits from a range of healthcare professionals including tissue viability nurse, dietician and continence advisor. Moving and handling equipment was available on both floors and pressure relieving mattresses were provided for people at risk. We looked at the arrangements for storing and recording medicines. A medicines audit is carried out monthly by one of the nurses and records a consistently high score. We saw that storage, including controlled drugs, was safe and secure, and the records we inspected indicated that people always get the medicines that are prescribed by their doctor. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are able to choose how they spend their time and social activities are available for people who wish to join in. Evidence: The home employs an activities organiser for 30 hours a week and she arranges social activities within the home and trips out. She told us that she also spends time with people who dont want to, or are not able to, join in the activities but enjoy a chat. There is a choice of two lounges on each floor and some people prefer to stay in their own room. Visitors are welcomed at any time that suits the resident and we observed that some family members are very involved in the home. Most people had brought in some belongings from their home to make their bedroom more homely and personalised. Most people had their lunch in one of the two dining rooms, which are nice and bright. There is a four-weekly menu cycle but the lunch served on the day we visited was not what was on the menu for that day. We saw that people get a choice of meals and the residents we spoke with confirmed this. The lunch served on the day of our visit looked appetising and nicely cooked, but several people told us that the quality of the Care Homes for Older People Page 13 of 23 Evidence: meals is not consistent and is sometimes poor. The meals are put onto plates in the kitchen, which is not an ideal arrangement because the care staff are more likely to know what each person likes and how much they want, however extra potatoes and vegetables were available for anyone who wanted them and the gravy was served separately. The kitchen at Hollymere House provides the meals for the neighbouring Primrose House, which is a total of 84 people if both homes are fully occupied. This means that the kitchen is very busy and the manager needs to ensure that there are enough staff with the required skills working in the kitchen each day so that a consistent standard can be maintained. We were told that the assistant chef had left recently. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 living at the home are protected from abuse and complaints are taken seriously. Evidence: The home has a good complaints procedure that informs people who they should contact if they wish to make a complaint, and how their complaint will be dealt with. We saw good records which showed us that complaints made had been fully investigated, action taken where needed, and a full written reply sent to the complainant. The procedure is displayed in the entrance area and is included in the Service User Guide. Southern Cross provides policies and procedures for staff to follow if they suspect that someone has suffered abuse. All of the staff have had training recently from a training company to ensure that they know how to recognise and report abuse. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home is spacious, comfortable, safe and clean, but there are some issues with maintenance of the building that need to be addressed. Evidence: The home is modern and spacious and each resident has a bedroom of good size with en-suite toilet and wash basin. There are two lounges and a dining room on each floor. The grounds were tidy when we visited and the large garden, that is shared with Primrose House, had been much improved. Ventilation of the first floor has been improved since our last visit so it no longer gets so hot and stuffy. Overall the decor is looking tired and in need of some refurbishment. There are two long-standing issues that have not been addressed. A number of window panes are blown and contain condensation which means that people cannot see out properly. They have been like this for several years. Bathing facilities are very poor. The two bathrooms on the first floor are not fit for use but there is a shower room. One of the bathrooms on the ground floor is usable but has a broken bath panel and a rusty seat. There is no shower room on this floor. The lighting at the nurses station is poor and this must make it difficult for staff doing paperwork. We found that the standard of cleanliness was much improved and there were no unpleasant odours. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are enough staff to meet the needs of the people living at the home and a good range of training is provided for the staff to make sure that they know how to work safely. Evidence: There are two nurses and seven carers on duty between 8am and 8pm. The rotas showed that these numbers are usually maintained but there had been one day this week with only six carers. At night there is a nurse and three carers. We considered that the number of staff appeared to be adequate to meet the needs of the people living at the home and we saw no evidence of people waiting a long time for attention. However we did think that the manager should consider having an extra member of staff between 8pm and 10pm, which is a busy time and the nurse is occupied giving people their night medication. Southern Cross have a bank of staff for the Crewe area and they can be used to cover any shortfalls. The general manager told us that agency staff may also be used if necessary. We looked at the recruitment records for some new members of staff. We found that good records were maintained and these showed that references were received and Criminal Records Bureau disclosures were applied for before anyone new started working at the home. This is to protect people from staff who may be unsuitable to work with vulnerable people. Care Homes for Older People Page 17 of 23 Evidence: 23 care staff are employed and only four have a national vocational qualification in care (NVQ). We were told that nine others have either started working towards a qualification or enrolled to start in the near future. The general manager said that retention of qualified care staff is difficult because they can get better pay in other places, for example hospitals. The staff we spoke with were pleased with the training they receive. One carer told us that she has worked at the home for five months and has completed training about safeguarding, moving and handling, and fire safety. She has enrolled to do NVQ. Another carer said that she has worked here for nearly a year and has done training about health and safety, safeguarding, moving and handling, dementia, control of hazardous substances, fire safety and food hygiene. She is going to do first aid then start NVQ. There is a new regional training manager and courses are booked for the next few months. Training is shared with other Southern Cross homes in the area. We were also provided with up to date training matrix which showed that 31 staff have had fire safety training in the last six months and 35 have attended a fire drill in the last six months. During the last year, 23 people have had food hygiene training and 25 have done safe moving and handling. Other training has been about control of hazardous substances, health and safety, safeguarding, infection control and nutrition. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 home is well managed to ensure that people are able to express their views and are kept safe. Evidence: The home has had a new manager since our last visit and she has recently been registered with CQC as manager of this service. There is also a general manager shared with Primrose House. A member of staff told us Ann is a fantastic manager, very supportive. She is working towards a management qualification. Unfortunately we were unable to meet the manager as she was on holiday when we visited. We saw records of regular meetings for residents, relatives and staff, and people given opportunities to express their views. There is a weekly managers surgery when people are invited to come and talk to the manager. The operations manager visits at least monthly and writes a report as required by the Care Homes Regulations. A Southern Cross key outcome audit was last done on 28/8/09 and the home scored 74 . An external company has been commissioned to carry out a customer Care Homes for Older People Page 19 of 23 Evidence: satisfaction survey. The home also has its own satisfaction survey form and the operations manager likes these to be sent to new residents and to people who have made a complaint to check if they are satisfied. An administrator is employed part-time to deal with day to day office work. People who live at the home may put some personal spending money in safe-keeping to pay for items such as hairdressing. Detailed records are kept and balances are checked weekly. The administrator can provide a print out for the resident and/or their family. Staff at the home do not help any residents with their finances An internal health and safety audit was done in February 2009 and scored 94 . A maintenance person is employed full-time to ensure that day to day repairs and maintenance can be done without delay. The AQAA gave us dates when all plant and equipment had been tested and serviced as required to make sure that the home is safe. The fire alarm is tested weekly and the emergency lighting monthly. The maintenance person keeps good records of the regular safety checks he carries out. An environmental health officer visited in March 2009 and identified some minor issues in the kitchen which we were told have all been addressed. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 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, Care Homes 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 21 23 The home must provide 27/11/2009 adequate bathing/shower facilities to meet the needs of the people who live there. So that people can have a bath or shower safely and comfortably. 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 2 3 4 19 19 27 28 Window panes that are blown should be replaced. Improve the lighting in the areas where staff do their written work. Consider deploying an additional carer between 8pm and 10pm when the nurse is busy with medicines. More staff need to achieve NVQ so that there is a wellqualified team. Care Homes for Older People Page 22 of 23 Helpline: 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). 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