Care Home: Holmwood House

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What the care home does well The service offers a comfortable home to those living there, with support from a well trained staff team. The home has improved the facilities available, to make it more comfortable for those living there. Detailed assessment and care planning ensure that new admissions are as smooth as possible, and unless it is an emergency, the service do not plan admissions on a Friday afternoon or at weekends, ensuring that they are able to arrange doctors, medication and other facilities required, which may otherwise be difficult. Staff are well trained and recruitment procedures ensure that all the required checks are made, and support from the management of the company is very good. The chief executive visits regularly, and speaks with residents, which was particularly liked by one of the people we spoke with during the inspection. What has improved since the last inspection? Since the last inspection, management changes have been made. New procedures have been introduced, and the overall support available to residents of the home has improved. This was also acknowledged by the local authority following a recent visit. Improvements have been made in a number of areas, including care planning and assessment, a wider range of activities, better domestic routines and continued refurbishment of the home. People we spoke to, and the local authority, all commented on this. What the care home could do better: The service should ensure that more choice is available in the range of food available, and that the quality of food served is more consistent. The planned improvements to the garden will benefit the residents, and the improvements detailed in the AQAA to improve the dining room and corridors will make the home feel more comfortable for the people living there. Key inspection report Care homes for older people Name: Address: Holmwood House Austin Fields King`s Lynn Norfolk PE30 1PH     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: Alan Buttery     Date: 3 0 1 2 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Holmwood House Austin Fields King`s Lynn Norfolk PE30 1PH 01553773529 01553773529 pjordan@inhcare.com IntegratedNursingHomesLimited Integrated Nursing Homes Ltd care home 36 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Holmwood House is a care home providing personal care and accommodation for up to 35 older people. The home is owned by Integrated Nursing Homes Ltd. The home is located in the town of Kings Lynn, close to shops, pubs, post office and other local amenities. Holmwood House is a single storey, purpose built home. 50 of the rooms are en suite. There are small gardens at the front and rear of the home. The manager said the resident or their representative is advised verbally of the fee rate that will apply before the resident is admitted to the home. They are also advised at this time of any additional charges that may be relevant to the resident, for example chiropody and hairdressing. Current fees range between 366.00 and 450.00 GBP per week. 0 Over 65 36 Care Homes for Older People Page 4 of 25 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: This was an unannounced visit, during which we discussed the service provided with the manager of the home, who provided documentation required. During the inspection, we looked around the home, and spoke to four of the people living there, and also spoke with three staff members. Prior to our visit, the service submitted their Annual Quality Assurance Assessment (AQAA), and this has been used in compiling this report. Care Homes for Older People Page 5 of 25 What the care home does well: What has improved since the last inspection? 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 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 6 of 25 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 7 of 25 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. Detailed information is gathered from a number of sources before anyone moves into the home, ensuring that the prospective resident can be confident that their needs can be met. Evidence: The service provides information for prospective new residents in a variety of forms. The providers website features all the services they currently operate, including Holmwood House, and can be used as an initial point of contact. Many family members choose to visit the home when considering a placement for a relative and this is welcomed. The manager of the service told how they encourage visitors, and provide a brochure to take away. At the present time we were told there are 6 people living in the home that fund their own care, the remainder funded by the local authority, but the processes followed are Care Homes for Older People Page 8 of 25 Evidence: the same irrespective of funding arrangements Either the manager or deputy manager will visit the prospective new resident to carry out an assessment of that persons needs, and to ensure that the service is able to meet those needs. Once this is done, and they are confident that the identified needs can be met, a place would be offered and wherever possible the prospective resident encouraged to visit them if they had not already done so. During our inspection visit, we looked at the individual files for four residents of the home, and each had a copy of the assessment that had been carried out. We also spoke with four residents, two of them whose files we had seen, and discussed the process followed with them. All three remembered the manager visiting them and taking down information about their needs. As soon as it has been agreed that the home is suitable and can meet the persons identified needs, arrangements are made for the new resident to move to the home. They are given a copy of the Service User guide, which contains basic information about the service, although the copy we were given during our visit does need to be reviewed, as it refers to the previous regulator and not the Care Quality Commission, and has incorrect contact information. The AQAA confirmed that anyone funding their own care would receive a written contract confirming the financial details, and this was confirmed by one resident we spoke to, who funds their own care. The AQAA also indicated that the service are looking to provide information in alternative formats and in large print to meet the needs of those with communication problems. The service does not offer intermediate care. Care Homes for Older People Page 9 of 25 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. Individual care plans show how the identified needs will be met by the service, and how this is done in a manner suited to the individual person concerned Evidence: The assessment information gathered prior to anyone moving into the home is used to prepare initial care plans, which normally cover the first 48 hours of a new residents stay in the home. At this stage, more detailed plans should then be in place. In this initial period, new resident normally receive a visit from a GP they have chosen to be with. There are 5 local GP practices used by the home, and if a new resident is local and is already registered with one of the GP practices, this would continue. Arrangements are also made at this stage for prescribed medication to be available. On occasions, where admissions occur on an emergency basis, arrangements would be made with the doctors to ensure medication was available immediately if required. The individual care plan details all the health and social care needs of the person, and shows how staff should be providing care and support to suit the person. The plans Care Homes for Older People Page 10 of 25 Evidence: also include risk assessments as required, including pressure care nutrition and moving and handling. Health records we looked at for four of the residents included all of these risk assessments, together with suitable care plans, and all showed weights were recorded at least monthly. The individual plans also included details of the likes and dislikes of people living in the home, and the type of activities they had enjoyed previously, and activities are arranged to meet those likes and to try and encourage gentle exercise and stimulation. Senior care staff are given responsibility for reviewing the care plans, and this is done on a monthly basis, and the AQAA informed us that the careplan files are audited by management at least every other month to ensure that they are being reviewed and kept up to date. As part of our visit, we looked at the individual files of four people livening in the home, and spoke to two of these people. They were familiar with the care plans, and the files we examined showed that the individuals had been involved in the planning and writing of the care plans. One of the residents we spoke to told us how the staff sit with them every month and go through the care plan, and that it is very individualised. We looked at this particular file, and found this to be the case, with details of their liking for sports programmes, and the help given for them to access their own satellite television account. The other files examined also showed evidence that the care plans were being reviewed on a regular basis, as detailed earlier, and contained a great deal of information about the person. Medication is administered by senior staff who have all received training to ensure they are competent, and the group of senior staff collectively take responsibility for the monthly medication order and delivery. At the present time we were told that no one chooses to look after their own medication, although this would be supported if required. Some people living in the home use an inhaler, and these are kept in their room. Medication records were examined for the people we were tracking and were all up to date. Care Homes for Older People Page 11 of 25 Evidence: In the coming months the AQAA told us that the service hope to use computer printed care plans, making them easier to follow and easier for staff to records changes. Care Homes for Older People Page 12 of 25 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. A range of events and activities are arranged both in and out of the home, ensuring that all residents have a choice of things to do whilst living in the home, and a range of nutritious food is generally available, although they should ensure that a range of foods is provided to meet the likes of everyone living in the home. Evidence: The service employs an activity coordinator, and it is their responsibility to arrange activities both for groups and individually. The AQAA detailed some of the activities that are arranged, which include some activities aimed at providing exercise and mental stimulation such as music and movement sessions, music mornings, singing and quiz sessions. Other group activities include bingo, games afternoons, arts and crafts, DVDs and karaoke while individually there is reading, painting, music, reminiscence and conversation. Some trips are also arranged, shopping in the town, trips to the Theatre, to Hunstanton and to the Royal estate at Sandringham. The service also arranges celebrations at Christmas, Easter, Valentines day and other special occasions, and Care Homes for Older People Page 13 of 25 Evidence: hold a summer fete. A local clergyman visits the home monthly and holds a communion service for those that wish to attend, and the service welcomes family members who also wish to attend. The clergyman is available to visit at any other time should someone wish to see them. The manager told us that visitors are always welcome, and this was confirmed by all of the residents we spoke to who all had regular visitors from their family, friends and neighbours. One resident who has family living abroad is supported to keep in contact through email. Meals are served in a large open dining area, and we were told by the manager that a varied diet is provided. The four people we spoke to had mixed views on the quality and quantity of the food provided, one person said the food was good, with lots of choice and several types of vegetable, another person told us that there were good days and bad days, he liked more spicy food than was served and a third person told us the food was often poor quality, with small portions It was generally agreed by all that their Christmas dinner had been poor this year, and we told that rather than a Sunday roast, which they were used to and all liked, they were recently served Cornish pasties and frozen vegetables. This was discussed with the manger during our visit, who agreed to look further at the variety of menu, and arrange for this to be discussed at the next residents meeting. Care Homes for Older People Page 14 of 25 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. Procedures are in place to ensure that any concerns, complaints or allegations are dealt with. People who live in the home are all aware of how to make such concerns known. Evidence: Procedures are in place to manager any concerns, complaints or allegations made. The AQAA submitted prior to our visit showed there had been five complaints received in the last year, and no safeguarding referrals. Shortly before the inspection, the commission received a concern from a relative, and this was referred to the local safeguarding team. A detailed enquiry was undertaken, but in general they found that the home had managed the situation very appropriately, and found significant improvements if the quality of care compared to a previous investigation two years previously. Residents that we spoke to all knew how to make concerns known, and staff records examined showed that regular safeguarding training takes place for all staff. A copy of the complaints procedure is available to all, but the service should ensure that this contains up to date information about the Care Quality Commission. The AQAA indicated that the policies have been reviewed this year to included requirements under the Mental Capacity act, and that they hope to have the Care Homes for Older People Page 15 of 25 Evidence: procedure available next year in alternative formats such as braille and large print. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is clean, and provides a safe and comfortable place to live in for the residents living there. Evidence: As part of our inspection, we looked around the home, and discussed with some of the residents the facilities they had available. As already indicated, one person told us how the home had helped provided a satellite system for him to watch more sports programmes, another showed us some of the personal effects they were able to bring. The service encourages people to bring their own items with them, and if these cannot be accommodated in their room, they may be able to have them in the lounge or dining area. The AQAA confirmed the arrangements within the home around infection control included hand wash gels, washing facilities in every room, disposable laundry bags for contaminated laundry, and a more structured cleaning programme led by a newly appointed head housekeeper. During our visit the hand wash facilities were seen, and were being used. During our look around the home, there were no unpleasant odours, and it appeared to be clean, and domestic staff were seen cleaning individual rooms. Care Homes for Older People Page 17 of 25 Evidence: The garden has recently had new fencing, and plans for the coming year, which were detailed in the AQAA include some new plants and a gazebo in the garden together with new garden furniture. Plans for inside the property include continued refurbishment of rooms, and the plastering and painting of a brick faced wall in the dining room, which is in response to feedback from residents that it is very dark. It is also planned to improve the lighting in communal areas of the home, again these are considered very dark. Further external works planned include new double gates at the front of the property, and further improvements to the garden area, with plans already in place to landscape some of the garden ensuring it is more accessible to residents. Care Homes for Older People Page 18 of 25 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. Procedures are in place to ensure that suitable checks are made when recruiting staff, and sufficient training provided, to ensure the needs of the people living in the home can be met, and they are not placed at risk. Evidence: The AQAA describes the recruitment process followed by the service, and this was discussed during our visit with the manager of the home. Detailed recruitment checks are carried out in accordance with the regulations, and on the three staff files that were examined during our visit, the required information was in place. Details of the training provided in the past year was also given in the AQAA, and this included moving and handling, food hygiene, abuse awareness, coshh, first aid, medication, infection control, Mental capacity act, diabetes, catheter care, and safeguarding. Staff records that were examined during our visit for three of the care team, all contained evidence of the training that they had received. During our visit we observed staff going about their work, and spoke with two of the carers. They appeared unhurried, and had time to talk to residents, and those we spoke with told us that the training they were now getting had improved. Residents that we spoke to were all very complimentary of the staff in general, although one person feels that more staff are needed, as at times they has to wait for assistance to Care Homes for Older People Page 19 of 25 Evidence: move from their wheelchair to their bed. This was discussed further with the manager, who agreed to look at options with the resident concerned. In the last year, more care staff have completed level 2 or 3 NVQ, and we were told in the AQAA that the chef has completed a food hygiene and infection control course. Care Homes for Older People Page 20 of 25 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 service is well managed, and the views of those living there taken into account. procedures are in place to ensure that those living or working in the home are not at risk. Evidence: The service is one of a number of homes owned and operated by the provider, and has good local links with the other homes in Norfolk. The manager of the home is experienced, having worked with older people for 11 years. The service is run with the interests of the residents in mind, and measures to ensure that their views are taken into account include monthly meetings, quality assurance surveys and an open door policy of management. Examples of changes made or planned at the request of residnets include the re plastering of a wall in the dining room and the provision of Sky sports for one of the residents. We were told by one resident that nothing is too much trouble, by another that the Care Homes for Older People Page 21 of 25 Evidence: carers are very good and if I can do something from myself, they support me. Another comment received was I have everything I need. However we were told by another resident that the manager is too busy and does not have time to see everyone. It is important that the service ensure that everyones views are taken into account. Procedures are in place to ensure that staff and residents are not placed at risk, and all staff receive health and safety training. The service employs a maintenance person who is responsible for all the required safety checks, and we were told within the AQAA that the necessary checks are all made and that all the equip met in use in the home has up to date servicing agreements in place. The AQAA also detailed improvements planned in the coming year, continuing the refurbishment of the property, better auditing tool to be used and in proving staff retention. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 1 The service should ensure that all documentation is kept under review, to include correct information about the regulatory authorities. The service should ensure that a choice of food is available so that the likes of everyone living in the home are catered for. The service should ensure the complaints procedure is up to date, with correct contact information available. The service should ensure that sufficient time is available for management to speak with people living in the home on a regular basis. 2 15 3 4 16 31 Care Homes for Older People Page 24 of 25 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). 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. 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