Care Home: Holmwood Nursing Home

What the care home does well The Registered Provider has appointed a new manager however an application to register them with the Commission for Social Care Inspection has not yet been received. What the care home could do better: The newly appointed manager had not made any of the changes indicated in the last inspection report. They had not taken any action to ensure that the Registered Nurses currently working in the service had undertaken the assessments of risk, or changed the way that medication is managed in the service as required in the Statutory Requirement Notices issued for those breaches of the regulations. There was no evidence that the Registered Provider had taken any action to ensure that this had occurred, or to ensure that the people he had appointed had undertaken any action to comply with the Statutory Requirement Notices. The management of the home remains poor, and evidence was seen of non compliance. All perspective residents should have a fully completed pre-assessment undertaken before they are offered a place at the home to ensure that their needs can be met by the experience and skills of the staff working there. This is not currently happening placing people who use the service at risk of harm A care plan written with the residents and or family involvement should be available for staff to follow to ensure all the residents care needs wishes and preferences are followed. The care plans should reflect the assessments undertaken and changes to care needs indicated by that assessment. This is still not happening, placing people who use the service at risk of harm Residents are at risk due to the lack of safe systems regarding the regarding the ordering, recording and administration of medication. There needs to be systems for monitoring medication administered to ensure residents receive the medication they are prescribed. With nursing staff abiding by the NMC guidelines for the administration of medicines. The homes policies and procedures need to be reviewed and reflect the practice with in the home. All people who use the service that require assistance with moving should have a moving and handling risk assessment. There should be a risk assessment available for any identified risk, it should detail the risk, give the management strategy, and record the date when reviews will take place. This is still not happening placing people who use the service at risk of harm or abuse. Although evidence had been seen previously that staff training on prevention of abuse had taken place restraint without risk assessing was still undertaken. No service user should be subject to restraint unless securing welfare and then only in exceptional circumstances. In all cases the circumstances must be recorded in which restraint is used and the type of restraint. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB zero star poor service 15/12/2008 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Sally Hall Date: 0 2 0 3 2 0 0 9 Information about the care home Name of care home: Address: Holmwood Nursing Home 53 The Avenue Tadworth Surrey KT20 5DB 01737217000 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) : Robert William Kibble care home 48 Number of places (if applicable): Under 65 Over 65 0 48 dementia old age, not falling within any other category Conditions of registration: 48 0 The maximum number of service users to be accommodated is 48 The registered person may provide the following category of service: Care home with Nursing(N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Holmwood is registered with the Commission for Social Care Inspection as a care home with nursing for forty-eight service users. The home is located in Tadworth in Surrey and close to public amenities and other facilities. Accommodation is provided on two floors and comprises of an office, lounge, dining area, kitchen, bathrooms, toilets, showers, laundry and bedrooms with en-suite facilities. The home has an attractive garden which is private and accessible to service users. Care Homes for Older People Page 2 of 17 1 5 1 2 2 0 0 8 Brief description of the care home Care Homes for Older People Page 3 of 17 What we found: The purpose of this random unannounced inspection was to monitor compliance with the Statutory Requirements Notice issued on 23rd January 2009 following a key unannounced inspection on the 15th December 2008 The Care Home Regulations 2001. We explained the purpose of our visit and spoke to the previous appointed manager, the clinical lead nurse and the current appointed manager. Documentation and evidence to support making a judgement about the quality of care within the home that was seen at the previous inspection was re evaluated in order to measure compliance with the Statutory Requirements Notices issued. Documentation pertaining to a new resident was also sampled to further triangulate evidence to make sound judgements. The safe handling of medicines was assessed by a CSCI specialist pharmacist inspector. They looked at the medication records and medicine supplies for 11 people, the care plans for 4 people, the policies and procedures for medication handling and talked to staff. The amounts of each medicine received into the home is now being recorded but the home is yet to start its own auditing of these records to ensure that people are getting their medicines as prescribed. We checked the quantities of medicines, for three medicines prescribed for one resident new to the home, with the quantities recorded as being received into the home and the records of medicines given. The correct number of tablets had been used for one medicine. However, more tablets had been used than should have for the other two medicines. Staff were not able to account for these missing doses. When medicines were prescribed to be given at a variable dose, such as one or two tablets, the actual dose being given was not recorded and so it was not possible to reconcile the records and stock levels for these medicines. The medication policy and procedure in the home was a standardised copy purchased in from a management organisation. These had not been reviewed to ensure that they described the procedures in place in this home. Part of a medicines procedure, page 2 only, was in the front of one of the medication administration record chart files. This described an out of date practice no longer in use in the home. Having a part copy of an old procedure in daily access to staff when they are giving medicines to people could lead to staff following inappropriate practices. We found evidence that people are at risk of not receiving their medicines at the dose and frequency their doctor has prescribed for them. We found: Two people were prescribed sedative medication to be given only when needed but they were both being given the medicine regularly every day. There was no care plan for these people describing the circumstances under which staff would be expected to give these medicines, nor any other strategies for avoiding the use of sedative medicines. Another person had a sedative medicine prescribed to be given at a dose of one or two tablets twice daily. This person was always given the higher dose of two tablets. Again, there was no care plan describing the circumstances under which staff would be Care Homes for Older People Page 4 of 17 expected to give the higher dose of this medicine. One person had a sleeping tablet prescribed to be given at a dose of one or two at night. The higher dose of two tablets was being given each night. Again, no care plan was available. One person was prescribed insulin, which was being given by the nursing staff. The amount to be given at each dose was handwritten on the medication administration record charts by the nurses. No one in the home was able to evidence what doses of insulin had been prescribed for this person. For two people prescribed creams there was no record of then being used. During the inspection of a sample of care plans, one residents file evidenced that the pre assessment record had information added to it since the last inspection making it more comprehensive. The pre assessment information for the new resident admitted since the last inspection was not however fully completed and the assessment and care plan from the social services department of the placing authority was not available. No evidence within the care planning process was seen that the residents had ownership of their plan of care or are supported by relatives or advocates to ensure that they are person centred. In the files examined evidence was not seen that care plans have been kept under review on a regular basis. Evidence was also seen that where information was available to indicate a change to the care plan this had not been either undertaken or any action taken to address the change. No evidence was seen that moving and handling assessments along with the management strategy to minimise any identified risks had been undertaken since the last inspection. This included both new and existing residents. No evidence was found of risk assessments pertaining to the risk of pressure damage to skin for those residents being nursed in bed, where records seen had indicated that they was a risk. Where there were other risk assessments there was no clear documented action for staff to follow to minimise the risk identified. No new risk assessments had been undertaken since the last inspection. The Registered Nurse appointed as the clinical lead for the home has not undertaken any further training as required at the last inspection with regard to dementia care and risk assessment. During the compliance visit in one file sampled, reference was made to a resident being placed in a reclining chair because they would not stay in bed, were wandering in out of other residents rooms at night and because staff were worried they could fall down the stairs. The chair was therefore being used as a restraint as the resident could not get out of it easily, this carried on for a number of days. There was no evidence that this had been documented appropriately and that other professionals involved in this persons care had been consulted. What the care home does well: Care Homes for Older People Page 5 of 17 The Registered Provider has appointed a new manager however an application to register them with the Commission for Social Care Inspection has not yet been received. 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 6 of 17 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 14. Assessment of service 09/02/2009 users 1, The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so, a, needs of the service user have been assessed by a suitably qualified or suitably trained person, b, the registered person has obtained a copy of the assessment, c, there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. The Compliance visit on the 02/03/09 found this requirement had not been met. All prospective service users should be assessed and that assessment fully documented evidencing that service users are only being offered a place at the home if their needs can be met by the home. If the service user has been referred by the local authority or heath authority then a copy of their assessment should be Care Homes for Older People Page 7 of 17 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 available in the home before admission again to help with the decision process. Other than in an emergency when with in three days a review will be held and documentation made avaiable. Service users and their families where appropriate should be part of the assessment process also. 2 7 15 15 Service users plan 1, 09/03/2009 Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan, the service users plan, as to how the service users needs in respect of his health and welfare are to be met. The Compliance visit on the 02/03/09 found this requirement had not been met. All service users when admitted should a have a care plan that informs staff at the home of the care provision required by the individual. The care plan in the first instance should be based on the assessments undertaken prior to admission and in consultation with the service users and family if appropriate. The care plan will then remain under Care Homes for Older People Page 8 of 17 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 review and at the end of the trial period should be reviewed with all interested parties, which includes the service user, their family, the placing authority if appropriate, the key worker and the homes manager/lead nurse. 3 8 13 13.4 The registered person shall ensure that c, unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, The Compliance visit on the 02/03/09 found this requirement had not been met. To ensure that service users remain as safe as possible risk assessments should be undertaken for individual service users, where a risk is identified then the action required by staff to minimise that risk should be documented, the risk management strategy. The risk assessment should contain the review date, which should be determined by the level of the risk identified. Good practice would be to review all risks at least six monthly. 4 8 13 13.5, The registered person shall make suitable arrangements to provide a safe system for moving and 20/02/2009 20/02/2009 Care Homes for Older People Page 9 of 17 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 handling service users. The Compliance visit on the 02/03/09 found this requirement had not been met. To ensure the service users and staff safety, all service users must have a moving and handling risk assessment undertaken, where risks are identified then the action required by staff should be clear, the risk management strategy. The risk assessment must contain the review date, which should be determined by the level of the risk identified. Good practice would be to review all risks at least six monthly. 5 8 12 Health and welfare of service 09/03/2009 users The registered person shall ensure that the care home is conducted so as a, to promote and make proper provision for the health and welfare of service users. The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Page 10 of 17 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 The Compliance visit on the 02/03/09 found this requirement had not been met. That service users are consulted along with their families or representatives if appropriate, on a health action plan, this may be part of the service users care plan or a separate document. It should be underpinned by health assessments undertaken to identify the service users health needs and any risks they may pose. it should not only prevent or reduce risks but look to promote good health. 6 8 14 14.2 The registered person 09/03/2009 shall ensure that the assessment of the service users needs is a, kept under review, and b, revised at any time when it is necessary to do so having regard to any change of circumstances. The Compliance visit on the 02/03/09 found this requirement had not been met. All service users needs once assessed must be kept under review and changed to reflect changes in circumstances. 7 9 13 13.2 The registered person 20/02/2009 shall make arrangements for Page 11 of 17 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 the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The Compliance visit on the 02/03/09 found this requirement had not been met. Nurses must follow the NMC guidelines for the ordering, storage, administration and disposable of medication. Making sure that there are systems in place to audit and monitor medication regularly to ensure service users get the medication they have been prescribed. 8 14 13 13.7 The registered person 20/02/2009 shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. The Compliance visit on the 02/03/09 found this requirement had not been met. That the use of fall out cahirs breviewed and evidence be documented as to the use of these chairs regarding individual service users to ensure they are not being Care Homes for Older People Page 12 of 17 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 used as a form restraint 9 24 16 16 Facilities and services (c) 09/06/2009 provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users and screens where necessary. Service users should have adequate draw space and a comfortable chair for their own use in their bedrooms. 10 30 18 18,c, ensure that the persons 09/08/2009 employed by the registered person to work at the care home receive i, training appropriate to the work they are to perform Ensure that registered nurses have sufficient training and qualifications to enable them to work within their proffesional code of cunduct 11 31 10 10 Registered person: 09/07/2009 general requirements 1 The registered provider and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficient care, competence and skill. Page 13 of 17 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 It is the responsibility of the registered person to ensure that the person they have appointed as the manager has the necessary experience, training and qualifications to understand and care for the category of service users the home care for, in this case older persons with dementia and in need of nursing. Care Homes for Older People Page 14 of 17 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 1 18 13 13. 8 On any occasion on which a service user is subject to physical restraint, the registered person shall record the circumstances, including the nature of the restraint. That restraint is recognised and the circumstances are documented by the registered person to include how or what was used to restrain the individual. 17/03/2009 2 18 13 13. 7. The registered person 17/03/2009 shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. (7) The registered person shall ensure that no service user is subject to physical restraint unless (a) restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances; or (b) in the case of a person who lacks capacity in relation to the matter in question, the act meets the conditions of section 6 of the 2005 Act. Care Homes for Older People Page 15 of 17 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 That no method of restraint is used unless no other course of action is available and then it is agreed with other agencies involved in the persons care and includes the social services and health for example. 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 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 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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