Care Home: The Hollands Nursing Home

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What the care home does well Residents at the home were being cared for and supported well by the manager and his staff. Residents spoken to said the quality of care provided was good. Residents said staff spoke to them respectfully and maintained their dignity, particularly when personal care was being given. Comments made included ` the staff are very polite and treat me well`, `the staff always knock before they come in and talk to me while they are helping me`, ` all the staff are very good, considerate and very caring`. The home provided a clean, warm and comfortable environment. Records kept by the home were well organized, appropriate and up to date. What has improved since the last inspection? Since the last registered manager left the home in December 2008 a new home manager has been appointed who previously worked at the home as a senior nurse. The requirements made at the last inspection have been complied with. The lounges, corridors and a number of residents bedrooms have been redecorated and refurbished. The manager was in the process of recruiting a member of staff to organise and support residents with social and leisure activities. What the care home could do better: It is recommended that the pre-admission assessment record is developed to provide more details of what was assessed/identified during the assessment. Also to enrich residents leisure time opportunities to enable residents to pursue activities outside the home be developed. To strengthen the way the home cares for, supports and keep residents safe staff should be enabled to access safeguarding training and other training provided by the local social services department. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Hollands Nursing Home 2 Church Road Farnworth Bolton Lancashire BL4 8HQ     The quality rating for this care home is:   two star good service 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. Lead inspector: Michael Murphy     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: The Hollands Nursing Home 2 Church Road Farnworth Bolton Lancashire BL4 8HQ 01204574386 01204575986 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) : The Hollands Care Homes Ltd care home 39 Number of places (if applicable): Under 65 Over 65 39 0 old age, not falling within any other category physical disability Additional conditions: 0 39 The registered person may provide the following category/ies 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: Physical Disability - Code PD Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 39 Date of last inspection Brief description of the care home At The Hollands care home care services are provided in a large adapted property built on two levels with a passenger lift to the first floor.The Hollands Care Home provides a total of 39 places for both nursing and residential care for young physically disabled and older Service Users. 32 bedrooms are of single occupancy and four are shared. The home which has an adjacent garden area, is situated off the main street in Farnworth about three miles from Bolton town centre, is close to main bus routes and there are shops within walking distance. Information provided by the home states the current fees for older persons are from 378.78 pounds and 713.44 pounds per week Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included an unannounced visit to the home on the 15th of April 2009 between 8.30.am and 4pm. During the visit we talked to residents, staff and the home manager. We also looked at documents and records the home have to keep such as residents care records, medicine records, written policies and other records. Before the inspection, we also asked the home manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form had been completed in sufficient detail and provided useful information. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 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 set out 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 Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. All prospective residents have their care and support needs assessed prior to admission to the home to ensure the home is appropriate for their individual circumstances. Evidence: All prospective residents are assesed prior to being admitted to the home. The home manager (a qualified nurse) or one of his senior team of qualified nurses do the preadmission assessment. Such an assessment is very important to ensure the home is able to decide if the prospective resident can be supported properly if they are admitted. Residents spoken to said that they felt they were actively consulted and involved in pre-admission and post-admission process and that it was their choice to enter the home. Whilst a record of the pre-admission assessment is kept it is recommended that that this document should reflect in more detail what was assessed/identified during the assessment. This will help ensure that as much information as possible is available when it comes to planning how newly admitted residents are to be cared for and supported by staff. The pre-admission assessments Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: carried out by the home manager were supported by assessments conducted by social workers and/or health professionals such as doctors. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Residents were being supported through risk assessment and care planning to exert choice and retain maximum independence in their daily lives. Evidence: We looked at the care records of 3 residents at this inspection. All contained care plans that described what the individual care and support needs were and how staff were to support residents whilst maximizing their independence. Care plans were being reviewed at least once per month. Care records also detailed what contacts residents had had with various health and social care professionals who support their individual medical and social needs. Progress records were being maintained for each resident at least twice a day - these were signed, dated and timed. Care plans reflected that relatives and residents were consulted and involved in planning and reviewing care. Residents spoken to said they were encouraged and enabled to make decisions about their daily life and staff support them to do this if required. Information on accessing independent advocacy was prominently displayed in the Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: home. Residents were able to manage their own finances and the home only held a small amount of personal allowances for a small number of residents and the arrangements for this were secure and appropriately documented/receipted. Residents spoken to said staff support them to take risks as part of independent lifestyle. Risk assessments were conducted and documented in the care records. For example assessments were seen relating to - for skin integrity, nutrition (including weight monitoring), the risk of falls, the ability to manage their own medicines, the need for bed rails, moving and handling needs, and continence. Also care files contained general and specific risk assessments relating to the daily life of residents. The purpose of the these were to keep residents safe and maximize independence. Risk assessments in the care records were being reviewed/evaluated at least once per month. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Residents were enabled to live as independent a lifestyle as possible whilst being cared for and supported in a way that met their needs properly. Evidence: Residents were of the view that leisure activities within the home were suitable and that they were actively consulted by staff regarding their views and ideas about these. However the general view was that although there were some organised outings they would like more opportunities to go out either on day trips or shorter outings locally. A variety of entertainers come to the home on a regular basis. A programme of activities was prominently displayed. We were informed that the home was in the process of recruiting an activities/leisure organizer. And that once this post has been filled a comprehensive review of social and leisure provision would take place in consultation with residents. Residents stated there were no unreasonable restrictions to them Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: retaining contact with family and friends at or outside the home. They also stated they could receive their visitors in private. Residents said that the daily routines at the home were reasonable and as flexible as possible in a community living setting. They report staff treated them with respect and maintained their privacy and personal dignity (particularly when personal care was being given). Staff were said to be polite, friendly and very supportive. Residents spoke positively about the quality of the meals they were provided with. Menus were varied, balanced and provided choice. 3 meals a day were provided and light snacks and drinks were said to be available at all times. Residents said they are regularly asked for their views n all aspects of food provision at the home. Dining areas were clean and suitably and comfortably furnished. Residents said they can choose where to eat. Lunch was observed on the day of inspection. Meals were suitably presented, appeared to be enjoyed by residents, and staff served and assisted residents appropriately and sensitively. Residents nutritional needs (including weight monitoring) were being regularly assessed and recorded. Nutritional issues identified were being referred to the appropriate health care worker. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Proper arrangements were in place to ensure the personal health care support provided to residents is consistent and appropriate. This is important to ensure residents are confident they will be cared for and supported appropriately. Evidence: Residents spoken to said that they were being provided with the personal care and support they preferred - staff were described as being sensitive and flexible when providing personal care and support. Such care and support was said to be provided in a way that was respectful and maintained the dignity of residents. Residents were of the view that the daily routines were flexible as possible in a home setting and staff did their best to accommodate residents preferences. Adequate general and individual aids and adaptations have been provided to maximize residents independence. Discussion with residents and information provided in care records indicated that residents are able to access health care services such as those provided by (amongst others) GPs, district nurses, dentists, opticians and physiotherapists. The arrangements to support residents with their medicines were safe and Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: appropriate. Residents medicines are looked after and administered by the qualified nurses. Where residents are able to look after their own medicines appropriate assessments have been made to ensure this is safe and appropriate. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Suitable arrangements were in place to keep residents safe and ensure their complaints or concerns were listened to and acted upon. This is important as such arrangements help residents feel confident their interests are protected. Evidence: Proper arrangements were in place to address residents (or other peoples) complaints. Residents spoken to on the day of inspection said that the manager and staff at the home always listened to their concerns and that issues raised were addressed quickly and effectively and rarely needed to become formal complaints. A record of complaints made is kept. The record details the nature of the complaint, how it has been investigated and what the outcome of the complaint is - including actions that habeen taken to address the issues raised. Proper arrangements were in place to ensure residents are protected and feel safe. Residents spoken to during the inspection said that they felt staff helped to keep them safe. The home has policies and procedures in place that describe how to properly deal with any instances of abuse. The way the home recruits staff include checks that help to ensure those employed are suitable to care for and support vulnerable people. Discussion with staff on the day of inspection revealed that they were aware of the importance of keeping residents safe and were aware of what keeping residents safe means. They have been provided with safeguarding training by the manager. However it is recommended that this training is supported by safeguarding training provided Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: locally by the Social Services. Care Homes for Adults (18-65 years) Page 19 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 provided a clean, warm, suitably adapted and comfortable environment in which residents can be cared for and supported appropriately. Evidence: The home provided a homely and comfortable environment for residents. Suitable aids and adaptations have been provided to ensure residents collective and individual needs can be met. A tour of the premises revealed that it was clean, free of bad odours, suitably furnished and decorated. Residents spoken to said they were happy with their own rooms and the lounge and dining areas of the home. All these areas were suitably furnished and decorated. The home is centrally heated and was warm, well lit and well ventilated on the day of this inspection. Toilet, bath and shower areas were easily accessible to residents and were suitably equipped and adapted. Proper arrangements were in place to ensure residents laundry was dealt with. Laundry equipment was suitable for a care home setting. There were also suitable hand washing facilities throughout the home and staff were provided with suitable equipment (such as disposable gloves and aprons) - important for reducing the risk of infections spreading. Staff have also been provided with training in infection control. Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Suitable and appropriate numbers of staff were provided to meet the care and support needs of residents. Staff had been appropriately recruited and trained. This is important so that residents are confident that the staff supporting them are competent and suitable to do so. Evidence: Staffing records showed that qualified nurses and carers were on duty at all times, in addition to nursing and care staff, the home employs a manager, administrative staff, catering staff, laundry staff, maintenance and other staff to ensure that residents needs can be met appropriately. Inspection of staffing records, discussion with residents, the home manager and staff revealed the care and support needs, of the 31 residents living at the home at the time of this inspection appeared to be being met. The home continues to make progress in the provision of NVQ 2 and 3 training. At the time of inspection in excess of 90 of the care staff had received such training. 3 staff recruitment files were inspected on this occasion. They contained evidence of CRB checks (including POVA first checks), 2 written references, criminal convictions declarations, proof of identity, a completed application form and included a detailed work history and a declaration relating to the prospective employees health status. Checks are made and recorded in respect of the status of registered nurses with their Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: registered body. Training records and discussion with staff indicated that they were provided with induction training on commencing employment. There was also documentary evidence that staff had been provided training in moving and handling, safeguarding, fire safety and basic food hygiene and other relevant topics. Most of the training is provided to staff at the home by the manager and senior nurses. It is recommended that the home access staff training by the local authority training partnership to complement training provided at the home. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 was being managed in a way that seeks to ensure residents are confident they are cared for and supported properly and safely in a home that is well run. Evidence: A New home manager has been appointed since the previous registered manager left the home in December 2008. The registered manager is a qualified nurse who worked as a senior nurse at the home prior to being appointed manager. We were informed by the manager that he intends to apply to the Care Quality Commission to be the registered manager for the home and also to complete an appropriate management qualification. Discussion with residents and staff revealed that the home manager is highly visible in the home and creates a positive, open and inclusive atmosphere. This is important as both residents and staff need to be confident that the home is being managed in a way that provides strong leadership and support. Residents and staff were confident that their views were regarded as being important to how the home was being run. Their views are regularly sought through satisfaction questionnaires, residents meetings and staff meetings. The manager conducts regular checks (audits) Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: on how smoothly and effectively the home is being run. For example he regularly checks how well care records are being completed, how residents medicines are being looked after, residents satisfaction with their care and accommodation, and residents relatives satisfaction with the home. A representative of the person who owns the home regularly visits to support the manager and assess how effectively the home is being run. It is however recommended that the views of others who visit the home are sought. For example GPs, social workers, physiotherapists etc. This will provide more feedback for the manager to assess the quality of the service being provided by the home. The health, safety and welfare of residents were being promoted and protected. Safe working practices were being ensured including training in safe moving and handling techniques and fire safety. Staff are also trained in first aid, basic food hygiene and the prevention of the spread of infection. Such measures are important in helping to provide a safe setting for residents to be cared for and supported properly. Information provided by the home indicates that equipment and electrical and gas systems in the home are checked/serviced regularly. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 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 2 That the pre-admission assessment record is developed to provide more details of what was assessed/identified during the assessment. That to enrich residents leisure time opportunities to enable residents to pursue activities outside the home be developed. That to maximize the safety of residents staff are enabled safeguarding training provided by the local social services department. That staff are enabled to access training provided by the local authority training partnership to complement training provided at the home. The views of others (apart from residents relatives) who visit the home should be sought. For example GPs, social workers, physiotherapists etc. This will provide more feedback for the manager to assess the quality of the service being provided by the home. 2 12 3 23 4 34 5 39 Care Homes for Adults (18-65 years) Page 26 of 27 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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