Honeywood House Nursing Home

Honeywood House Nursing home is a care home situated outside the village of Rowhook. The home is a large converted and adapted 18th century mansion house standing in 10 acres of park and woodland. It offers personal and nursing care to 25 older people, some of whom live with dementia. There is level access throughout with a shaft lift to the first floor.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In this service the registered manager is also the registered person.

We carried out an unannounced comprehensive inspection of Honeywood House Nursing Home on the 26 August 2015. As part of this inspection we checked what action had been taken to address the breaches of legal requirements we had identified at our last inspection on the 8 and 16 January 2015. Following that inspection we issued warning notices stating the provider must take action in relation to management of people’s medicines, the assessment of risk, the planning of person centred care and treatment, and obtaining people’s lawful consent to care and treatment by the 2 May 2015. We also identified the provider was not meeting the requirements of the law in relation to staff recruitment, staff supervision, staff training and appraisals and good governance.

After our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection we found improvements had been made and all the breaches had been addressed. However further improvements are needed to be made in relation to the completion of medicine administration records (MAR).

The provider had taken action to improve the safe management of people’s medicines. The arrangements in place for the ordering, storage and administration of people’s medicines were safe and people received their medicines when they needed them. However some people’s MAR charts contained gaps which meant that it could not be identified whether they had received their medicine as prescribed and intended. Without this information it is difficult for the effectiveness of medicines to be monitored and is an area of practice we assessed as needing to improve.

Improvements had been made to the safety and delivery of care people received and sustained. Risks had been appropriately identified and robustly addressed in relation to people’s specific needs. For example assessments of people’s risk of falls and developing pressure areas had taken place and strategies were in place to reduce these risks, Staff were aware of people’s individual risk assessments and knew how to mitigate the risks.

Following the last inspection improvement had been made and sustained in relation to planning people’s care. People and their representatives had been involved in the development of care plans which were person centred and detailed their likes and dislikes and where known, their personal histories.

The provider had made improvements to making sure they gained lawful consent from people for their care and treatment. Mental capacity assessments had been completed in line with legal requirements. Where people lacked the mental capacity to make decisions the management and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and how to submit one. Deprivations of Liberty Safeguards (DoLS) authorisations were in place and care plans clearly identified if someone was subject to a DoLS. The management team had been working with staff to raise awareness of DoLS and the impact DoLS had on people and this was evident from staff meeting minutes.

Staff recruitment had improved and all the relevant identity and security checks had been completed before staff were deployed to work at the service. Staffing levels had also improved and were based on the individual needs of people. People’s level of need and the number of staff required to provide safe, effective and responsive care had been assessed and the relevant number of staff had been deployed. Staff were seen spending individual time with people and responding to call bells and requests for assistance quickly. One person explained that on her “bad days” when she preferred to remain in bed, staff responded to her call bell very quickly.

Staff training had improved. Staff had completed training that was relevant to their roles and which provided them with the skills they needed to meet people’s needs. For example staff had completed training in the administration of medicines and supporting people living with dementia. One person told us “They (the staff) certainly seem to know what they are doing; I’ve no complaints about them what so ever”. Staff felt they were well supported had received formal supervision on a regular basis at which they could speak in confidence with their line manager about their personal development or any issues of concern they may have. One staff member said “We do have supervision but I don’t have to wait for that to ask for training. We can ask for that anytime”. They also had an annual appraisal of their performance and the opportunity to complete nationally recognised qualifications in care.

Everyone we met with spoke highly of the delivery of care and of the caring nature of the staff that worked there. One person told us “They are lovely (the staff).” They explained they had never heard staff raising their voices to anyone or with each other and that they always let them do things at their own pace. People felt well looked after and supported by caring staff. We observed friendly relationships had developed between people and staff. One relative told us “We are greeted like family when we come here; it’s a real homely place”. A staff member said “We’re just one big family here”. Another explained “I would be happy for my mother to be here”. An agency nurse told us “This is the nicest and most caring home I’ve worked in”.

People’s dignity and privacy was protected. For example we saw staff knocked on people’s doors and waiting for a response before entering their rooms. Doors were shut when staff supported people with personal care and made sure they were appropriately covered when lifting them in a hoist.

Dedicated activities coordinators were in post who were responsible for the oversight of stimulation, interaction and meaningful activities. People could choose how to spend their day and they took part in activities. People told us they enjoyed the activities, which included arts and crafts, exercises and being entertained by singers and musicians.

People had a choice of food at meal times and specialist diets were catered for. People who needed help to eat and drink were supported appropriately. People’s weight was monitored and referrals were made for specialist health care support as needed. For example for Speech and Language Therapy and input from GP’s.

People had been provided with a guide to the service and were aware of how to raise concerns and complaints and felt able to do so. Relative and resident meetings had been held and people were able to contribute to these meetings and suggestions for how to improve the service had been acted on. For example how improvements could be made to the menu on offer and the activities provided.

People and staff told us the registered manager and management team were approachable, open and transparent. Improvements had been made to the quality assurance systems in place and internal audits the results of which were used to help drive improvements in the service. Accidents and incidents were recorded and the results analysed to identify and emerging themes and patterns, and action had been taken to reduce the risk of re-occurrence.