Inspection on 18/04/05 for Holland House

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holland House 16/11/07

Holland House 08/08/06

Holland House 01/11/05

Holland House 12/08/04

Holland House 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Holland House Coulsdon Road Caterham Surrey CR3 5YA Lead Inspector Mary Williamson Unannounced 18/04/05 10:00 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holland House Address Coulsdon Road Caterham Surrey CR3 5YA 01883 383715 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Surrey Oaklands NHS Trust David Alchin CRH 10 Category(ies) of LD - Learning Disability - 3 registration, with number LD(E) - Learning Disability - over 65 - 7 of places Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The age/age range of the persons to be accommodated will be: 45-65 (3 OF WHOM MAY BE OVER 65 YEARS OF AGE) Date of last inspection 12/08/04 Brief Description of the Service: Holland House is owned by Surrey and Borders Partnership NHS Trust and is located in The Trust grounds. It is one of a group of purpose built bungalows and is designed to accommodate up to ten service users with a learning difficulty. Accommodation includes ten single bedrooms without en-suite facilities. There is also a large lounge, smaller lounge, dining room, and ample toilet and bathroom facilities. The bungalow is set in its own grounds with its own garden and patio. There is easy access to the local community facilities. The home has its own transport. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the first inspection in The Commission for Social Care inspection programme year for 2005/2006. Mary Williamson the lead inspector for the home undertook the inspection. It was carried out over a period of four and a half hours. Denise Ward who is the home manager was present throughout the inspection. Three staff and ten service users were spoken to during the inspection. Some service users were able to contribute to the inspection better than others due to communication skills. A tour of the premises was undertaken and some service users invited the inspector to view their rooms. Records relating to the care of the service users and the management of the home were inspected. Lunch was observed during the inspection. This included a selection of sandwiches, fresh fruit, and yogurt. The daily routine and activities were also sampled. There were no relatives or visiting professionals in the home during the inspection to provide feedback. This was generally a positive inspection. All the service users who could contribute said they were happy living at Holland House. Staff were observed to interact in a positive and kind manner with service users. Where communication skills prove difficult, staff use actions and gestures to communicate effectively with service users. What the service does well: The manager and her staff team provide good quality care for the service users living there. The activity, recreational and social activities are varied providing for individual needs and choice. The home includes service users in decision making with regard to all aspects of their daily lives. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 6 Individual care plans reflect the care being provided and are reviewed regularly. The standard of cleanliness in the home is good with staff supporting service users to maintain their own personal space. The service users who were able to contribute to the inspection all stated that they like living at the home. What has improved since the last inspection? What they could do better: The home has an assessment process in place however consideration should be given to internal transfers to avoid inappropriate placements. The manager stated that service users do not have individual bank accounts, which is difficult when instant access to money is required for larger items. Procedures must be developed to support service users to manage their financial affairs. The 4.5 staff vacancies must be addressed and all employment records retained in the home for inspection. The assisted bath must be ordered and installed to avoid unnecessary risks to the service user and staff while trying to manage personal care in a universal bath. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 and 5 A statement of purpose and service user guide is in place in individual bedrooms. Pre admission needs are in place for all but one service user. There have been no admissions to the home since the last inspection. Written contracts of terms of occupancy are in place. EVIDENCE: A statement of purpose and service users guide is in place. These need to be updated as Surrey Oaklands NHS Trust has merged and it is now known as Surrey and Borders Partnership NHS Trust. Needs assessments are in place and are reviewed regularly. However one service user was transferred from another home within the organisation without a needs assessment. The outcome of this is an inappropriate placement due to challenging behaviour. This situation is not very satisfactory for the other service users having to live in the home. Written contracts are in place in individual files. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 10 Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7, and 9 Individual care plans are in place, which contain detailed information on all aspects of service users care. Risk assessments are in place to manage daily life and choice, particular when service users are outside the home. Service users are supported to make choices and decisions regarding their care and activities. However service users do not have individual bank accounts. EVIDENCE: Three care plans were inspected and all three were well maintained, and contained detailed information regarding personal and social care. They are reviewed regularly with the service user and multidisciplinary team. Risks are identified and assessed. The manager stated that the home works closely with the psychology department when drawing up guidelines to manage individual risks and behaviours. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 12 Two service users stated that they are supported to make decisions regarding their daily lives. For example what they wear, where they go and what they choose to eat. Service users do not hold individual bank accounts with service users monies managed in central office. The manager stated that this could prove difficult when service users want to book holidays and do not have instant access to their money. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,and 17 Activity programmes are varied and on the whole are designed to meet individual needs. Links with families, friends and the local community are good. The standard of food is good. EVIDENCE: Opportunity for personal development is provided and service users are supported to attend a local day centre where classes are provided in drama and movement, handy craft, language skills, cookery and keep fit. Community links are maintained and two service stated how they like to go shopping for clothes and toiletries. One service user attends the local church service weekly and another stated that he likes to go to the local pub in the evenings. One service user explained how she likes being a member of the rambling group and taking part in weekly planned walks. Activities provided in the home include board games, knitting, music and renting a video on a Saturday evening. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 14 Two service users explained to the inspector how they are preparing for their forthcoming holiday to Tunisia and are checking passports and shopping for sun cream and holiday clothes. Family links are maintained and one service user stated that she has regular visits from her relatives, and enjoys her trips out with them. The menus are planned with input from the service users on a four-week rota. These were seen during the inspection and the choice of food offered is varied and nutritious. The main meal is served in the evening with sandwiches or a light meal offered for lunch. Two service users stated that sometimes on a Saturday evening there is opportunity to have a takeaway and all take turns to either choose fish and chips, Chinese or Indian food. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19, and20 Individual care plans are in place and the care needs identified are appropriately met. Service users are treated with dignity and respect. Medication is administered according to the home’s policies and procedures. EVIDENCE: Personal care is provided in a sensitive and caring manner. One service user stated that she could choose when to have a bath and what clothes to wear. The behavioural needs of one service user need regular monitoring, as this placement is inappropriate and affecting the wellbeing of the other service users living in the home. All service users are registered with a local GP. There is also access to a chiropodist, dentist, and optician. Physiotherapy and psychology are accessible and depend on individual needs. Medication is administered in accordance with the home’s medication policies and procedures. All staff who administer medication receive regular training. There is no service user in the home who self medicates. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 16 Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,and23 Service views are listened to. The complaints procedure is available in service users rooms. Service users are protected by the homes abuse awareness policy. EVIDENCE: Two service users confirmed that house meetings take place and ideas and suggestions are acted upon. There is a complaints procedure in place and all service users have a copy of this in their bedrooms. Staff confirmed that abuse awareness training takes place during their induction training. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,and 30. The standard of cleanliness and hygiene in the home is good. The environment is homely and comfortable with some minor repairs noted. The bathing facilities provide privacy but do not meet the mobility needs of some service users. EVIDENCE: The home is appropriate for the service users lifestyle and is accessible to all necessary services and community facilities. Some service users invited the inspector to view their bedrooms, which were individualised to reflect individual personalities. One bedroom window required a window restraint while another bedroom ceiling needed redecorating. All the communal areas of the home have been repainted since the last inspection and the manager confirmed that the colour was chosen collectively. The home has two bathrooms and four toilets. The bathing facilities are not adequate to meet the assessed mobility needs of the service users. The manager was able to produce two price quotations for an assisted bath to be Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 19 installed. Meanwhile a moving and handling assessment must be compiled for one service user who requires four staff to undertake a bathing procedure. The lounge overlooks a secluded garden and patio where several service users were having afternoon tea, however the carpet at this exit needs to be repaired as it is frayed and a potential trip hazard. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,and 36 The staff working in the home have clear defined roles and responsibilities. The home relies heavily on bank and agency staff. There are shortfalls in the recruitment procedure. Training is provided for all staff working in the home. Supervision is provided both formally and informally. EVIDENCE: Two members of staff confirmed that they had written job descriptions and contracts of employment. They were also able to identify training received and forthcoming training planned. The home relies on agency and bank staff to fulfil the staffing compliment in the home. There are currently 4.5 full time staff vacancies. During the inspection the manager was on duty supported by her deputy and two care staff, one of whom was providing one to one cover to meet the assessed needs of one service user. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 21 The manager stated that she is involved in the selection and recruitment of staff. One staff file was examined and was satisfactory. There was however a member of staff transferred to the home from another home in The Trust and no information was available in the home on that staff member. The Trust is very committed to staff training and appropriate training opportunities are in place for permanent and agency staff. There is a programme of NVQ training available which is ongoing. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,41,and 42 The home is well managed and the staff working in the home have a sound understanding and knowledge of the service users in their care. The standard of record keeping is generally good with shortfalls in staff employment records, and pre admission needs assessment. The health and safety of service users are promoted by staff development and training. EVIDENCE: The home is well managed by a competent manager who is well supported by her deputy manager and senior care team. The manager and team are fully aware of the assessed needs of the service uses in the home. Regular meetings and supervision groups take place to review and evaluate care being provided. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 23 The standard of record keeping is generally good. Risk assessments must include an assessment for the interim management of mobility needs while awaiting an assisted bath. Pre admission needs assessments must accompany all service users to avoid service users needs not being met. Employment details must be available for inspection for all staff. The health and safety policies and procedures were seen throughout the inspection and all staff are aware of these. Some staff explained the fire procedures in the home. Fire records were seen and are well maintained. First aid training is provided for all staff. Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 2 2 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holland House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 2 x x 2 3 x h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 and 19 Regulation 14(1)(a) Requirement The registered person shall ensure that a full needs assessment is carried out and that the care home is suitable to meet the service users needs. The registered person must ensure that the service users have the right to choose if they wish to have a bank account Ensure that the bedroo ceiling is redecorated and the window restraint is repaired and lounge carpet made safe. The home must ensure that specialist equipment is installed to meet the changing mobility needs of the service users. The home must employ staff in sufficient numbers to meet the identified care needs of the service users living there The home must ensure that all required employment documents are retained in the home for inspection. The home must ensure that all records relating to service users and staff are maintained in the home at all times. Timescale for action 30/06/05 2. 7 12(2) 30/06/05 3. 26 and28 23(2)(b) 30/06/05 4. 27 and 29 23(20(n) 30/06/05 5. 33 18(1)(a) 30/06/05 6. 34 19(1) 30/06/05 7. 41 17(1)(2)( 3) 30/06/05 Holland House h58_s13676_Holland House_v224351_180405_stage 4.doc Version 1.30 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 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