Inspection on 08/08/06 for Holland House

This inspection was carried out on 8th August 2006.

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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holland House 16/11/07

Holland House 01/11/05

Holland House 18/04/05

Holland House 12/08/04

Holland House 26/04/04

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Insight - Eastchurch

Southfields

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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 Holland House Coulsdon Road Caterham Surrey CR3 5YA Lead Inspector Mary Williamson Key Unannounced Inspection 8th August 2006 10:00 Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 1 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 Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 2 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 Stationery 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 DS0000013676.V307514.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holland House Address Holland House Coulsdon Road Caterham Surrey CR3 5YA 01883 383715 Telephone number Fax number Email address Provider Web 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 Borders and Partnership NHS Trust Mrs Dennies Donicia Ward Care Home 10 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (7) of places Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 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. The average fees charged are £963 per week but this may vary depending on individual needs. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken by Mary Williamson who is the Lead Inspector for the service. The Registered Manager Mrs Dennies Ward was present for the duration of the inspection. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. The home was functioning well with a relaxed and homely atmosphere noted. The inspector had the opportunity to meet all the service users. It was possible to talk with some in more detail than others. Some service users invited the inspector to view their bedrooms, which are all furnished to a high standard. The staff on duty were interacting with service users in a positive and respectful manner. All the service users were involved in an activity relating to their individual profile from unpacking shopping, dusting their room to making cups of tea. There was opportunity to talk with staff who are confident in their individual roles and have a sound knowledge of the service users needs. The inspector would like to thank the service users and staff team for their hospitality and positive contribution to the inspection process. What the service does well: The service provides good quality of care and support for the service users living in the home. The standard of care planning is good and person centred profiles are well maintained and reviewed regularly. The home is well decorated and provided a comfortable and homely atmosphere. Key workers are undertaking a six- month project of refurbishing individual bedrooms with input from service users. The bedrooms, which, have been completed, are of a high standard and much appreciated by service users. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Holland House DS0000013676.V307514.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 4, and 5. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Prospective service users have the appropriate information available to help them make a choice about living in the home. Pre admission needs assessments are in place and trial visits are encouraged. EVIDENCE: The home has a statement of purpose and service user guide in place and all service users have a copy of this in their bedrooms. The service users in Holland House have been living there for several years. The manager stated that she would undertake a pre admission needs assessment on prospective service users. Needs assessments were seen for SS, EH, and MR. These are detailed and well maintained. When needs change a multidisciplinary review of care takes place. The manager explained the admission process, which ranges from an initial visit to overnight stay before a three- month trial period is offered. Contracts of occupancy are in place, which included the fees paid and the funding authority financing the placement, and the care and accommodation to be provided. These contracts need to be signed by the service users or a designated representative. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6, 7, 8, 9, and 10. Quality in this outcome area is good. Judgement has been mage using available evidence including a visit to the service. Individual care plans outline care and support to be provided according to choice and risk. Information relating to service users is handled appropriately. EVIDENCE: All service users have a care plan (person centred plan) in place. Care plans were seen for SS, EH, and MR, which are detailed well maintained and reviewed regularly. These plans also include a health action plan, an activity programme, and daily record notes. Risk assessments are in place to manage daily life and choice and include manual handling, fire safety, kitchen skills, and when accessing community activities. SS stated that she makes choices regarding how she spends her day, the activities she participates in and how she spends her leisure time. Another service user stated that she likes to go to the hairdresser in the village, and likes to go on foreign holidays, as she likes flying. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 11 Two service users stated that they have meetings when they can choose menus, and who goes shopping for the food. Service users were observed returning from the supermarket with staff having undertaken the house shopping. The inspector observed a service user in discussion with her key worker regarding the colour of the paint for her bedroom. The home has a confidentiality policy in place and all staff observe this. All information relating to service users is stored appropriately when not in use. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 14, 15, and 17. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The activity arrangements in place meet the individual and collective needs of the service users. Links with friends and family are maintained. The nutritional needs of the service users are being met. EVIDENCE: Opportunity for personal development is provided and service users are supported to attend the Driscoll day centre on site where classes are provided in hand craft, drama, cookery, growing plants, language skills, music and movement and hydrotherapy. Activities are also provided within the home and include board games, card games, knitting, music, videos, and television. Community activity is encouraged and service users stated they like to go to Croydon shopping. They also go to the local village for personal shopping including toiletries. One service user stated that he liked to go to Tesco store for a cup of tea and a cake. SS likes to attend church when she can. Evening trips to the pub, going to the cinema, and bowling are also enjoyed. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 13 One service user was observed preparing to go to the local hairdressers, which she said she enjoys. Service users enjoy regular holidays. Two service users have recently been to Greece and two more are planning a week in Brighton next month. Family links are maintained and visitors are welcome into the home at any reasonable time. The manager explained how one service user has elderly parents and arrangements are in place to take him to visit them in residential care. Relatives are also included in the care planning process and will attend reviews whenever possible. The catering arrangements in the home are satisfactory. The service users and staff at house meetings plan the menus. These draft menus are then examined by the dietician for nutritional content. The food offered is varied and nutritious. The main meal is served in the evening. This is prepared and cooked by the staff with input from service users. All staff who prepare food hold a current food hygiene certificate. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18, 19, and 20. Quality in this outcome area is good. Judgement has been made using available evidence including visit to the service. Personal, health and emotional needs are provided as outlined in individual care plans. Arrangements for the administration of medication are satisfactory. EVIDENCE: Personal care is provided as outlined in individual care plans in a sensitive and caring manner. Since the last inspection one bathroom has been adapted with an assisted bath to meet the mobility needs of service users. One service user stated that she could choose when she has a bath. All the service users are registered with a local GP in Old Coulsdon. Service users can attend the surgery or home visits can be arranged. Chiropody treatment is provided every month in the home. Service users visit the optician in the village every two years. Physiotherapy, psychology, and speech and language therapy can be arranged as required. The home has a policy in place for the administration of medication. All staff who administer medication are familiar with this policy. Zina Pharmacy supply all medication to the home. Records are kept of all medication entering and leaving the home. The medication recording charts were examined and these are well maintained. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 15 Currently there are no service users in the home who self medicates. The Trust’s pharmacist undertakes medication training for staff and also carries out regular audits. Medication is stored appropriately, however the home would benefit from a larger or second storage cupboard to meet the increasing quantity of medication required for service users. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22, and 23. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The complaints procedure and the abuse awareness procedures in place protect the service users. EVIDENCE: The home has a complaints procedure in place and all service users and their relatives have a copy of this procedure. This is also available in symbol format. There have been no complaints since the last inspection. The Trust has an abuse awareness policy in place and all staff receive training in this during their induction training. The home also has a copy of Surreys Multi Agencies Safeguarding Vulnerable Adults Policies and Procedures in place and the manager has attended training in these procedures. She has also cascaded this information throughout her staff team. During conversation with staff they were able to confirm training had taken place and were aware of what to do if they suspected or witnessed an episode of abuse. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24, 25, 27, 28, and 30. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. The home is appropriate for the service users lifestyle and is accessible to all necessary services and community facilities. EVIDENCE: The home is clean and tidy and decorated to a good standard, providing a comfortable and homely environment for the service users living there. Communal facilities include a good size dining room, which is bright and well furnished. The large lounge is comfortable and is also used as the television lounge. There is also a smaller lounge, which is a quite area where service users can relax. Bedrooms are single occupancy some of which have been recently refurbished. These have been decorated to a high standard, by the key workers, which is an ongoing project within the home. Service users are fully involved in this project and have the choice of colour scheme and selection of furniture. The kitchen is domestic in appearance and was clean and orderly. Some kitchen cupboard doors need repair as the hinges are loose and the kick panel needs to be repainted. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 18 There are ample toilets and bathrooms situated throughout the home. Since the last inspection one bathroom has been adapted to provide assisted bathing facilities to meet service users mobility needs. The home has an infection control policy in place and all staff have training in this procedure during induction training. There was no evidence of malodour in the home and arrangements are in place for the collection of clinical waste. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, and 36. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Service users are supported by a competent and effective core staff team, with the skill mix necessary to meet their needs. The recruitment procedure safeguards the service users. EVIDENCE: The staff duty rota was seen and indicated a good mix of staff on duty with the skills necessary to meet the assessed needs of the current service user group. It was also evident that the home relies on bank and agency staff. There are three staff on duty throughout the day and a member of staff who provided a one to one support. Two staff work a waking night duty. Staff also undertake the cleaning, cooking and driving duties. The Trust operated a thorough recruitment procedure with the home manager involved in the recruitment of staff. Staff employment records examined contained all the required documentation, to include an employment history, written references, and a CRB (Criminal Records Bureau) disclosure. All staff undertake induction training which includes manual handling, first aid, health and safety, food hygiene, medication administration, epilepsy awareness, abuse awareness, and fire safety. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 20 All the permanent staff hold an NVQ level 2 in care and three staff are currently undertaking NVQ level 3. The knowledge and skills framework is also in place. Formal staff supervision is in place and takes place, and recorded every two months. Evidence was seen to support this. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, and 42, Quality in this outcome area is good. Judgement was made using available evidence including a visit to the service. Service users benefit from a well run home and their health welfare and safety is promoted. EVIDENCE: The home is well run in the best interests of the service users. The registered manager is a qualified nurse with an RNMH qualification. She has several years experience of working with, and running units for service users with a learning disability. She also has an NVQ level 4 Award in management and is a qualified assessor. She operates an open door policy and service users were observed during the inspection to come and go from the office on a regular basis seeking her encouragement and support. The staff who were spoken to stated tat the level of management support was good. Quality assurance is monitored through service users meetings, and regulation 26 visits. Service users survey questionnaires and relative questionnaires are distributed fro a quality audit yearly. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 22 Health and safety policies and procedures and these were sampled during the inspection. All staff undertake health and safety training during induction training and are aware of the COSHH procedures. Risk assessments are in place for safe working practice. Fire safety records were observed and are well maintained. Fire alarms are tested weekly. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. Regular fire safety training is provided for staff. The accident records are well maintained and recorded according to the Trusts policies and procedures. Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 3 Holland House DS0000013676.V307514.R01.S.doc Version 5.2 Page 24 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 YA5 Standard Regulation 5(1)(b) Requirement The standard contract supplied to the service user for provision of care and, accommodation must be signed by the service user, or their designated representative. The provider must ensure that the kitchen cupboards are repaired or replaced. Timescale for action 20/09/06 2 YA24 23(2)(c) 20/09/06 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 Refer to Standard YA20 Good Practice Recommendations It is recommended that a larger or second medication cupboard be provided to store the increasing quantity of medication required by the service users. 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