CARE HOMES FOR OLDER PEOPLE
The Hollies 7 Mornington Road Southport Merseyside PR9 0TS Lead Inspector
Orla Murphy Unannounced 24 August 2005
th 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 Older People. 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. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Hollies Address 7 Mornington Road Southport Merseyside PR9 0TS 01704 541506 01704 541506 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) Mr John Eslick Mr John Eslick PC - Care Home Only 25 Category(ies) of OP - Old age - 25 registration, with number of places The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 25 OP. Date of last inspection 14th December 2005 Brief Description of the Service: The Hollies is located in Southport, close to the main shopping street and the Promenade.. The home is owned by a private individual, Mr Eslick. The home can have up to 25 residents who are of old age . The home is 3 storeys and bedrooms and bathing areas are on accommodation floors. There is a large garden to the rear of the house which residents use. The house is accessible to public transport and Southport, Lancashire and Liverpool are all within reach from the home. Parking is available to the front of the home, with paid parking available on Mornington Road & on side streets. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was unannounced and neither residents nor staff knew the Inspector was coming. The last inspection report was examined and some requirements needed to be followed up on this visit. The Inspection was the first in the home’s required visits, which are 2 inspection visits per year. 4 residents and two staff were spoken to at the inspection. Two residents were “case tracked”. Case tracking means that the Inspector concentrates on the care given and experiences of one or more residents to get an idea of what is like to live there and how that person’s needs are being met. Case tracking also shows the inspector where needs aren’t being met. A variety of records (care plans, medical notes, complaints records, assessments, medication sheets, meeting minutes, menus, timetables, staff rotas and significant events) were examined. What the service does well: What has improved since the last inspection?
The home appears to maintain high standards as previous reports have indicated minor improvements needed. Over 50 of staff now hold NVQ Level 2 qualification from above. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 6 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 contacting your local CSCI office. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3. Residents are issued with a contract upon admission to the home. Residents are admitted following a full assessment of their needs and the homes own assessment of their ability to meet these needs. EVIDENCE: The 2 residents case tracked held a contract of terms & conditions on file and these were satisfactory. 2 residents that spoke to the Inspector were aware of the contact & were happy with them. Two resident’s assessments were examined in detail. These detailed each resident’s needs and strengths about their health, mobility, medication, support needed, family and lifestyle, spirituality and their wishes, likes & dislikes. Care Plans had been formulated from these assessments. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10. Care Plans are detailed and structured to ensure consistency in care provided. Resident’s health care needs are met. Residents feel they are treated respectfully and their privacy is upheld and protected. EVIDENCE: The 2 care plans examined were extremely detailed and structured. They clearly laid out resident’s needs and strengths and gave staff details as to how to help residents with these. Reviews have varied but should be done monthly. Resident’s health issues were detailed in assessments and in care plans. Records are held of all medical appointments and treatment received. One resident said staff had been very attentive to her health concerns & problems. 3 residents spoken to say all staff were kind and respectful. One stated, “ The carers make me feel as private as possible when helping me wash. Its so important to have this because I have lost so much independence with my illness”. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15. Residents have contact with family, friends and the community and staff encourages this. Residents have a healthy, varied diet available to them and are informed of choices available where they don’t like a menu item. EVIDENCE: Several visitors were in the home on the day of the visit and they were observed interacting freely with their relative/friend and moving about the home freely. The atmosphere between staff, residents and visitors was relaxed and warm. All resident’s files seen held clear family and contact history and detail. One resident spoken to say their friends visited whenever they wished too and staff were good at contacting family/friends when they wanted them to. Menus are on display in the home. Everyone spoken to said the food was nice and if you didn’t like it you could request something else. The range of food on the menu was varied, healthy and nutritious. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. Residents are protected from abuse. EVIDENCE: Staff have been trained in POVA (Protection Of Vulnerable Adults). The home has a copy of & follows Sefton’s POVA policy. All residents spoken to said if they were scared or worried they would definitely tell the home’s Manager and trusted her to deal with the issue. One resident said she felt any behaviour that was unacceptable would be picked up immediately by senior staff. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 & 25 Residents live in a safe, comfortable home. The home is well maintained. Communal areas are comfortable, safe, attractive and accessible. EVIDENCE: The areas of the home seen were attractive, well maintained, safe and comfortable. Equipment and fittings were of a good standard. All residents said their bedrooms were nice and suited their needs. A lift accesses all floors. Sufficient support equipment (such as hoists and showers) are in place to help staff support residents. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The number and skill mix of staff meets resident’s needs. Staff are mostly trained in statutory training. EVIDENCE: The staff rota for a four week period was examined and showed that staffing numbers meet the numbers set by the previous regulating body. 3 staff are on duty in day hours and 2 staff are on duty, one awake at night. There is a rolling programme of statutory & additional training for staff. The training plan was seen and was satisfactory. This showed where staff had been booked in to undertake training in Health & Safety, First Aid, Food Hygiene, and POVA, Manual Handling & Fire awareness. For some staff these are outstanding but have been booked. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33. The home is run in resident’s best interests. EVIDENCE: Observations, discussions and examination of records all show that residents are of primary importance in this home. Systems are planned to suit them and the management of the home is relaxed and comfortable. Visitors are seen as part of the home and the Manager and staff were all attentive, supportive and respectful toward residents. Residents are very aware that they are highly thought of by staff and this is reflected in the various ways they said they felt safe and happy. The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x x x x 3 x STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x x The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 16 no 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 30 Regulation 18 Requirement Ensure all staff complete statutory training as per schedule. Timescale for action 31/02/06 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 Good Practice Recommendations The Hollies F53 F03 The Hollies S5329 V248267 24.08.05 Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crsoby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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