Inspection on 08/06/05 for Hollies, The

This inspection was carried out on 8th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Hollies, The 23/11/09

Hollies, The 26/09/07

Hollies, The 22/09/06

Hollies, The 11/01/06

Hollies, The 01/11/04

Hollies, The 12/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE THE HOLLIES 9 Fox Lane Palmers Green London N13 4AB Lead Inspector David Hastings Unannounced 8th June 2005 at 9.30 am 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service The Hollies Address 9 Fox Lane, Palmers Green, London N13 4AB 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) 020 8886 3068 John & Patricia Phillips Tracy Simcox PC Care Home Only 19 Category(ies) of OP Old Age registration, with number of places THE HOLLIES Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1 November 2004 Brief Description of the Service: The Hollies is a private care home registered to provide care and support for a maximum of nineteen people over the age of sixty-five years. The aim of the home is to ensure that service users feel safe and relaxed as they would in their own home, but with the added security of knowing that help is always on hand if they need it. The home is a large detached Victorian, two-storey building with 15 single and 2 double bedrooms located on the ground and first floors. There are two bathrooms and two toilets on the first floor and an assisted bathroom and two toilets on the ground floor. The home has kept many of the original Victorian features.The manager’s office, lounge, dining area, kitchen and laundry room are on the ground floor.There is a small parking area at the front of the home and a wellmaintained accessible garden at the back of the home. The home is situated on a residential street, close to a variety of shops, restaurants and public transport located along the high street at Palmers Green. THE HOLLIES Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Wednesday 8th June 2005 and lasted five hours. Three visitors and six residents were spoken to. Comments from visitors and residents were overwhelmingly positive regarding the care provided. A partial tour of the premises took place and care records were inspected. The inspectors were assisted throughout the inspection by the registered provider and registered manager. All staff, the registered provider and registered manager were open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Five requirements from the last inspection have been restated. The frequency of team meetings and staff supervision must improve. Risk assessments must be further developed for all safe working practices at the home. The registered provider must decide if the home should apply for a dementia category so that residents can be admitted with a diagnosis of dementia. A minor variation THE HOLLIES Version 1.10 Page 6 must be applied for so that the exiting residents with dementia can be accommodated at the home. The registered provider must improve the recording of health and safety monitoring including fire and electrical checks and water temperature monitoring. The registered manager must tighten up procedures in relation to medication to ensure the safety of all residents. Seven new requirements have been issued as a result of this inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. THE HOLLIES Version 1.10 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 Version 1.10 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) 3 and 4 Detailed assessments are provided by trained professionals for all service users before they are admitted to the home. The staff and management know the service users very well and are able to meet their individual needs. However the home must not admit service users with a diagnosis of dementia unless the registered provider applies to the CSCI for a variation to their conditions and this is agreed by the CSCI. EVIDENCE: Two new service users have been admitted to the home in the last few months. There was evidence that comprehensive assessments had been carried out by social workers prior to the service users moving in. One of the service users had a diagnosis of dementia. The home is not registered for people with dementia and a requirement was issued at the last inspection that the registered provider must apply for a variation of conditions for the service users already living at the home who have dementia. This requirement has not been complied with and is restated. The new service user does not have challenging behaviour and it appears the staff at the home are meeting her needs. However her needs may change in time and the staffing levels are not currently sufficient to care for a number of service users with dementia. The management of the home must decide whether to apply for a THE HOLLIES Version 1.10 Page 9 major variation so they would be able to admit service users with a diagnosis of dementia. If not the home must not admit anyone with dementia and this must be clearly stated in the home’s statement of purpose. A requirement relating to this has been issued in the relevant section of this report. Relatives, visitors and service users that the inspectors spoke with were very positive about the care provided by the home. It was clear from discussion with the registered manager and registered provider that they knew the service users very well and were aware of how to meet each service user’s individual needs. THE HOLLIES Version 1.10 Page 10 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, 9 and 10 Service users’ health, personal and social needs are clearly identified in their individual care plans. Service users have good access to health care professionals. Service users get the medication they have been prescribed at the right times by staff who have been appropriately trained. The registered manager must make sure that only service users who have been assessed as being able to self medicate have medication in their rooms. Service users are treated with respect and their privacy is maintained. EVIDENCE: Eight care plans were examined. There was evidence of consultation and of the service user plans being reviewed on a monthly basis. The assessed needs were reflected in the care plans. Risk assessments in respect of falls and manual handling were in place. As a requirement from the last inspection, risk assessments were seen for service users with dementia and these were being reviewed. The inspectors discussed with the registered manager how the care plans could be developed to provide a more holistic approach to the needs of service users. It was clear from discussion with service users that they felt THE HOLLIES Version 1.10 Page 11 their needs were being met. One service user commented that the home provides “better care than the hospital”. The inspectors found up-to-date records of health care appointments attended such as dentist, hygienist, GP, audiologist, chiropodist, optician and district nurse records also contained detailed outcomes. Emotional and social health needs had also been detailed in service user plans. Waterlow risk assessments were in place for service users who were considered to be at risk of developing pressure sores. The home has provided a pressure sore mattress for several service users as a preventative measure. It was reported that no service users have pressure sores. A requirement was issued at the last inspection that all service users should have a nutritional assessment carried out. Satisfactory records were seen in relation to this and the requirement has now been complied with. Medication records were generally satisfactory. It was noted that a new service user to the home had some medication in her room. This was in addition to the medication the home was giving her. The medication was immediately taken away, with the service user’s permission and the doctor was informed. The registered manager must ensure that service users, visitors and relatives are made aware that no medication should be left in service users’ rooms unless the service user has been assessed as being able to self medicate and the registered manager is aware of this. It was also found that one service user was having her tablets crushed as she has a problem swallowing. However there was no written confirmation from either the doctor or the hospital that this was acceptable practice. The registered manager was able to supply the CSCI with written confirmation the day after the inspection. Two requirements relating to these medication issues have been made in this report. During the inspection staff were seen knocking on service users’ doors before entering their rooms and service users commented to the inspectors that the staff respected their privacy. THE HOLLIES Version 1.10 Page 12 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) 12, 13, 14 and 15. The home has a lively atmosphere and there is a good range of activities available. Visitors are always made welcome and service users can see visitors in private if they wish. The management and staff are able to meet the service users ‘ recreational interests. Service users’ independence is encouraged and they receive a wholesome, appealing and balanced diet. EVIDENCE: The home arranges quizzes, scrabble competitions, entertainers, poetry reading, diversion therapy, concerts, clothes show and singing sessions. Service users were observed talking to each other, laughing and generally enjoying the company of each other. Staff also spent lots of time interacting with the service users and joining in with conversations. Service users social, emotional and leisure preferences are documented in their service user plans. One visitor commented that it was really good to see that the television was not on all the time. Visitors informed the inspectors that they were always made welcome by staff. There were a number of visitors during the inspection and they were very positive regarding the management and staff at the home. A recommendation was issued at the last inspection that relatives meetings should be organised. The registered manager informed the inspectors that this was being addressed. THE HOLLIES Version 1.10 Page 13 A requirement was made at the last inspection that the registered provider must ensure that the arrangements for supporting service users with their finances are documented including any benefits that are entitled to them. Appropriate records were seen in relation to this. The requirement has been complied with. Service users spoken to during the inspection commented that they where given choice in many areas of their daily lives including food, activities and clothing. One service user has recently moved into the home with her pet dog. She was very happy that her dog was allowed in the home and was clearly benefiting from having him there. The kitchen was clean and tidy and the cook was making a homemade meat pie on the day of the unannounced inspection. Service users commented that the food was very good. The menus were varied and there was a large amount of fresh ingredients used. THE HOLLIES Version 1.10 Page 14 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) 16 and 18 The home takes complaints seriously and deals with them in a professional manner. Service users are protected from abuse by clear policies and procedures and appropriately trained staff. EVIDENCE: There have been two complaints made since the last inspection. The homes complaints record documented clearly the nature of the complaint, the investigation and the outcome of the investigation and if the complainant was satisfied with the outcome. The home had a complaints procedure that met the requirements of this standard. Service users and relatives spoken to state that they were happy with the support provided and that they did not have any cause to complain. They were familiar with the homes complaints procedure and felt confident that any complaint made would be dealt with appropriately by the registered person. The home has a copy of the local authorities adult protection policy and procedure in place. The registered manager has undertaken abuse awareness training and records showed that she has presented adult abuse training with the staff at the home. This was a requirement from the last inspection that has been complied with. THE HOLLIES Version 1.10 Page 15 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, 25 and 26 The home is clean, safe and well maintained. Suitable systems are in place to ensure that a good standard of hygiene is maintained. EVIDENCE: The home is well maintained and provides a homely environment for the service users. A requirement made at the last inspection that fire door guards must be fitted to doors that are to remain open during the day has been complied with. The home is decorated to a good standard. The registered provider has fitted radiator covers to all radiators in the home and thermostatic valves to all wash hand basins. Lighting was domestic in character and service users were able to regulate the temperature in their own rooms. The home was very clean and free from offensive odours. The home employs a cleaner to clean all communal areas. There were appropriate infection control policies and procedures in place. The laundry was clean and there are suitable washing machines in place. THE HOLLIES Version 1.10 Page 16 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, 29 and 30. The staff working at the home are able to meet the needs of the service users living there. Service users are protected by the home’s policies and procedures in relation to staff recruitment. Staff receive suitable training in order to do their job properly. EVIDENCE: At the time of the unannounced inspection there were sufficient staff on duty to meet the needs of service users. A requirement was issued at the last inspection that the registered provider review staffing levels including staffing levels at night. The registered provider informed the inspectors that staffing levels had been reviewed and no changes had been made. However if service users require a higher level of care during the night, two waking staff would be deployed. At present there is one waking night staff and one sleeping in staff for nineteen service users. Staffing levels had been agreed with the CSCI. Service users were very complementary about the staff. All staff file examined contained the information required by Regulation including CRB disclosures and two references. All staff files contained proof of identity. This was a requirement from the last inspection that has now been complied with. There was evidence that staff are undertaking appropriate training. A requirement was issued at the last inspection that staff undertake training in pressure care prevention and dementia care. The registered manager informed the inspector that she had given training in pressure care to all staff and a dementia training course has been arranged for a few weeks time. THE HOLLIES Version 1.10 Page 17 THE HOLLIES Version 1.10 Page 18 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) 32, 33, 36 and 38 Staff meetings at the home and staff supervision need to happen on a more regular basis to assist professional communication. Service users views about the way the home is run are recorded and available to prospective service users. Systems to monitor health and safety at the home must improve to ensure service users and staff’s safety is promoted and protected. EVIDENCE: Two requirements issued at the last inspection regarding regular staff supervision and staff meetings have not been complied with and are restated. The inspectors saw service user surveys regarding their views on the quality of service provided by the home. These views have been recorded and are available to prospective service users. There was also evidence that these views have informed good practice changes at the home. This was a requirement from the last inspection that has now been complied with. THE HOLLIES Version 1.10 Page 19 A requirement restated at the last inspection that risk assessments must be produced for all safe working practices has still not been complied with and is restated. The registered provider informed the inspectors that he has purchased a CD rom in order to help with this task. The home is sending a record of all reportable incidences to the CSCI. This was a requirement that has now been complied with. The inspector saw a risk assessment for Legionella. This was also a requirement from the last inspection that has now been complied with. The registered provider informed the inspector that he would ensure that a Legionella check is carried out by professionals in the very near future. Records in relation to fire safety were examined and were satisfactory except that emergency lighting was not being checked as regularly as required. It was also found that fire call points were not being systematically checked. Two requirements relating to these issues have been made in the relevant section of this report. The electrical installation certificate had expired and a requirement has been issued that this be carried out. Other records in relation to health and safety that were examined were satisfactory. Although all wash hand basins have been fitted with thermostatic controls to make sure the water is not too hot, these valves are not being regularly checked. This is a requirement as limescale can build up and affect the valves. THE HOLLIES Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 2 3 x x 2 x 2 THE HOLLIES Version 1.10 Page 21 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 38 Regulation 13(4) Requirement The registered person must ensure that risk assessments are carried out for all safe working practice topics listed under NMS 38 and that significant findings of the risk assessment are recorded. (Timescale of 31/01/05 not met) This requirement is restated from the last inspection. The registered person must apply to the CSCI for a variation of conditions of registration in respect of service users with dementia care needs. A comprehensive assessment of each of these service users must be carried out by a social worker and/or their GP and must be enclosed with the application form. (Timescale of 01/02/05 not met) This requirement is restated. The registered provider must decide if a major variation should be applied for so that service users can be admitted with dementia. Unless this variation is obtained the home can not admit service users with dementia. Version 1.10 Timescale for action 31/07/05 2. 4 14 31/07/05 3. 4 12 01/09/05 THE HOLLIES Page 22 4. 32 12(1) 21(1) 5. 36 18(2) 6. 7. 9 9 13(2) 13(2) 8. 38 23(4) 9. 38 23(4) 10. 38 23(2)(b) 11. 38 13(4)(b) The registered person must ensure that staff team meetings occur on a regular basis to enable clear communication with regard to work practices and continuity of care. (Timescale of 01/12/04 not met) This requirement is restated. The registered person must ensure that all staff including the registered manager receive formal documented supervision at least six times a year. (Timescale of 31/12/04 not met) This requirement is restated. The registered manager must ensure that no medication is left in service users rooms. The registered manager must ensure that no tablets are crushed unless written permission is given by the doctor The registered provider must ensure that emergency lighting is checked on a regualr basis and records maintained. The registered provider must ensure that all fire call points are regularly checked and records maintained. The registered provider must ensure that a satisfactory electrical installation certificate is obtained for the home. The registered provider must ensure that all wash hand basins are regularly checked to ensure water temperatures do not exceed 43 degrees. 31/07/05 31/07/05 31/07/05 31/07/05 31/07/05 31/07/05 31/07/05 31/07/05 THE HOLLIES Version 1.10 Page 23 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 No recommedations were issued at this inspection. THE HOLLIES Version 1.10 Page 24 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 THE HOLLIES Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!