CARE HOMES FOR OLDER PEOPLE
Hollies, The 7 Mornington Road Southport Merseyside PR9 0TS Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 10:00 9 and 15th October 2007
th X10015.doc Version 1.40 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 Hollies, The DS0000005329.V347331.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 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. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hollies, The Address 7 Mornington Road Southport Merseyside PR9 0TS 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) 01704 541506 Mr John Thomson Eslick Helen Eslick Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 24 OP Date of last inspection 7th December 2006 Brief Description of the Service: The Hollies is a care home situated in Southport, close to shops and transport links to Liverpool. The home is owned by Mr Eslick and managed by Ms Helen Eslick and accommodates up to twenty-four elderly people. There is off street parking is at the front of the building and a secluded garden at the back. Accommodation is provided on three floors, which can be reached by a passenger lift. Disabled access is provided at the rear entrance via the patio doors. The Hollies has two lounges and a dining room, which are comfortably furnished. The bathrooms are fitted with aids to assist those who are physically frail, and there is a call system for residents to summon assistance if necessary. To the side of the premises is the annexe or cottage, where visitors from out of the area may stay overnight if they wish. The annexe is not registered with the Commission. The fee for the service is £365.00 per week with extra charges for hairdressing, chiropody and newspapers. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced and was carried out over two days, the manager, Ms. Eslick and proprietor Mr. Eslick, being present on the second day. The methods used were, discussion with the manager, residents and staff, reading records and care plans compiled in the Hollies and touring the premises and grounds. Eight resident satisfaction questionnaires were read and reference made to the Annual Quality Assurance Assessment, which had been completed by Ms. Eslick and returned to CSCI before the visit took place. What the service does well:
The Hollies provides a relaxed and comfortable home for residents and feedback from them was positive during the visit and in questionnaires. A comment made by one of the residents during the visit was typical of their opinions on the service in the Hollies, “I have all I need, I couldn’t want for better.” Residents’ diversity is respected in policy and best practice in the Hollies, through support for religious and cultural needs, disability and frailty, in a manner, which respects independence and choice. Prospective residents have had their needs assessed and are provided with the information which will inform their choice as to whether the Hollies will make a suitable home. For those who live in the Hollies, there is ongoing consultation regarding their support and lifestyle, through care plan reviews and residents’ meetings. There are opportunities for residents to express their opinions on quality of service through regular distribution of questionnaires and residents’ responses on all aspects of service, are monitored and acted upon. A clearly set out complaints procedure is given to residents of the Hollies to ensure they feel that their concerns will be listened to and acted upon. To ensure that staff have the qualities and skills to support residents, there is a well-vetted and experienced staff group who have undertaken regular training and updates. Residents said they were satisfied with the way in which staff support them, considering them to be kind and caring. Relatives and friends of residents who commented, stated they were, “Extremely satisfied,” and, “Very pleased” with the care and support provided in the Hollies. The Hollies is managed in a manner, which protects the residents’ health and wellbeing. The building and equipment is regularly maintained and staff receive training related to health & safety, infection control and patient handling. There are procedures in place for residents’ protection including those for managing personal finances and protection of vulnerable adults. Hollies, The DS0000005329.V347331.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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. To ensure that the Hollies will make a suitable home, prospective residents have had their needs assessed and are given the information they need about the Hollies before deciding to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 1 and 3. Current and prospective residents are provided with a service users’ guide and statement of purpose, which give information about the service and facilities on offer including details of accommodation, staff qualifications, the most recent inspection report and the complaints procedure. A resident said, “They were very helpful when I moved in here and I felt as if I had some control over what was happening.” Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 9 Residents’ care files contained copies of assessments of the health and social care needs. Residents who are referred by social services have social work assessments and senior staff from the Hollies, also carry out an assessment which follows a standardised format, to ensure that the Hollies will make a suitable home for each individual. The outcomes of assessments form the basis of each individual’s care plan. Intermediate care is not provided in the Hollies and the service was not assessed against standard 6. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents of the Hollies have their health and personal care needs met and their privacy and dignity respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9,10. A sample of three care plans was tracked by checking assessment outcomes against the plans of action set out to inform staff as to how the person’s health, personal care and social needs will be met. When discussing her care plan, a resident said, “I am happy, I have all I need and get help with things I can’t manage any more. The staff are very helpful and caring.” The care plans, which were read, had been regularly reviewed and amended and there were detailed risk assessments in place to address pressure care, mobility, bedrails and self-medication.
Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 11 To ensure that residents’ diversity is addressed in care plans, their cultural and religious affiliations, interests and preferences are recorded and action plans set out as to how these will be met in the Hollies. All residents of the Hollies are registered with local G.P.s and detailed records of medical interventions, are maintained by the staff. There were records of referrals to district nurses and specialist services contained in residents’ care plans. A resident said, “The chiropodist visits me here, and if I need the doctor they arrange for him to come and see me.” A number of residents were receiving their flu injections from the district nurse, at the time of this visit. For staff guidance, the Hollies has policies and procedures on managing residents’ prescribed medication and staff who give out medicines to residents have received relevant training. A resident who commented said, “They bring my pills round at the same time every day, I would never remember to take them if they didn’t sort it out for me.” For residents who wish to selfmedicate, a detailed risk assessment is carried out to assess whether or not they are able to do this safely. The medication storage area was visited, administration records were read for all residents and drugs stocks were checked for three residents and found to be in order. Shortfalls were noted regarding storage of medication and management of medication records, and recommendations are made. The storeroom is not well ventilated and felt warm at the time of the visit. To ensure that medication is stored safely, it is recommended that the temperature of the medication area is monitored through use of a thermometer designed for the purpose, which will provide a reading of when the temperature is at a safe storage level. To ensure safe recording of medication and avoid errors, it is recommended that handwritten medication administration records are signed by the writer and checked against the pharmacy containers and signed by a colleague. Residents expressed no concerns about how their privacy and dignity are respected in the Hollies. Staff who were spoken with were aware of procedures in place for care giving in private and storage of records in secure and designated areas. Residents looked well cared for and obvious attention had been paid to their personal grooming. The hairdresser was on the premises, and residents said, “It is good to know I can have my hair done every week.” “It gives me a lift to know my hair is tidy and we have a chat when we are having our hair done.” Residents are consulted and involved in the planning of their care, their signatures were seen on care plan agreements. Communication with relatives and representatives is good as there were records of relatives having been informed of any deterioration in a resident’s condition and of their attendance at care plan reviews. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The lifestyle in the Hollies meets residents’ social and cultural needs and preferences and they are provided with a wholesome and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. There is a relaxed and friendly atmosphere in the Hollies and residents said they spend time as they please. The hairdresser was visiting and a number of residents were having their hair done. Residents’ interests are recorded on their care plans and there are opportunities for them to continue with their hobbies (such as gardening). Outings provided include shopping trips and a barge trip. A member of staff said that residents sometimes like a game of bingo and barbecues when weather permits. The manager, Helen Eslick, said visiting entertainers are arranged at regular intervals to provide musical sessions for the residents. Those who commented expressed satisfaction with the entertainment on offer in the Hollies. Religious services take place regularly for those who wish to follow their chosen faith.
Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 13 Residents said that there are no undue restrictions on visiting times for their family and friends, and their privacy when entertaining them is respected by staff in the Hollies. There was evidence in policies and care files that residents have access to independent advocacy services and of contact with local voluntary organisations and local churches. Residents of the Hollies are consulted about the way in which care will be provided. This was evident in care plan agreements, which contain their (or their representatives’) signatures. They said they are asked about what they would like for their meals, they may eat in their bedrooms or in the dining room and that mealtimes are flexible. The menus are rotated on a four-weekly basis and give evidence that residents are offered a good range of choice and alternatives at mealtimes. Residents’ care plans contained records of their weight and staff confirmed that the G.P. would be informed of any prolonged loss of appetite or weight loss to a resident. The serving of the main meal of the day was observed and was relaxed, more frail residents being assisted to their dining tables. The dining room is close to the kitchen and the tables were nicely laid and there was enough space and seating for each resident to enjoy their meal at leisure. Designated cooking staff are employed and food stores and catering records were in good order at the time of the visit. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through the complaints and adult protection procedures and relevant training for staff in the Hollies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16-18. The Hollies has a simple, clear and accessible complaints procedure to ensure that residents know that their complaints will be listened to and dealt with effectively. A record of complaints is maintained in the Hollies and on checking this it was evident that residents have not made any complaints to the manager, since the last visit. The Hollies has procedures for protection of vulnerable adults and “whistleblowing” to guide staff if abuse of a resident is suspected. Staff who were spoken with were aware of the indicators of abuse and the procedures to be followed in alerting suspected abuse of a resident, to the relevant authorities. There have been no POVA investigations about this service since the last visit. A resident said, “They are all very kind here. I have control of my money and have no complaints about the way this place is run.” Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. To ensure residents’ comfort and wellbeing, the Hollies is well-maintained and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19, 22 and 26. To ensure that the Hollies is a suitable home, there is an ongoing maintenance programme and the building was generally in good condition. The outside of the premises has recently been painted and some of the windows have been replaced. The rear garden is secluded and secure and is well established and tended with a seating area for residents. Residents’ bedrooms are highly individualised containing many of their personal possessions, photographs and ornaments. There are two lounges and a dining room for communal use. The larger lounge, which has access to the gardens, is currently in use as a smoking area for a minority of residents who smoke. A number of residents
Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 16 were making use of the smaller lounge and said they were comfortable there. Some of residents spend time during the day, in their bedrooms, reading or watching television. Areas of the building which may be in need of decoration are prioritised by the manager and remedial work carried out accordingly. The manager said that the carpet in the large lounge is to be replaced in the near future. Residents’ diversity regarding physical frailty is acknowledged and supported through provision of a range of environmental aids for disabled people. There is a passenger lift to upper floors and a ramp, which gives access to the garden from the rear lounge. Bathing facilities include an assisted bath and double walk-in showers with seats. For residents’ convenience, there are toilets throughout the building with raised toilet seats and support frames. To ensure the building is hygienic, the Hollies has policies and procedures for infection control and records show that staff have received the relevant training. The building was clean and odour free at the time of the visit and staff confirmed that there are good supplies of protective clothing available and no shortage of cleaning materials. The laundry is well equipped and organised and laundry equipment was in working order at the time of visit. There are procedures for control of substances hazardous to health and cleaning materials were being managed accordingly at the time of the visit. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 17 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through the recruitment and training of staff in the Hollies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27, 28, 29, 30. Training records and the staffing rosters were read, and discussion took place with staff who were on duty. The documents provided evidence that staffing levels, qualifications and skills appeared to be meeting residents’ care and social needs. Three members of staff confirmed that they are well supported by the manager and have six-weekly supervision sessions and appraisals when their training and development needs are discussed. To meet the skill base identified in their job descriptions, staff have been provided with a wide range of training, including NVQ qualifications in care, mandatory courses and updates and training in protection of vulnerable adults. The Hollies provides induction training for newly appointed staff and there is a rigorous recruitment procedure to ensure that prospective staff are well vetted and have the qualities needed to fulfil their roles and responsibilities. All staff have police clearance before taking up their posts and two satisfactory previous employers’ references are obtained. A sample of staff files was read and had been satisfactorily maintained giving evidence of vetting and training of the relevant staff members.
Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The Hollies is managed in a way which protects residents’ health, safety and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,38. The manager, Ms. Helen Eslick, has several years of experience in care and management. Staff confirmed they receive regular supervision and appraisals and feel well supported. During the visit, Ms. Eslick showed awareness of residents’ care needs and the support being provided by staff for each individual.
Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 19 The Hollies has a quality assurance system based on seeking the views of residents and their representatives through the distribution of questionnaires. A sample of the survey April 2007 was read and a comment written by a visitor states, “I look forward to visiting the Hollies. It’s a pleasure. Top marks.” The opinions of residents are monitored and action taken to ensure that improvements to the service are made accordingly. There is ongoing consultation with residents through care plan reviews, residents’ meeting and through an open door management style. Residents confirmed that they (or their representative), hold control of their personal finances without the involvement of staff. For some of the residents, their personal allowances are held in safekeeping until needed for personal expenses such as hairdressing, chiropody and newspapers. Records of the accounts of each person’s credit and expenditure were available and all transactions had been signed for to ensure staff’s accountability. Health & safety certification regarding maintenance of equipment was in good order and the fire book had been satisfactorily maintained to ensure good standards of safety in the building. Staff have received training and instruction regarding fire safety, patient handling and health & safety. A record of accidents to residents and staff is maintained, these are monitored and risk assessments carried out as necessary. It was observed that some fire doors were wedged open during the visit. To ensure that residents are protected in case of fire, it is recommended that advice be obtained from the fire safety officer regarding use of automatic closers where fire doors are routinely wedged open to provide more freedom of movement for residents. Residents were seen being transported in wheelchairs which did not have footrests fitted. To ensure residents’ comfort and safety, it is recommended that footrests be in place at all times when residents are being moved. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A 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 Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. 2. 3. 4. Refer to Standard OP9 OP9 OP38 OP38 Good Practice Recommendations To ensure the safe storage of medication, the temperature of the medication room should be monitored. To ensure the safe recording of medication, handwritten MAR sheets should be signed by the writer and checked and signed by a colleague. To ensure residents’ comfort and safety, it is recommended that footrests be in place at all times when residents are being moved in their wheelchairs. To ensure that residents are protected in case of fire, advice should be obtained from the fire safety officer regarding the fitting of automatic closers to fire doors which are wedged open. Hollies, The DS0000005329.V347331.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Merseyside Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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