Inspection on 23/10/07 for Holly Close

This inspection was carried out on 23rd October 2007.

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

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Holly Close 6 Holly Close Brackley Northants NN13 6PF Lead Inspector Kathy Jones Unannounced Inspection 23rd October 2007 1:30 Holly Close DS0000070269.V351846.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 Holly Close DS0000070269.V351846.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. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Close Address 6 Holly Close Brackley Northants NN13 6PF 01280 840577 01280 840049 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) www.grooms-shaftesbury.org.uk Grooms-Shaftesbury Mrs Ann Jones Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: No additional conditions. Date of last inspection Not applicable as new registration. Brief Description of the Service: Holly Close is a care home, which is registered to provide personal care and accommodation for three people with a learning disability. The service is one of six homes in the area, which were owned by the Shaftsbury Society until June 2007 when they merged with John Grooms. The owners are now Grooms – Shaftesbury. Holly Close is situated in a residential area of Brackley in Northamptonshire. The home is within walking distance of Brackley Town Centre where community resources include shops, pubs, restaurants, gymnasium and a swimming pool. There are three single bedrooms for residents and a sleep in room/office for staff use. There is a kitchen/diner and lounge on the ground floor. There is a well-maintained garden at the rear of the property. The Registered Manager, who is also Registered Manager for Holly Close and Remus Gate, has an office base at Hanover Drive, which is in the same area. Fees are dependent on the level of support required and currently range from £773.83 to £778.00 per week. Fees include accommodation, food and personal care and support. Additional costs include newspapers, clothing, toiletries and activities and holidays. Information about the services provided in the form of a statement of purpose and service user guide is available in the home. This is the first inspection of this registration and when published the registered manager will ensure that a copy of the inspection report is made available. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Standards identified as ‘key’ standards are highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls and any complaints received. The information reviewed has been taken from the date of the current registration, which was June 2007. The unannounced inspection visit covered the afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and the inspector spoke briefly with residents about the support that they received. Residents were all given the opportunity to speak with the inspector but their right to settle down into their evening routine was respected. Staff were also spoken with to ascertain their views on the service provided. In addition information received following the inspection in surveys completed by two residents, a relative and two staff members has been taken into account. The management of a sample of residents’ medication was checked. And a sample of staff files, which are held at Hanover Drive, were reviewed to check the adequacy of the recruitment procedures in safeguarding residents’. Verbal feedback was given to the Registered Manager throughout the inspection. What the service does well: There is an experienced staff team who appear committed to meeting the needs of residents. Residents were obviously comfortable and relaxed in the presence of staff and had developed good relationships with them. Routines within the home are flexible and based around residents’ individual choices and commitments and Holly Close is treated as the residents’ home by staff. Staff work with residents to provide them with support to meet their individual needs and they seek advice from relevant health professionals where appropriate. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 6 Residents were encouraged to take responsibility and have some independence in their daily routines. Residents spoken with were happy with their daily lives and the level of support that they receive from staff. Residents are clear about their right to raise any concerns and are encouraged to do so. This helps to ensure that any issues can be dealt with and that residents are safeguarded. 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. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 7 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 Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process provides assurances that the needs of people admitted to the home can be met. EVIDENCE: There is a statement of purpose and service user guide, which provides information about the service provided for prospective and existing residents’ and their families. The content was not reviewed during this inspection, however it was identified through discussion with the Registered Manager that some update of information is needed. For example there is a need to include clear information about fees and additional charges to ensure people understand what the fee covers and what additional costs they are likely to have. It is now a requirement that this information is available to help prospective residents make decisions about their care. At the time of the inspection there were no vacancies in the home, however it was established that if there were to be a vacancy there is a thorough admission process. The admission process involves an assessment of needs and several visits to the home to establish if the prospective resident’s needs can be met and to allow them the opportunity to decide if they want to move Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 9 in. Records reviewed for one resident confirmed that there had been several visits including an overnight stay before moving in. Holly Close DS0000070269.V351846.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are supportive of residents’ individual needs and choices, however more thorough review of progress in meeting individual goals within care plans may provide residents with a greater sense of achievement. EVIDENCE: A sample check of residents care files confirmed that care plans are in place and are reviewed regularly. While the information within the care plans was clear and staff knew the individuals and their needs, advice was given to review the adequacy of the care planning in relation to monitoring residents progress in achieving agreed goals, identifying achievements and any additional support needs. For example care plans dated August 2005, identified areas where support and encouragement was needed to achieve specific things, had been reviewed with Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 11 the comment “no changes”. It was not clear from the review if the goals had been achieved or if different strategies were needed. The staff team is relatively stable and residents are generally cared for and supported by staff who know them and their needs very well, providing good outcomes for residents. However care plans are considered to be important tools to help staff work with residents needs to ensure their needs, aspirations and agreed goals are fully met. Responses from residents in surveys and discussion with them confirmed that they are involved in making decisions in their daily lives. They have weekly in house meetings where the household routines are discussed and agreed. There were records in place identifying situations where residents’ rights may be infringed, which had been signed by them. The infringed rights were in the main, the right for staff to enter the resident’s personal room, in the event of a fire and for fire prevention and maintenance checks to take place. Holly Close DS0000070269.V351846.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are generally satisfied with their lifestyles and are happy living in the home. However plans to increase social activities will improve the daily lives of some residents. EVIDENCE: Residents attend the Links day centre, which is run by Grooms-Shaftesbury for residents from several care homes. Surveys received from two residents, identified that they are able to do what they want during the day and at weekends, however one said that they couldn’t do what they wanted in the evening. The annual quality assurance self assessment (AQAA) submitted by staff at Holly Close, discussion with them and surveys form residents indicates that residents are generally satisfied with their lifestyles and are happy living in the Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 13 home. However it was identified that more could be done to improve residents’ lifestyles. This appear to be due to a combination of factors which include closure of the local Mencap social club and County Council funding being withdrawn from evening classes. The fact that there is only one member of staff on duty in the house is also difficult for weekend and evening activities as residents have different interests and don’t all want to go out. Public transport in the area is limited and there was only one car shared between six houses, however they now have access to the day centre care at weekends and in the evening. The AQAA does however state that there are plans to set up an activity club which would be available for all the six homes to access. The day centre would be used for some of the activities and access to the community for others, such as bowling,cinema and public houses. This is likely to give individuals a better range of opportunities and social experiences, however needs to be linked with individual care planning to ensure residents needs and expectations are met. Records indicate that residents’ are supported to maintain contact with their families. Residents’ said that they have choice with their meals and that the menus are planned with them on a weekly basis. Residents are encouraged to be involved in shopping for food and taking responsibility for some of the domestic tasks, which are part of daily life. Individual food preferences are documented within residents’ care plans. One residents care plan identified that they needed to be encouraged to drink more and choose healthy food options. The original plan was dated August 2005 and as the reviews just stated “no change” it was difficult to establish if any progress had been made with the care plan. Holly Close DS0000070269.V351846.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive good care and support with health care services being accessed as appropriate. EVIDENCE: Care records reviewed for a resident confirmed that care plans are in place, which include the information about their personal and healthcare support. Care records demonstrate that residents are supported to access health care services such as dentist, optician and chiropody. Appointments and advice are sought from health care professionals as required such as General Practitioner, Consultant psychiatrist and the Community Learning Disability Nurse helping to meet physical and emotional needs. A questionnaire received from a General Practitioner confirms that the service works well with them. Discussion with staff confirmed that they have a good understanding of the needs of the individuals and the support that they need. However although reference was made within residents’ care notes to guidelines given to staff by Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 15 the Community Learning Disability Nurse on managing behaviour, these were not incorporated within the care plan or on the care file. It is important to ensure that such information is available for all staff including any new or agency staff to help ensure a consistent approach towards meeting resident’s needs. A sample check of the management of residents’ medication identified that it is generally well managed. The medication was also securely stored. Staff spoken with, were mindful of the need to ensure that the procedures in place for the safe administration of medication are followed and that any discrepancies are reported to the Manager. This is important to ensure that residents are not put at risk, however advice has been given to consider if a missed signature, where it is clear medication has been given, could be dealt with through the staff supervision and training process rather than safeguarding adults. Holly Close DS0000070269.V351846.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are procedures for dealing with concerns and complaints, which residents are aware of and staff are aware of their responsibilities for protecting the people in their care. EVIDENCE: The Commission for Social Care Inspection have received no complaints about the service. The Registered Manager advised that they have received no complaints. Surveys received from two residents confirm that they know who to talk to if they are not happy and how to make a complaint Staff spoken with including agency staff were aware of their responsibilities for safeguarding the people in their care and reporting any concerns that they may have. Northamptonshire County Council safeguarding adults procedures were available for reference in the event of concerns being raised. It was identified that the organisations procedures require completion of a protection of vulnerable adults referral for all medication and medication errors regardless of risk. Advice has been given to consider whether it is necessary to make a safeguarding referral to social services and notify the Commission for Social Care Inspection in cases where it was clear that a resident had not been placed at risk. It is of concern that overuse of the procedures may lead to incidents not being taken sufficiently seriously. Holly Close DS0000070269.V351846.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s live in a home that is comfortable and homely. EVIDENCE: The home is of domestic layout situated in a residential area within easy travelling distance to the town centre and local community resources; all areas were clean, tidy and well maintained. Residents confirmed in the two surveys received that the home is always fresh and clean. The three resident all have single rooms. Residents spoken with were happy with their rooms, which were personalised, having TV, Video and personal entertainment systems within the rooms. Residents confirmed that staff respect their right to privacy. Staff were observed to knock and be invited in, before entering residents rooms. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements are generally very good, however the recruitment process needs to be more thorough to ensure that residents are not put at risk. EVIDENCE: Discussion with staff identified that the fact that there is only one member of staff on each shift can sometimes make it difficult to support residents who wish to go out if others do not. The annual quality assurance self assessment identifies that one of the plans for improvement was to “look at ways of using a flexible rota to support individual choices”. It also refers to working together with the other houses to arrange activities. Agency and permanent staff spoken with presented as caring and knowledgeable about the needs of individual residents. The agency staff used are all familiar to the residents having in some cases worked in the home for a few years. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 19 Residents spoken with were happy with the staff team and interactions between staff and residents indicated that good trusting relationships had been developed. Surveys from residents confirmed that staff listen and act on what they say. One said “Carers very kind to me”. Staff files were sample checked during the inspection at Hanover Drive. The same staff team work at Hanover Drive, Holly Close and Remus Gate. This identified some shortfalls in the information obtained as part of the recruitment process. Criminal record bureau clearances had been obtained prior to staff working in the home. However shortfalls were identified in the process for a member of staff who had been recruited while the Registered Manager was away on sick leave. The application indicated that a full employment history had not been declared and there was no evidence of challenge or further discussion. Advice was also given about gathering references from people able to comment on a person’s suitability for working with vulnerable people. This is important in helping to safeguard residents. It was identified during the inspection at Hanover Drive that new staff receive induction training and that staff receive training appropriate to meeting the needs of residents. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a manner that promotes and safeguards the health, safety and welfare of residents’. EVIDENCE: The Registered Manager has several years experience of working with the client group and appears committed to providing good care and support for residents. Discussion with the Registered Manager identified that she had been away on sick leave for a period of seven weeks. CSCI received no notification of this or of the arrangements for managing the home in her absence. Under the Care Homes Regulations 2001 there is a requirement that CSCI are informed of any Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 21 absence of a registered person including a registered manager over 28 days. The role of the registered people is considered to be particularly important in relation to the welfare of residents as they hold the legal responsibilities. The Commission for Social Care Inspection (CSCI) requested completion of an annual quality assurance self assessment (AQAA). Review of the information, indicates that that there is an awareness of the need to carry out an ongoing review of the support provided to residents to ensure that their needs and expectations are met. On the day of the inspection the Area Manager was carrying out a monthly visit to monitor the quality of care provided. Discussion identified that each month there is a different focus to the visit and that checks are made as to how well the home is meeting the National Minimum Standards. No health and safety concerns were identified during the inspection. Records and discussion with staff confirm that appropriate training in safe working practices is provided for staff such as first aid, movement and handling and fire safety. This helps to reduce the risk to residents. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 22 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 2 2 3 3 X 4 X 5 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 23 N0 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 YA34 Regulation 19 (1) (b) schedule 2. 6 Requirement Timescale for action 20/12/07 3. YA37 38 A more thorough check of information supplied as part of applications for employment must be carried out to ensure that all information including a full employment history has been declared. This is to help safeguard residents’. 20/12/07 The Commission for Social Care Inspection must be notified in writing of an absence of a registered person including a registered manager where this is 28 days or more. Information must include the reasons and proposed arrangements for management of the home during the absence. This is to confirm ensure that proper arrangements are in place to safeguard residents. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 24 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 YA6 Good Practice Recommendations The care planning process should be used more effectively to monitor and support residents in achieving goals and aspirations. Holly Close DS0000070269.V351846.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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