Inspection on 11/02/06 for Holly Court

This inspection was carried out on 11th February 2006.

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

Holly Court 25/09/08

Holly Court 23/11/06

Holly Court 18/10/05

Holly Court 31/01/05

Holly Court 16/06/04

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

CARE HOMES FOR OLDER PEOPLE Holly Court 8 Priory Grove Salford Gtr Manchester M7 2HT Lead Inspector Anthony Cliffe Unannounced Inspection 11th February 2006 06:40 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 Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holly Court Address 8 Priory Grove Salford Gtr Manchester M7 2HT 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) 0161 708 0174 Southern Cross Healthcare Services Limited Mrs Brenda McStravick Care Home 25 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24) of places Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named individual currently accommodated is below 65 years of age. If this service user leaves, the service user category will revert to DE(E). 18th October 2005 Date of last inspection Brief Description of the Service: Holly Court is a care home offering personal care only to 25 older people diagnosed with dementia. The home is situated in a residential area of Salford within close walking distance of local community facilities. Holly Court is a purpose built provision owned by Southern Cross Healthcare. The accommodation comprises of 25 single en-suite rooms and appropriate communal facilities on two floors. Catering and laundry are conducted from Laburnum Court, a provision in close proximity to the home and also owned and managed by Southern Cross Healthcare Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A regulatory inspector conducted this unannounced inspection on 11th February 2006 over a period of seven hours. Feedback was given to the deputy manager. Records were inspected and staff practice was observed. Discussion took place with residents and staff. One requirement remained outstanding from the last inspection visit. What the service does well: What has improved since the last inspection? The majority of requirements identified at the previous visit had been met. Residents had a copy of the standard contract of residency. Records relating to the care of residents and their involvement in social care had improved. Arrangements for residents receiving an early morning drink had improved. The provision of food to Holly Court had improved. Cleaning of the satellite kitchen areas had improved. No odours were noted at the time of the visit. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 the following standard(s): 2, 3 & 4 Residents have been provided with a statement of terms and conditions of residence. A resident was not appropriately assessed prior to moving into Holly Court and the home could not ensure the resident’s needs were met. EVIDENCE: The manager was not present during the visit and the deputy manager did not have access to the manager’s office. The deputy manager stated that all residents had been provided with a statement of terms and conditions of residence. As these records contained confidential financial information they were locked in the manager’s office and could not be examined. The records of a resident who had recently moved into Holly Court were examined. The pre admission assessment was not available as this was locked in the manager’s office. An admission assessment clarified a pre admission assessment had been completed at the resident’s previous place of residence. An assessment from the local authority was available with the resident’s care plan. Theses documents confirmed the resident had been identified with deteriorating cognitive function and increased unpredictable aggressive behaviour. Holly Court was identified as the appropriate place to meet the resident’s needs. On moving into Holly Court the resident was identified as being at risk from falling due to aggressive incidents with other residents. The Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 9 resident’s ability to communicate was recorded as incoherent speech, anxious, distressed, disorientated and angry. There was a number of care plans and assessments completed to identify the resident’s needs. Over the period of a month daily records and challenging behaviour records noted numerous serious incidents of aggression toward residents and staff. Three incidents were identified when the resident attempted to use a sharp object to injure a resident and on two occasions staff members. Other incidents recorded residents and staff being assaulted and resident’s being tripped. Daily records did not record any contact with the local mental health services until a month after the resident moved into Holly Court. A consultant psychiatrist reviewed the resident. Following the review the resident’s behaviour had settled. The resident had fallen and subsequently complained of pain and a sore ankle noted. Daily records noted it took staff three days to contact a general practitioner. There was no risk assessment, care plan or risk management plan regarding aggressive behaviour and no risk management plan regarding falling. See requirements 1 and 2. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. Residents received support in aspects of personal care, health, and the care of medication. However, Holly Court must ensure all aspects of care are monitored and reviewed to demonstrate residents’ needs are met and ensure a consistent approach to care. EVIDENCE: The visit took place at 06.40 hours and six residents were already up and dressed. Residents were having a drink of tea and offered a biscuit or piece of toast. The satellite kitchens on each level at Holly Court contained enough essentials to prepare beverages, breakfast or light snacks. Day staff prepared breakfast. The care plans of several residents were examined. All plans had a wide range of assessment documents fully completed; with a care plan to address residents’ identified needs. From looking at care plans, and talking with residents, the health needs of residents were generally met. The health of the residents was well recorded and understood by the staff team. Records were kept about all health professionals and GP involvement in the care of residents. One resident’s care plans were well written and recorded frequent contacts from the community psychiatric nurse. The resident was noted as being at risk from falls. A risk assessment for this was completed. The reviews of this recorded that the care plan in place was working with only two falls recorded over a period of three months. The resident was identified as being at risk of Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 11 choking and a risk assessment and risk management plan were in place. However there was an example of a resident’s mental health not being reviewed for over a month and the resident being a risk to residents and staff. Two care plans had not been reviewed for two months. One of these for a resident who had been assessed as requiring nursing care. The resident had developed a skin condition being monitored by the district nurse. Information identified from a review had not been transferred into the care plans and assessments, as these had not been reviewed following it. Two residents had care plans in place to manage their continence needs. The care plans were headed ‘doubly incontinent’ when referring to the residents’ needs. These should be separate care plans to cover urine and faecal elimination. The medication records were examined. Medication records were completed and up to date. Holly Court is now using the Boots monitored dosage system. Staff who administered medication said there had been a smooth transition to the use of this system and it had reduced errors in administration. See requirements 2 and 3. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15. Residents are supported in making choices in their lifestyle and in meeting their social needs, but the recording of residents’ involvement in social activities needs to improve. Families and friends are welcomed into Holly Court at any reasonable time. Residents have a choice of meals in pleasing surroundings. EVIDENCE: The environment in Holly Court was relaxed and sociable. Residents were seen listening to music, watching television, reading newspapers and spending social time with staff. There was a weekly programme of activities displayed. This covered a variety of activities from light exercise, to music and dancing. Residents were engaged with staff in conversations about their life, and were knowledgeable about residents. Staff sat and read with residents and talked about news items in the local newspaper. Another resident talked about a career in football to staff. Holly Court is using a new document format from Southern Cross Healthcare, which includes a format for recording social activities. These were present in residents’ care plans. The relatives of residents had completed a social profile for information on their relatives’ life. However information in individual residents was not recorded in a social care plan. Daily records of residents did not refer to information about what residents were able to do, or enjoy doing now. Staff were seen to knock and enter residents’ bedrooms and heard to ask if they wished to have a lie in. At meal times staff reminded residents what the Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 13 choice of meal available to them was and asked them what they wished to choose for lunch. A resident who had lived at Holly Court for a short period of time talked about her experiences. She said ‘I thought I had not had a cup of tea but my memory is bad. Staff will tell you if you have had one and make you one if you want. I enjoy living here you get well looked after. Other people live here and they are very nice. I have made a friend, she is very nice, she doesn’t say much but I enjoy her company. The staff are very sociable and will sit and chat with you. The food is good, well pleasant I would say. I enjoy what’s brought to me. We had cheese and biscuits for supper last night, which was nice. I remember we had chips, fish and peas for tea. I see the other people having visitors all the time. I recognise the staff but cannot remember their names, I know they go home and come back. They don’t live here with the others and me. They are nice friendly and helpful. I need my frame to walk about and they help me to have a bath, choose my clothes and wash my hair’. The menu plan for the day was detailed on the notice board displayed in each lounge. Holly Court keeps a record of meals served, including supper and the choices available at meal times. See recommendation 1. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 the following standard(s): 18 Procedures relating to protection were in place that safeguarded residents from abuse. EVIDENCE: From talking with the members of staff on duty, they were aware of the issues of adult protection and confirmed they had received training on this. Holly Court has kept a record of staff that had read the local authority guidelines on adult protection. All staff on days had read this. The deputy manager confirmed that two night and two domestic staff had not read the guidance and the matter would be addressed. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 the following standard(s): 19, 22, 24 & 26. Residents live in a safe and well-maintained home, which is clean and hygienic. The signage of bedrooms, bathrooms and toilets could improve to enable residents who are cognitively impaired to recognise these facilities and aid independence. EVIDENCE: Holly Court had a comfortable and a pleasant relaxing atmosphere. The lounge, dining areas, corridors and a number of bedrooms were pleasantly decorated. A tour of the building was completed. The furniture was seen to be in a good condition. The satellite kitchen on the ground floor and drinks making facilities on the first floor were clean and hygienic. These areas had been stocked with additional provisions to respond to residents’ choices and preferences in the morning. These were restocked on a daily basis and records of the items sent from the main kitchen were kept. Fridge temperatures were monitored along with a record of the schedule of the cleaning of these areas. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 16 On the first floor the signage to the toilets and bathrooms had been removed. Signage was evident on the ground floor. The toilet and bathroom doors are painted a different colour ton those of bedrooms doors to aid residents to recognise them. Holly Court has not used signage on residents’ bedroom doors to enable residents to recognise their bedroom other than their name. The use of pictures and symbols that residents recognise would enable residents to identify their own individual bedrooms and the toilet and bathroom facilities. The corridors are decorated in the theme of a street, with street names and postcodes to enable residents to recognise their whereabouts. See recommendation 2. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30. The numbers and skill mix of staff are adequate to meet residents’ needs. The supervision and training programme needs to improve provided a more informed and skilled staff group. The policy and use of physical intervention needs to be clear EVIDENCE: Examination of the staff rota confirmed that the staffing numbers for both days and nights were as confirmed by the senior staff on duty. The deputy manager confirmed that no agency staff were used at Holly Court. Night staff interviewed confirmed that not all of them had received training in the administration of medication. One of the senior staff on duty clarified she had received training within the last two months and the other senior staff had not received training in two years. The staff on nights said they did not receive supervision in a structured format. Staff confirmed they received appraisal, but not regular planned individual supervision. A staff member said ‘the manager recently came and held a staff meeting on nights and we sorted a lot of problems out. No I have not had supervision but I have had an appraisal’. The deputy manager stated that the manager is dealing with the provision of a third senior care assistant on nights to cover sickness/holidays. The staff team were seen to be motivated and sensitive to the changing needs of residents. Staff interacted with residents and spent time with them. Staff were knowledgeable about residents needs. Staff interviewed discussed the needs of one resident who had presented aggressive and challenging behaviour. The resident’s records recorded that the resident may need one to one supervision at times. Staff said they had not needed to provide one to one supervision but could not leave the resident unsupervised in the company of Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 18 other residents. Staff training records were not available as theses were locked in the manager’s office. Staff talked about how they dealt with aggressive and resistive behaviour. A staff member said ‘She has not been physically aggressive recently only shouting at other residents. If she tried to hit another resident I would stand in front of her, yes I would act as a barrier to stop her hitting someone. I get between them and explain to calm her down’. Staff were asked about the use of physical intervention to protect other residents and themselves. A staff member said ‘we can leave people to calm down but holding peoples hands is not clear. If you shave a man you can hold his hands and talk to him while another staff shaves him. You can hold his hands gently, as like that resident, he sometimes gets very agitated’. The deputy manager said ‘we had to ask the community psychiatric nurse for some training about a residents aggressive behaviour. There should have been some guidance from Manchester City Council on this. The manager had to ask around for training, as staff were very keen and enthusiastic about training. No routine training on managing challenging behaviour or on dementia care takes place form Southern Cross Healthcare’. Two staff verified that they had watched training video on managing challenging behaviour when working at another Southern Cross care home. The deputy manager clarified that there was a training video on managing challenging behaviour that staff had watched. She said ‘staff had to fill in a questionnaire on the video but we have had no other training, we have not had any practical training on what is right’. Staff on duty verified they had received training on moving and handling, food hygiene and fire safety. Not all staff on nights had received training in medicines administration. The deputy manager confirmed that two staff hold an NVQ level 3 qualification and two staff hold an NVQ level 2. Five staff were undertaking an NVQ level 2 qualification. See requirement 4 and recommendations 3, 4 and 5. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The residents’ safety was promoted through appropriate management and administration procedures. EVIDENCE: The records relating to accidents were recorded on the appropriate data protection register, with the reference number recorded in sequence. Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 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 X 3 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1)(a)( b)(d) Requirement Residents must not be admitted to Holly Court without a full assessment of all their needs and care plans, appropriate risk assessments and risk management plans being completed. Arrangements for residents to receive treatment from the relevant healthcare professional must be done without delay. Care plans must be completed accurately on individual needs and reviewed regularly to ensure that the information they contain is up to date. (Timescale 17/02/06 not met) Training must be provided for staff on the management and administration of medication, management of challenging behaviour, use of physical intervention and dementia care. Timescale for action 01/03/06 2 OP4 13(1)(b) 01/03/06 3 OP7 14 and 15 01/03/06 4 OP30 18(1)(c)(i ) 01/04/06 Holly Court DS0000008362.V278844.R01.S.doc Version 5.1 Page 22 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 5 Refer to Standard OP12 OP19 OP28 OP30 OP30 Good Practice Recommendations Daily records should be more reflective of residents’ lives. Signage of residents’ bedrooms, toilets and bathrooms should be improved. Further opportunities for staff to undertake NVQ level 2 training should be provided. Staff should receive formal supervision of a minimum of six times a year. Staff must have suitable guidance on the use of physical interventions by reading the registered providers’ policy on this. 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