Inspection on 11/05/06 for Holly Grange Residential Home

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Grange Residential Home 17/03/08

Holly Grange Residential Home 27/03/07

Holly Grange Residential Home 19/10/05

Holly Grange Residential Home 10/05/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Holly Grange Residential Home Cold Ash Hill Cold Ash Thatcham Berkshire RG18 9PT Lead Inspector Marie Carvell Unannounced Inspection 11th May 2006 11:10 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 Grange Residential Home DS0000062526.V290025.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 Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holly Grange Residential Home Address Cold Ash Hill Cold Ash Thatcham Berkshire RG18 9PT 01635 864646 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) Mr Sundith Ramdany Mrs Koomari Nanda Ramdany Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2005 Brief Description of the Service: Holly Grange provides accommodation and care for up to nineteen service users over the sixty five years, who have care needs associated with old age. The home is not registered to provide care to people who have care needs associated with dementia or require nursing care; this would require additional registration categories. The current scale of charges as at May 2006 are between £440 and £520 per week. There are additional charges for toiletries, hairdressing, newspapers and chiropody. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been prepared using information recorded on the preinspection questionnaire completed by the provider/manager of the home; our inspection records held at the local office of CSCI; twelve service user surveys; an unannounced site visit on the 11th May 2006 and a short notice visit on the 18th May 2006. During the unannounced site visit, time was spent with service users and members of staff, observation was made of the delivery of care; a tour of the premises was made and five service user case files were case tracked. During the short notice site visit records concerning the management of the home were reviewed, time with spent with the manager, deputy manager, staff on duty and two visiting district nurses. The manager was present during the site visits. The first site visit took place from 1.10 pm until 6.10pm and short notice site visit from 10.10am until 1.10pm and both site visits were conducted by one inspector. What the service does well: What has improved since the last inspection? The admission process has been developed to ensure that service users have the information needed to make an informed choice about moving into the home. An activity organiser has been recruited and this is having a positive impact on service users. Staffing recruitment procedures have been developed and are now robust. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 6 Staff training has been developed with the majority of staff having completed NVQ level II or III. All staff have a training and development programme. Supervision and annual appraisal of all care staff has been developed and is well evidenced. Monthly reports on the conduct of the home written by the second provider are being completed and a copy sent to the CSCI. These are detailed and comprehensive. Policies and procedures have been developed and all records relating to health, safety and fire are well recorded. What they could do better: The home is not able to evidence that it is meeting the health care needs of some service users. The care planning documentation has improved, and now makes reference to the psychological health and nutritional screening. How these needs are met is not recorded. Service users are not involved in the care planning process. Treatments given by healthcare professionals must be undertaken in private. Not all service users are provided with a balanced diet, this includes service users who require special diets. Not all complaints received by the home are recorded in the home’s complaints book. All staff need refresher training in the protection of vulnerable adults from abuse, multi- agency procedures and the home’s whistle blowing policy. Care staff need refresher training in moving and handling and the use of the home’s hoist. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 7 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 Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 8 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 Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 9 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): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and deputy manager undertake a pre-admission assessment of all new service users to ensure that the home is able to meet their needs. The assessment covers health, welfare and social circumstances. Prospective service users and their friends/family are encouraged to visit the home and to move in on a trial period. The completed service user surveys confirmed that information is received about the home in order to decide whether the home was the right place to live in. One service user commented “I was provided with a brochure and a tour/visit prior to my coming into the home. I was also introduced to the other residents and staff”. From a sample of service user files it was evidenced that a written contract or terms and conditions are provided to all service users. One service user Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 10 commented, “ I was explained the contents of the contract in depth by the manager and care was taken to ensure that I fully understood the contents prior to my signing”. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 11 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 and 10 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. An exception being that medication administration and recording was satisfactory. EVIDENCE: Five service user care plans were case tracked, it was not possible to evidence that the home is proactive in meeting the health care of some service users. Information regarding GP and healthcare visits are not always recorded, although the manager assumed that this information was recorded by care staff. It was evidenced that at least one service user, who should be receiving free chiropody treatment, is in fact paying for this service. Advice from specialist advisers is not always followed through e.g. special diets. Care plans have been developed since the last inspection and now make reference to the psychological health and nutritional screening, and although recorded, as a care need, it is not evidenced that these needs are being met. Guidelines are not in place to care for service users with behavioural needs, which challenge the service. Care plans are reviewed on a monthly basis, however service users are not involved either at the planning stage or the Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 12 reviews. The manager advised the inspector that five service users have mental health needs. In discussion with care staff, it was clear that they are aware of the care needs of all service users, although this is not necessary documented. In discussion with service users and comments recorded on surveys it was clear that the majority of service users feel that their care needs are being met “always” or “usually”. One survey stated that care and support “tends to vary according to the member of staff involved, some are extremely caring and supportive and do an excellent job, while a few are perhaps not up to that high standard”. Staff who administer medication are required to undertake appropriate training. Medication administration records were seen to be up to date with no obvious gaps in recording. Medication storage is satisfactory and policies and procedures are in place. Service users were seen to be well groomed and appropriately dressed. Service users confirmed that their right to privacy is respected. Staff were observed to communicate with service users in a respectful and appropriate manner. The majority of staff have worked in the home for a number of years and have developed a good rapport with service users. During the short notice site visit, it was observed that a health care professional was changing a wound dressing in the dining room as other service users were leaving the room having just finished lunch. Both the manager and deputy manager were in the home, but had not noticed this event. The manager agreed that this was unacceptable practice and would discuss the issue with the healthcare professional. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. An exception being that not all service users are provided with a balanced diet. EVIDENCE: Service user meetings take place every two months and in September 2005 questionnaires were sent out to all service users, family members and regular visitors to the home. The manager is hoping to collate the information received; most comments were made regarding lack of food choices and activities available. Recently a new activities organiser has been recruited. This is having a positive impact on service users, as several service users said that they had been approached to discuss their interests and hobbies. Several outings had taken place and more were being planned. Generally the more independent service users organise various activities between themselves. Comments made by service users included “More activities could be made available, more trips could be made outside, although some have mobility problems”. “Bingo is held weekly, as are exercises. Scrabble, puzzles and other games are available”.“ I am not very interested in activities as there are very few other residents to converse”. During the second site visit, activities were taking place in the Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 14 conservatory, these were being enjoyed by most of the service users and staff were observed to be involving the more dependent service users as appropriate. Most service users have friends and family who visit the home on a regular basis. Service users are assisted to exercise choice and control over their lives, this was confirmed by service users and observed during the site visits, however this is not always recorded in service user plans. Food stocks in the home were adequate and may have an impact on food choices given to service users. During the unannounced site visit there was no salad, only potatoes and onions and small amounts of fruit. The manager said that he prefers to buy fresh produce daily. Comments made by service users included “I have asked to have fresh vegetables instead of frozen or tinned and I hope that my request will be granted”.” Too many cakes”. “The food is up and down depending who is doing the cooking”. “I would like to have more variety”. Records of food provided and menus are well documented. The menu offers an alternative choice of several dishes including salads. It was noted that over a four week period the only alternative was corned beef, with one service user having this every day for the previous eleven days. In discussion with service users it was clear that this is not always their preferred choice. Care staff have previously made the manager aware of this. The majority of service users enjoy the midday meals, during the site visits the inspector joined service users for a midday meal and an evening meal. The midday meal was well cooked and nicely served. All service users spoken to said that they had enjoyed their meal. The evening meal of a sausage roll, bread and butter and a cake, was less successful with several service users leaving the meal saying the sausage rolls were dry and unappetising. There are no guidelines in place for those service users requiring special diets. Supper is available if request, this is recorded. This has previously been highlighted as the majority of service users have only a hot drink from the evening meal served at appropriately 5pm until breakfast at 8am the following morning. It is the responsibility of care staff to offer a supper snack to all service users. The manager was unable to provide information on food budgets. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 15 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): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection, there has been three complaint recorded in the complaints book. Contact sheets evidenced that two additional complaints had been made in February 2006, but had not been recorded. The manager was aware of these and discussed his response. It was agreed that the complaints would be retrospectively recorded in the complaints book with action taken and outcomes. At the second site visit this had not been actioned. All service users are aware of the complaints procedure, which is displayed in the entrance hall, and said that they would speak to the manager or deputy manager. Service users felt confident that complaints would be addressed. Staff have received training in the protection of vulnerable adults from abuse. In discussion staff did not have a clear understanding of the home’s adult protection and prevention of abuse policies/ procedures. The home has a copy of the multi-agencies vulnerable adult procedures; staff were unaware of this document and of the home’s whistle blowing policy. One member of staff said she had only ever seen a video of vulnerable adult procedures. One member of staff told the inspector that abuse of vulnerable adults only happened in big institutions and not care homes, such as Holly Grange. This was discussed with the manager who expressed surprise, as he had previously discussed the various documents with all staff as part of the training provided. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 16 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 and 26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. An exception being that insufficient specialist equipment is available to assist service users with mobility difficulties. EVIDENCE: The home provides safe, comfortable and spacious accommodation for service users. Service users are encouraged to personalise their bedrooms. The communal areas of the home are comfortable and homely. The well maintained garden is used by service users. It was noted that attention is needed to a carpet in one bedroom, as this poses a trip hazard. Six of the eighteen light bulbs need replacing in the chandelier. Care staff expressed their concern about the lack of a suitable hoist in the home. The one hoist is not suitable for lifting service users up from the floor, following falls. This has resulted in three care staff being required to physically lift some service users. Several falls have occurred in the evening or at night, Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 17 when there are only two members of staff in the home, and staff have, had to ask the tenant living in the flat to assist. This was discussed with the manager who expressed surprise as all staff had recently received refresher training in the use of the hoist and had not raised any concerns about lifting service users from the floor or sitting position. In addition the manager had previously advised all staff to telephone him at home if assistance was needed and not to ask the tenant living in the flat. The home was seen to be clean, pleasant and free from unpleasant odours. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 18 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): 27,28,29 and 30 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There appears to be adequate staffing levels to meet the needs of the service users. The duty rosters evidence that there are generally three care staff on duty throughout the day from 7am until 8pm, with one awake care assistant on duty from 8pm until 7am the following morning. One care assistant sleeps in on the premises to assist as necessary. The manager must make necessary arrangements to ensure that sufficient staff are rostered on duty to cover annual leave and extended sick leave. There are no staff vacancies at present. Ten of the thirteen care staff have completed NVQ at level II; with three care assistants achieving level III. Since the last inspection only one member of staff has been recruited. The recruitment process and documentation was seen to be maintained to a high standard. Each member of staff has a staff training and development programme. All staff have completed mandatory training and other training courses are on going. The manager is to repeat training in the protection of vulnerable adults from abuse, whistle blowing, multi-agency procedures, the use of the hoist and moving and handling. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 19 Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 20 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): 31,32,33,35,36,37 and 38 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager is rostered to be in the home full time. Staff and service users said that the home is well run and responsibilities for care practices and the daily routine of the home is delegated to the deputy manager. It is not clear how the manager monitors care provided and staffing issues in the home. Service users benefit from an experienced, stable staff team who have cared for the service users over many years. Staff feel that communication with the manager has improved, but that the manager still communicates with the deputy manager, who then cascades information to staff on duty. Since the last inspection a communications book has commenced and handover Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 21 information is passed from one shift to the next. The last staff meeting was held in January 2006. Monthly reports on the conduct of the home written by the second provider of the home are completed and now sent to the CSCI. These reports are detailed and comprehensive. Service users confirmed that during these visits, their views are sought. Service users described the manager as “very kind and helpful”, “ always approachable and listens”. The home looks after the personal allowance of one service user. Records are maintained to a high standard, with details of all debits and credits with supporting receipts and two signatures. All staff receive formal planned supervision every two months and an annual appraisal. This is well documented. The home’s policies and procedures have been reviewed, including the home’s fire risk assessment and health and safety policy. Records relating to fire, hot water temperatures, accidents, and service records were well maintained. Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 22 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 x x 1 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 3 3 x 3 3 3 3 Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15 Requirement That the manager ensures that service user plans are generated from a comprehensive assessment. Previous timescale of 19/12/05 not met. That the manager ensures that the service users’ psychological health needs and nutritional screening is monitored on a regular basis. Previous timescale of 19/12/05 not met. That the manager advises the CSCI of action taken to ensure that medical treatment is provided to service users in private. That the manager advises the CSCI of action taken to ensure that all service users are provided with a varied, nutritious and well balanced diet, this should include seeking the advice of a dietician. The manager is to send details of the food budget allocated on a monthly basis in the home, with DS0000062526.V290025.R01.S.doc Timescale for action 11/07/06 2. OP8 13 11/07/06 3. OP10 12 11/06/06 4. OP15 16 18/06/06 Holly Grange Residential Home Version 5.1 Page 24 supporting evidence. 5. OP16 22 The manager is to advise the 18/06/06 CSCI of action taken regarding to two complaints not recorded in the complaints book, including action taken and outcome. That all staff receive training in 11/07/06 the home’s policies and procedures in the protection of vulnerable adults from abuse, multi-agency procedures and the home’s whistle blowing policy. That all moving and handling risk 11/06/06 assessments are updated as necessary. That suitable equipment is provided to meet the needs of the current service users and that all staff receive moving and handling training including the correct use of the present hoist. 6. OP18 13 7. OP22 13 and 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Holly Grange Residential Home DS0000062526.V290025.R01.S.doc Version 5.1 Page 26 - 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. 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