Inspection on 16/05/08 for Holly House

This inspection was carried out on 16th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly House 25/05/06

Holly House 19/10/05

Holly House 14/04/05

Holly House 07/12/04

Holly House 12/07/04

Holly House 25/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Holly House 32 Chapel Street Newport Isle Of Wight PO30 1PZ Lead Inspector Nick Morrison Unannounced Inspection 16th May 2008 10:30 Holly House DS0000012580.V363322.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 House DS0000012580.V363322.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 House DS0000012580.V363322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly House Address 32 Chapel Street Newport Isle Of Wight PO30 1PZ 00441983 825886 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) guy@hamiltonhousefreeserve.uk Mr G Elliott Mrs Brenda Mary Furse Mrs Brenda Mary Furse Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 2006 Brief Description of the Service: Holly House is a small home providing care and accommodation for up to three younger adults with a learning disability. The home is a mid-terrace town house situated in a residential area of Newport, the County Town of the Isle of Wight. Resident accommodation within Holly House comprises three single bedrooms, a communal lounge and shared bathroom and kitchen. Being a small care facility the proprietors/manager live in and share many of the homes amenities with the residents. The central location of the home affords residents easy access to the many shops and amenities the town centre has to offer. Transport is also readily accessible with the towns main bus depot a short walk from the home. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 16th May 2008 and lasted five hours. During this time we toured the premises, looked at the files of everyone living in the home and spoke with one person who lives there. We also spoke with the Manager. All records and relevant documentation referred to in the report was seen on the day of inspection. We have also considered all the information provided in the home’s Annual Quality Assurance Assessment (AQAA). Current fees for the home are £1869.62 per month. What the service does well: What has improved since the last inspection? What they could do better: Four requirements have been identified as a result of this inspection visit. These refer to risk assessments needing to be dated and kept under regular review, staff receiving training appropriate to their role and, specifically, training in physical intervention and to the home keeping necessary staff records for all people working in the home. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 6 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 House DS0000012580.V363322.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 House DS0000012580.V363322.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. Service users benefit from having their needs and aspirations assessed prior to moving into the home. EVIDENCE: The home requires a full care management assessment for each person before they move into the home. In addition to this, the home does it’s own comprehensive assessment. Records showed that all assessments were in place prior to the person moving in. The service user spoken with on the day of the inspection visit told us he had chosen to live in the home. The Manager of the home considers compatibility with existing service users when deciding whether or not to accept new referrals. There has been a vacancy in the home for eighteen months, but this has not been filled, as the Manager would rather have the vacancy than accept people whose needs the home could not meet or who might be incompatible with people already living in the home. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 9 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 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. They would benefit further from risk assessments being regularly reviewed. EVIDENCE: The service user we spoke with confirmed that he was aware of his own care plan and that he was involved in devising and reviewing it. He, and the other person living in the home, had both been involved in choosing a care plan format that they felt would be suitable to them and as a result they each had different care plan formats in place. Documentation showed that each person had a plan of care set out in a format that they would understand. The care plans contained clear and detailed information about how each person’s needs were to be addressed and what actions members of staff had to undertake to address the needs of people living in the home. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 10 There had been a requirement from the previous inspection to ensure that all significant events in residents’ lives are recorded in their personal plans. The new care planning formats were more suited to recording significant events for service users and records showed that this was now being addressed on an ongoing basis. Care plans also demonstrated that people living in the home were supported to make their own decisions about all aspects of their lives and this was confirmed in discussion with a service user. Discussion with the Manager showed that she was aware of the need to support service users to make their own decisions and that she understood how to do this. There were good risk assessments in place where it had been identified there was a need for one. Risk assessments were written in a way that supported service users to maintain and improve their own independence and had been used to ensure that people were able to retain as much independence as possible within a safe and managed framework. Although there was some evidence that some risk assessments had been adjusted in response to changing needs, the assessments were not signed by the people involved in devising them and were not dated. It was not possible to judge whether or not they had been kept under regular review, as there was no record of the initial date or the dates of any reviews. A requirement has been made in respect of dating risk assessments and demonstrating that they are kept under regular review. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 11 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 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. EVIDENCE: People who live in the home are involved in a range of different activities depending on their needs and wishes. The home had been active in liaising with an employment agency to find a job for one of the service users. When we spoke to him he told us that he really enjoyed and valued his job. In addition, both people living in the home attend the local day services for some of the week and the service user spoken with told us he enjoyed the opportunity to go there and meet with his friends. Service users were also involved in activities within the home and were developing skills in maintaining the house. They also had the opportunity to Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 12 use the local facilities in the town, either independently or with staff support depending on their needs. Risk assessments were in place to support people to use facilities on their own where they were able to do so. The Manager and the Provider of the home have a holiday villa in Spain and take service users there with them three or four times a year. The service user spoken with told us he could not think of any activities he would like to try but did not have the opportunity to do. The home supports service users to keep in touch with family and friends either by telephone or by taking them to visit people. The service user spoken with told us he felt he could have friends and family to visit him whenever he wanted to. The Manger of the home was actively working to overcome some difficulties one service user was having in visiting her mother. Care plans, policies and the ethos of the service emphasised the rights of service users to be in control of their own lives and to make their own decisions. Records showed that service users were able to make their own choices and the service user we spoke with confirmed this. Menus showed that the home provided varied and balanced meals. Service users were involved in choosing the meals on the menu and alternatives were available to cater for individual preferences and needs. The service user we spoke with told us that he was always asked about the kind of food he liked and that he never had to eat anything he did not like. He said the portions were sufficient and that the food was cooked well. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 13 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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their healthcare needs met and are protected by the home’s medication policies and practices. EVIDENCE: Care plans were very clear about the support that each person required and how they preferred to receive it. The service user we spoke with told us that he was fully involved in the devising of his care plan and was able to state the support he felt he needed. He also told us that the support he actually received was provided in line with his expectations. Service users were also able to comment on their support through regular reviews of the care plans and records of these reviews demonstrated that the service responded to any changes required. Evidence from people’s files demonstrated that the Manager of the home was very proactive in monitoring health needs and in liaising with health care professionals to ensure that people received the health services they needed. Records showed that where health issues had been identified the Manager pursued them with health services so that people received the treatment they Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 14 needed. Letters on service users’ files showed that the Manager liaised regularly and effectively with a range of other professionals in the interests of people living in the home. The home had a medication policy in place and kept clear records of all medication coming into and going out of the home and clear records of all medication that had been administered. Medication was stored safely and was only administered by the Manager, who has received training in administering medication. The service user spoken with said he felt he had the medication he needed when he needed it. One person living in the home administers his own inhaler when necessary and a risk assessment is in place to support him doing this. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 15 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 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from having their views listened to and are protected by the home’s policies and practices. They would benefit further from staff receiving appropriate training in the use of restraint. EVIDENCE: The service user spoken with told us that he felt safe in the home and that he understood how to complain if he needed to. He said he thought that the Manager would be able to sort out any problems or concerns he had. The home has a Complaints Procedure in place but has received no complaints. There is also a Safeguarding Procedure in place and the Manager has undertaken training in adult protection and is able to pass that training on to other members of staff. The Manager has demonstrated in the past that she is aware of local reporting procedures for concerns about safeguarding and has used them effectively in the interests of people living in the home. One service user’s care plan states there may be occasions when physical restraint is needed. Although the Manager informed us it is not usually necessary to use any restraint with this person, it is clear from the care plan that this may sometimes be something to which staff need to resort. Despite this, it was Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 16 clear that people working in the home had received no training in the use of physical restraint. In order to ensure that the use of physical restraint, if at all necessary, is carried out safely without the risk of injuring service users or members of staff it is essential that all staff are trained in using physical restraint methods properly and safely. Holly House DS0000012580.V363322.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service Service users benefit from living in a clean, comfortable and safe environment. EVIDENCE: Observation on the day of the inspection visit showed that the home was kept clean and tidy throughout. The house was also comfortable and homely. The service user spoken with said he thought the home was clean and had no concerns about the cleanliness or the safety of the home. No health and safety concerns were identified during our tour of the premises or in discussion with the service user or the Manager. Service users’ rooms were individually decorated and the service user and the Manager confirmed that people living in the home were involved in choosing colours and furnishings for their own rooms and for communal parts of the building. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 18 Service users’ rooms were well equipped and the service user spoken with said he could not think of anything he needed in his room that he did not already have. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 19 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): 31, 32, 34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are supported by adequate numbers of staff but would benefit further from the home providing relevant training to staff and from all necessary pre-employment checks being undertaken. EVIDENCE: The Manager of the home and the Provider live in the home, which is their main residence. The home is staffed mainly by the Manager, with assistance from her son and from the Provider. The employment information required for members of staff in care homes is not available in this home for the Manager’s son. There is also no training information available for the Manager’s son and no indication that he has received training relevant to his role in the home. Specifically there are support requirements recorded on service users’ care plans that require particular training that this member of staff has not received. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 20 In addition there is no evidence of regular support and supervision or of clearly defined job descriptions. The staffing levels in the home appear adequate for the needs of service users and the service user spoken with said there was always enough support available for his needs. The Manager’s interaction with the service user demonstrated an understanding of the need to support rather than direct service users and also demonstrated that the Manager was able to communicate well with service users and that people living in the home were treated with respect. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 21 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 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from a well-managed service that is focussed around their needs and wishes and have their health, safety and welfare protected. EVIDENCE: The Manager is registered and has demonstrated that she has the skills, qualifications and experience to manage the home. She ensures that she stays abreast of developments and good practice and keeps her own training up-todate. The management of the home is focussed around the needs of the people living there and feedback from the service user we spoke with confirmed that he believed the home is very well managed. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 22 There is no formal and structured quality assurance plan in place for the home to record consultation with service users and others who have an interest in the service. Consequently there is no written annual development plan. The omission of these means the National Minimum Standard relating to quality assurance is not met. Despite this, the size and nature of the home and the way it is managed result in a service that is focussed around, and responsive to, the needs and wishes of service users. People living in the home are involved in decisions about how they spend their time, what they eat, the kind of support they receive, how the home is furnished and decorated and they regularly have the opportunity to put forward their views about every aspect of the service they receive. The service user spoken with told us he felt he was in control of his life and that the home was responsive to the kind of lifestyle he wanted to lead and how he wanted to spend his time. Documentation and discussion with a service user demonstrated that people in the home were involved in reviewing their own care requirements and the service they needed to respond to these. There had been a requirement from the previous inspection to make arrangements for an electrical inspection by an NICEIC qualified electrician. The Manager was able to produce the necessary paperwork to demonstrate that this requirement had been addressed soon after the previous inspection. Records showed that health and safety issues in the home were monitored and managed effectively. No concerns were raised about health and safety issues throughout the course of the inspection visit. We discussed the model of the service with the Manager, as the home is more like an Adult Placement than a Care Home. We informed the Manager there was a different style of regulation for Adult Placement Schemes. The Manager told us she would contact Social Services to discuss whether or not it would be beneficial for the home to be part of the Adult Placement scheme rather than to be registered as a care home. Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 23 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 X 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 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 2 X X 3 X Holly House DS0000012580.V363322.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard YA9 YA23 Regulation 14 (2) (a) 13 (6) 18 (c) (i) 19 (1) (b) Requirement Risk assessments must be dated and kept under regular review. Staff must receive accredited training to use physical intervention safely. All staff must receive training appropriate to their role. The home must have all the information specified in Schedule 2 of the Regulations in place for all staff working in the home. Timescale for action 30/06/08 30/06/08 30/06/08 30/06/08 YA32 YA34 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 House DS0000012580.V363322.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Holly House DS0000012580.V363322.R01.S.doc Version 5.2 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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