Inspection on 30/10/06 for Holly House

This inspection was carried out on 30th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly House 17/01/06

Holly House 24/08/05

Holly House 21/01/05

Holly House 06/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Holly House 24 Queen Anne`s Place Enfield Middlesex EN1 2PT Lead Inspector Tom McKervey Key Unannounced Inspection 30th October 2006 09:30 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 House DS0000010640.V313319.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly House Address 24 Queen Anne`s Place Enfield Middlesex EN1 2PT 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) 020 8360 7622 020 8360 7622 hollandsepping@ntlworld.com Mr J N Holland Mrs Mary Alexandra Holland Mrs Ellen Mary Willcox Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Holly House is a privately run care home owned by Mr and Mrs Holland. The registered manager of the service is Mrs Eileen Wilcox. The home provides personal care and support for 16 older people of both genders. The home is in a large three-storey detached building, situated in a tree-lined avenue in the pleasant residential area of Bush Hill Park, near Enfield. There are restaurants, shops and a post office nearby and there are good public transport links to the area, including an underground station. The home has 12 single bedrooms and 2 shared rooms on three floors, all individually decorated. On the ground floor, there is a lounge and separate dining room. A lift provides access to the upper floors. A paved area at the front of the building provides some car parking. There is a large conservatory and an attractive garden at the rear of the premises. The home aims to provide a high quality of personal care and support for people who are over 65 years of age. The fees for the service range from £450 to £470 per week. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of five-and-a-half hours. The proprietor and the registered manager were present. The inspection was carried out as part of the Commission’s inspection programme and to check compliance with the key standards. The process consisted of speaking to residents, relatives and staff. Written comments were also received from relatives and professional staff who visit the home. These comments were very positive, and reflected a high level of satisfaction about the care provided and no concerns were raised. Residents’ case files, staff records, and documents relating to the running of the home were also examined during the inspection. What the service does well: The residents and their relatives consistently speak very highly of the care provided and the quality of their accommodation. Examples include, “The service couldn’t be bettered”. “The care is wonderful and there is a lovely relaxed atmosphere”. There is a very relaxed atmosphere and residents have a good rapport with the home’s managers and staff. Residents and visitors always comment positively about the cleanliness of the home and the quality of the food. The proprietors continually make environment to a high standard. improvements to, and maintain the The proprietors have always complied with any requirements made at inspections and within the set timescales. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were assessed. Standard 6 does not apply to this home. The quality in this outcome group is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The Statement of Purpose and Service User Guide contain full information about the service, and the inspection reports about the home are easily available to residents and visitors. Prospective service users have their needs fully assessed before, and at the time of admission. They are also able to view the facilities and talk to residents to enable them to judge the suitability of the home. EVIDENCE: The Statement of Purpose and Service User Guide are available to read in the residents’ lounge, where the inspection reports on the home are also available. This is good practice and is commended. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 9 The case files of two residents who had been admitted recently were examined. The files contained contracts of the terms and conditions of the service and the fees charged. The contracts are signed by the residents or their representatives. There was evidence that the residents’ needs were assessed by the placing authority and the home, before admission. At the time of admission, each resident or their relative are asked to complete a life history of the resident as part of the assessment process. Residents and visitors who were spoken to, said that residents’ needs were being met very well and that the staff were very caring. Relatives who were interviewed or sent comments, said that they had visited the home prior to moving in. One said;” I rang to ask about vacancies for my mum. I only live round the corner and I was told I could come right away if I wished. I was impressed that I could visit immediately, which proved that the home had nothing to hide.” Another relative wrote; “ We have always been delighted with the care that my sister has received at Holly House. The staff are welcoming and the home is kept in spic and span condition”. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were assessed. The quality in this outcome group is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and their relatives say the quality of care is excellent and the staff are very caring and courteous. The residents’ records document a full range of care provided by the health services. Medication is stored and administered safely, and residents who are able to do so, are supported to safely administer their own medicines. Residents’ wishes in the event of their death are recorded and respected. EVIDENCE: A sample of four residents’ care plans was examined. The care plans included risk assessments for moving and handling, and the risk of falls for residents with mobility and sight problems. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 11 The care plans were being reviewed monthly, and annual care reviews by placing authorities were carried out. In some cases, the care plans were signed by the residents and/or their representatives. Residents attended a range of healthcare appointments; for example, hospital outpatients, the G.P, optical, chiropody and dental services. At the time of the inspection, all residents were up and about and there were no pressure ulcers. However, as a preventative measure, special mattresses were use where appropriate. In a written comment, a resident said; “This home and the staff have remained in the years that I have been a resident, always the same; they welcome my relatives when they visit, and they, like me, are very happy with the care I receive.” The accident book showed that accidents were appropriately recorded and if necessary, these were followed up by referrals to the G.P or hospital. Relatives said they were always informed about any incidents concerning the residents. All residents were weighed monthly, and a quarterly review of their dependency levels were carried out to monitor their health and care needs. Two residents were able to administer their own medication. There were risk assessments in place, signed by the residents, to ensure that this was being done safely. The storage and administration of medicines was checked and was found to be in order. The date of opening of liquid medication was recorded on the bottles. The inspector observed the staff interacting with the residents in a very warm and courteous manner, and those residents who were spoken to, said that the staff supported them in their personal care discreetly and with dignity. Staff were also seen knocking on residents’ doors before entering. At the time of admission to the home, residents are asked about their wishes in the event of their death and this is recorded in their files. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of these standards were inspected. The quality in this outcome group is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The residents can participate in activities that are stimulating and meet their social and religious needs. Their individual choices and wishes are respected. There are frequent visitors to the home and they are warmly welcomed by the staff. There is an excellent standard of catering and the residents are very happy with the food provided by the home. EVIDENCE: At the last inspection, a requirement was made for residents to be consulted regarding their social interests. A questionnaire has been introduced to comply with this. This has been used to tailor an individual and group activities programme. There was an activities timetable on display for each day of the week, and it was evident that the proprietors and staff had improved this area of the service. The daily records also showed the activities that the residents took part in. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 13 The activities are led by the staff and by outside providers, and include armchair exercises, music therapy, bingo sessions and shopping trips. Some residents were seen reading newspapers and books. During the summer, a group of residents went on an outing to Southend, which they said they thoroughly enjoyed. There is a large attractive and well-maintained garden for the residents to sit out in when the weather allows. A minister of religion also visits the home regularly and some residents attend church services. The old dining room has been converted to a comfortable lounge where the residents can receive visitors. They can also see relatives in private in their rooms. A payphone is provided for the residents’ use. Relatives told the inspector that they could visit at any time and they were always warmly greeted by the staff. Their visits are recorded in the visitors’ book. Residents who were spoken to said that they could choose to opt out of activities and chose when to get up or go to bed. They also said they were consulted about what they wished to eat. There was plenty of food available in the kitchen stores, fridges and freezers and was safely stored. The menu contained a good variety of meals and was balanced and nutritious. The residents said they were very satisfied with the catering and there was always an alternative option available, including vegetarian dishes. Fresh fruit was also available. The inspector joined the residents while lunch was being served. It was hot and attractively presented, and wine and fruit juices were provided. The dining room is now located in the conservatory, and this makes a very pleasant environment in which to eat. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. The residents’ welfare and best interests are safeguarded by an appropriate complaints system, and staff have been trained in the procedures to protect service users from harm. EVIDENCE: No complaints were made by residents or relatives since the last inspection. Residents and their relatives were very positive in their comments about the service. For example; “My dad is very lucky to be here. The manager and the staff are very approachable and nothing is too much trouble. It’s like coming to visit a family home”. The staff records showed that they had attended training in adult protection. In discussion with the inspector, the staff demonstrated a thorough knowledge about issues of elder abuse and how to report these matter if necessary. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 The quality in this outcome group is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a well maintained, attractive and comfortable home. Service users are able to bring personal furniture and mementoes with them when they move in. Sufficient, suitable toilet and bathing facilities are provided for the personal care of the residents. The home is very clean, attractive and free from offensive odours. EVIDENCE: A tour of the premises showed that the home was very well maintained and there was a high standard of décor throughout. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 16 The garden was well maintained and contained suitable furniture for residents to sit out. Since the last inspection, the dining room has been transferred to the conservatory. This has created a greater impression of space in the main sitting area and provided another quiet lounge area where the dining room was located. The residents said they liked the new layout. The furniture in the lounges was appropriate to meet the residents’ needs and was in good condition. Since the last inspection, thermometers have been provided in the bathrooms to ensure the temperature of the water is safe for residents. New electronic door closures have been provided throughout the home and a downstairs bathroom was converted to a sit-in shower room, which has proved more practical for the personal care of the residents. Several bedrooms were seen, which were very attractively furnished and decorated. There were restrictors on the windows. There was ample evidence of personal possessions and mementoes that residents had brought with them when they moved in. The laundry is a well equipped with washing and drying machines and facilities for ironing clothes. The home had a very homely atmosphere and was very clean and tidy. There were no offensive odours, and cleaning materials were safely stored. Disposable aprons and gloves were available for staff to assist in the control of infection. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All these standards were examined. The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There are sufficient numbers of staff on duty at all times and they are well trained to meet residents’ needs. However, staff recruitment procedures must be improved in order to safeguard residents from potential harm. EVIDENCE: The staff rota showed that there were sufficient numbers of staff on duty at all times to meet the residents’ needs. Residents said that staff were always available and were prompt to attend to them. Staff undertake a written “Skills for Care” induction when they start work in the home, and at the time of the inspection, seven staff and attained the National Vocational Qualification level 2. The proprietor is an assessor for this qualification. Staff records also showed that they had been trained in mandatory health and safety subjects. Other training included dementia care and adult protection procedures. The inspector observed a member of staff having a practical training session in using a fire extinguisher. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 18 The records of three recently recruited staff were examined. The records showed that references had been obtained, but in one instance, a reference had not been obtained from the person’s last employer. A requirement is made for this to be done. Criminal Records Bureau checks had been made for two of the care staff before they started working at the home, but in the third instance a check had not been carried out. A requirement is made about this issue. There was evidence of training in the mandatory subjects and adult protection. At the time of the inspection, six staff had attained National Vocational Qualification level 2, and another carer was soon to begin NVQ level 3. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 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): All these standards were inspected. The quality in this outcome group is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The home is well managed and there is a relaxed and friendly atmosphere. However, the manager does not have an appropriate qualification to manage the service. The residents or their representatives are responsible for managing their personal finances. The staff are well supported through regular supervision and staff meetings. Records and other important documents in the home are well structured and kept up to date. There are good systems in place to ensure the health and safety of the residents, staff and visitors to the home. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager has extensive experience of managing the service and is held in high regard by the residents and staff. However, she does not hold an appropriate qualification as required by the National Minimum Standards for managing a care home. A discussion was held about this issue proprietor. A decision was made that necessary qualifications and experience, made for the proprietor to apply to manager of the service. between the inspector, manager and the proprietor, who does have the will take on this role. A requirement is the Commission for registration as Through discussions with residents, visitors and staff, and also observing various interactions between these persons and the management, it was apparent that the home was managed in a relaxed and efficient manner. This was also reflected in the written comments sent to the inspector. The inspector was informed that formal residents’ meetings were not held. However, after discussing this, the proprietor agreed to hold joint resident and relatives meetings during the year. This will afford an opportunity for these stakeholders to air their views and suggest improvements to the service. The inspector was shown the results of a quality assurance survey that was carried out in August 06. The audit showed a high level of satisfaction. A recommendation is made for the results of the survey to be summarised and included in the Service User Guide to inform potential placement officers and service users in the future. The home does not take responsibility for any residents’ personal finances and no staff are permitted to have Power of Attorney. The home’s business plan and financial records were available for inspection and showed that the business was financially sound and viable. Staff records showed that they received regular, formal supervision, and staff meetings are also held about every four months. Staff said that they felt very well supported and valued by their managers who were very approachable. Records, files and other important documents relating to the efficient running of the home were well structured and easily available for inspection. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 21 Certificates of safety and servicing records were up to date for fire, gas and electrical installations, and there was a current employers liability insurance on display. The lift and hoists were regularly serviced, and the fire log showed that alarms were tested regularly and drills were carried out. Holly House DS0000010640.V313319.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 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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 23 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. Standard OP29 Regulation 7, 9, 19 Timescale for action The registered person must 30/11/06 ensure that all staff who work at the home have a satisfactory Criminal Records Bureau check. The registered person must 30/11/06 ensure that at least one reference is obtained for all new staff from their last employer. The registered person must 01/04/07 ensure that an application is made to the Commission for Social Care Inspection to register the manager of the home. Requirement 2. OP29 7, 9, 19 3. OP31 9(2)(b)(i) 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 OP33 Good Practice Recommendations The registered person should include the results of the quality assurance survey in the Service User Guide. Holly House DS0000010640.V313319.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 House DS0000010640.V313319.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!