Inspection on 27/02/07 for Holly House And Oak Field

This inspection was carried out on 27th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly House And Oak Field 23/01/06

Holly House And Oak Field 05/07/05

Holly House And Oak Field 12/01/05

Holly House And Oak Field 24/09/04

Holly House And Oak Field 10/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Holly House And Oakfield 303 Gloucester Road Cheltenham Glos GL51 7AR Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 10:00 27th February 2007 Holly House And Oakfield DS0000016471.V320038.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 And Oakfield DS0000016471.V320038.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 and 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 And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly House And Oakfield Address 303 Gloucester Road Cheltenham Glos GL51 7AR 01242 522404 01242 522404 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) suehullin@tracscare.co.uk TRACS Mr Hanif Mohamed Patel Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (1), Mental disorder, excluding of places learning disability or dementia (12), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Physical disability (12), Physical disability over 65 years of age (1) Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the PD(E), MD(E), LD(E) Category refers to one named service user and will be removed when the service user leaves the home 23rd January 2006 Date of last inspection Brief Description of the Service: Holly House and Oakfield is registered to provide care and accommodation for up to 12 people with a learning disability, physical disability and/or enduring mental health difficulties. It is run by TRACSCARE; a specialist provider of care for people with acquired brain injuries and learning disabilities. The home is situated on the outskirts of Cheltenham. There are local facilities nearby including shops, a post office and a college of further education. The home has been adapted from two properties. There are 12 single rooms, three bathrooms, two lounges, a dining room and a kitchen. A conservatory is used as the designated smoking area. Each person has a copy of the Statement of Purpose and Service User Guide; further copies are available in the hall and from the office. A copy of the last inspection report is displayed in the office. Fees for people living at the home range from £950 to £1400 per week. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in early 2007 and included site visits to the home on 28th February and 6th March. The registered manager was in attendance during the second visit to the home. Time was spent observing and talking to people living at the home and discussing with staff the care they provide. Comment cards were returned from seven people living at the home, six members of staff, five relatives and four general practitioners. A range of records were examined which included care plans, personal information, staff files, health and safety records and quality assurance audits. A pre-inspection questionnaire was returned prior to the inspection. Regulation 26 reports have also provided additional evidence for this inspection. The care for three people was examined in depth and feedback was obtained from them about the care they receive. What the service does well: Each person has a care plan that they sign and they are given personal copies. These are reviewed regularly and any changes to their needs result in an amendment to their care plan. People living at the home indicated that they are happy with the service provided and their lifestyles. One person said, “This is the best home I have ever lived in”. A number of people living at the home are over 60 and it was evident that their needs are being considered. Several people go to a tea dance at the local town hall and they are consulted about their choice of diet ensuring traditional meals such as toad in the hole and faggots are provided. Robust training systems are in place, which provide staff with training specific to the needs of people living at the home such as mental health, dementia and diabetes training. Nearly 80 of the staff team have a NVQ award in care. This is excellent practice. All staff have access to a NVQ programme which is delivered through a local college. Holly House And Oakfield DS0000016471.V320038.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. The summary of this inspection report can be made available in other formats on request. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A review of the Statement of Purpose and Service User Guide will ensure that people have access to the latest information. An assessment of the needs and wishes of people moving into the home is completed to ensure that the home is able to meet their needs. A statement of terms and conditions provides people with information about the services they will receive. EVIDENCE: Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 9 The home has a Statement of Purpose and Service User Guide that have been reviewed to reflect changes in the management of the home. Further amendments need to be made to the Statement of Purpose to reflect that care is being provided to a person over 65 and how the home will meet their needs. These documents are produced in a format appropriate to the needs of people living at the home including the use of text and photographs. There have been three new admissions to the home since the last inspection. The home maintains a book of admissions providing a snapshot of information about each person. A full assessment of needs was completed for each person by TRACSCARE. Two different assessments were used, the Star Profile Achievement Record and an assessment for Acquired Brain Injury. The placing authorities provided care plans and an assessment of needs for two people. Three-month reviews of the 13-week assessment period are held. One person confirmed that they visited the home with their relatives prior to moving in and have settled in well. A relative commented that “I read the Commission for Social Care Inspection report before recommending Holly House to the consultant” and indicated that the home has worked hard to help her transfer from hospital. Each person living at the home has a service level agreement in place with TRACSCARE. The home does not provide nursing care. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning in the home is of a high quality promoting the development of skills and independence. Risk assessments encourage and support people living at the home to challenge and deal with problem areas in their lives. The systems for consulting people in aspects of the daily life of the home provide opportunities for involvement. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care of three people living at the home was examined in depth. This included reading their care plans and other personal information, looking at their medication and financial records, talking to them and staff about their needs as well as observing them during the visits. People have a care plan that has been developed from their assessment of needs. People living at the home sign these records. One person confirmed that they are given personal copies. There was evidence that plans are being monitored on a monthly basis and where changes are identified plans are amended. Annual reviews are taking place and invitations are extended to relatives and representatives from the placing authority. Key workers and the manager prepare a written report as part of the agenda for these meetings. There was evidence that minutes are also taken at these meetings with a final review report being produced. There was also evidence in some cases of the placing authority supplying a review of the care needs of the person. Any changes to a person’s needs are identified in a read and sign sheet. Copies examined indicate that all staff are reading these documents. Daily notes confirm that the identified needs of people are being met and monitoring records also provide further evidence that systems are in place to check the needs of people. Care plans for people over 60 pay attention to their needs in relation to changes due to the ageing process such as illness or lifestyle choices. Where people receive input from mental health services there was evidence of the care programme approach arrangements which are in place. People living at the home said that they are supported to make decisions about day-to-day activities. People were observed being supported to make choices about what to do such as going to buy a newspaper or go out for a coffee. Others were observed being supported in carrying out household tasks like cleaning their rooms, doing laundry or helping prepare their meals. Staff said that they enable people to be as independent as possible. Information is displayed around the home about independent advocacy services in the area. The registered manager confirmed that some people make appointments to see advocates at the local office and others use a drop in facility provided by the organisation. Financial records are regularly checked. Some people require support to manage their finances and this is indicated in their care plans. Financial risk assessments are in place. The deputy manager described the processes in place to scrutinise financial systems and these appear to be robust. A recent audit by TRACSCARE commended the home on a 100 outcome for this area. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 12 Any restrictions that are in place are recorded in care plans and/or risk assessments. For instance records explain the reasons for keeping the front door locked and the use of listening devices. People living at the home confirm that they have regular house meetings. An agenda was displayed in the dining room for the next meeting in March. People are individually consulted about their opinions and concerns giving them all an opportunity to express their feelings at the meetings. Risk assessments are developed from hazards identified in care plans. These documents are being regularly reviewed. Missing person’s information is in place including a current photograph of each person. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 14 Educational, social and recreational activities are being scheduled although staff availability is occasionally insufficient to meet the needs of people living at the home. People living at the home have access to a range of local community facilities and activities providing opportunities for them to be involved in their local community and lead active lifestyles. Relationships with family and friends are developed and maintained with the help of staff. Staff enable people living at the home to participate in activities of daily living promoting independence and choice. Freshly cooked meals are produced which provide a nutritional and balanced diet. EVIDENCE: Each day a white board in the dining room is edited to provide people living at the home and staff with information about activities of daily living and education, leisure and social arrangements for the day. People have an activities schedule on their files that corresponds with this. During the visits people were busily involved in helping with housekeeping duties or going out to the shops, to use the Internet at the library or for a drink. Daily diaries record activities completed each day. Those examined for the last month indicated a range of activities are being provided. A range of activities are offered at the home including arts and craft, bingo and a monthly music for health session. Themed activities are also arranged the next one being for Easter. Two people like to go to a tea dance at the local town hall and other people attend local churches. The range of activities scheduled meets with the diverse needs of people living at the home. Comment cards and comments received during the visits indicated that at times activity schedules could not be completed due to staff shortages. The deputy manager said that the home has a lack of drivers which means that some staff spend a considerable amount of time driving people for appointments. People living at the home and staff said that they are also encouraged to walk or use buses and trains in addition to using the home’s vehicles. The registered manager needs to ensure that staffing levels are maintained in line with the home’s risk assessment on minimum staffing levels and that people have access to a range of activities. (See Standard 33) One person said that they enjoy going to college twice a week in a nearby town. Another person described regular visits to a nearby restaurant. People Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 15 also confirmed that family and friends regularly visit them at the home. They said they usually prefer to meet with them in their rooms but can use the quiet room if they wish. Others said they like to go out for meals with visiting friends and family. Review records indicated that one person is to be supported by staff to make regular visits to their family. Their daily diary and contact record confirmed that this is being arranged. One relative commented that the home “is flexible and encourages me to visit and take her out when convenient to me.” They stated that contact is also maintained over the telephone. People were observed being treated with respect and dignity by staff. People were given notice and time of impending appointments. The atmosphere within the home appeared to be very relaxed and calm given the diversity of the people living there. People have keys to their rooms and staff were observed knocking and seeking permission to enter. People were observed choosing where to spend time and with whom, using all communal areas and the sun house in the garden. People help to choose the menus for the home and were observed helping prepare meals for themselves and helping to cook the main evening meal. Alternatives to the main meal are offered. Where people have an alternative to the menu or eat out this is recorded. Food is not kept in the kitchen but in the food store that is locked. Reasons for this were added to the risk assessment/restrictions in place during the visits. It is evident that this is done in the best interests of some of the people living at the home. People have access to drinks and were observed helping themselves throughout the visits. Staff said that if they want snacks they only have to ask and these will be provided. Food is brought into the house for meals and people have a choice of what they eat. There was plenty of fresh fruit and vegetables at the time of the visits. Meals are freshly prepared. Comments from a relative included, “I am impressed with the fresh foods used and the quality of meals”. They also commented that it would be nice for snacks such as fruit to be available. People living at the home are involved in the choice of meals on the menu that reflect the diversity of people living at the home. Meals range from a roast dinner, toad in the hole to lentil bake or chilli burgers. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) 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. The way in which the people living at the home would like to be supported is clearly recorded and managed ensuring that most of their personal and healthcare needs are being met. The home is improving its procedures for administering medication reducing the risk of harm to people living there. EVIDENCE: Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 17 The way in which people wish to be supported with their personal and healthcare needs is recorded in their care plans. People indicated that help is available when needed and that they have positive relationships with staff. Some staff were observed using sign language with people living at the home. One person confirmed they have regular appointments with a speech and language therapist. People’s communication needs are recorded in their care plans. Medical appointments are recorded and details kept of the outcome of each appointment. Comments from General Practitioners indicated “staff are very good at bringing the patients in to the surgery”. During the visits staff were observed contacting the surgery for advice. People requiring the support of a psychiatric nurse or consultant have regular appointments scheduled. During one of the site visits a visiting optician had an appointment with a person living at the home. Records confirmed that a chiropodist also visits the home on a regular basis. Dental appointments are made for people although it did not appear that new people who had moved into the home had been registered with a dentist. The registered manager and staff confirmed that one person had been referred to a local dental surgery and that this would be arranged for another new person. Records for one person were amended to reflect this during the visit. The deputy manager confirmed that senior staff have completed training in the ‘Safe handling of medication’ and all staff undertake training in the monitored dosage system. On the whole robust records and procedures are in place for the administration of medication. Protocols are in place for the use of ‘as necessary’ medication as well as stock controls. Staff follow guidelines recording when and why this medication has been given. Creams and liquids are labelled with the date of opening. Handwritten entries on medication administration records are countersigned and checked by two staff. When medication is administered two staff check and sign the administration record and another sheet to say it has been correctly given. This is good practice. The daily records for one person indicated that at times they wish to take their medication out with them. Discussions with the deputy manager about the systems in place identified that the home are secondary dispensing this medication into another container. By the time of the second visit alternative arrangements had been made. The person is now able to take medication out with them in the container in which it is dispensed from the chemist. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) 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 good. This judgement has been made using available evidence including a visit to this service. People living at the home do so with the knowledge that any concerns will be listened to and acted upon. Systems are in place to protect people from possible abuse by providing appropriate training to staff. EVIDENCE: The home has a complaints policy and procedure in place which is produced in a format accessible to people living at the home. Copies of this document are displayed in the dining room. People spoken with said that if they have any concerns they would talk to the manager or to staff and that they felt confident that any issues would be addressed. Surveys of people living at the home confirm that they feel that staff listen to them. Comments from relatives indicated that they would “call in to the office for a confidential chat” if they had concerns. Others stated that the complaints procedure is available in the home. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 19 All staff complete training in the management of challenging behaviour as part of their induction process. Those spoken with said that physical intervention is not used. Staff use diversion and distraction techniques effectively. Daily records support this. Staff confirmed that they attend training in the protection of vulnerable adults provided by TRACSCARE. The registered manager said that staff have attended training provided by the local Adult Protection Team and they have copies of the ‘Alerters Guide’. Discussions with staff indicated that they have a good understanding of how to recognise and report suspected abuse. Robust processes are in place to monitor people’s individual finances protecting them from possible financial abuse. Financial records are maintained with daily checks by staff and spot checks from management. Comments from a relative indicated “the staff are very transparent in their management of pocket money”. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) 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. The environment is homely and comfortably furnished. There is an ongoing maintenance and refurbishment programme in place to make sure that the home is safe and well maintained. Infection control measures are in place to minimise the risks to the health of people living at the home. EVIDENCE: Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 21 A walk around the home was completed with the deputy manager. Some individual rooms were examined. People said they had chosen colour schemes and how they wished their rooms to be decorated. They confirmed that they have a mixture of fixtures and fittings some supplied by the home and others purchased by them. Inventories are in place on their personal files. Communal areas are small but pleasantly decorated and furnished. People have the use of a lounge, conservatory, dining room and additional quiet room. The garden also has a sun house and patio. Day to day maintenance repairs are reported to the management who refer them for action. Records show that repairs are dealt with promptly. TRACSCARE is presently investigating cracks to the front of the building which appear to be caused by trees in the garden. Work is in progress to rectify this. The registered manager confirmed that long term developmental plans for the home include replacing the heating system and refurbishing part of the house to provide independent accommodation for three people. This will involve providing them with their own kitchen and en suites to their bedrooms. Health and safety procedures are in place to provide a safe environment. This includes environmental risk assessments, regular safety checks on equipment and the structure of the home. At the time of the visits communal areas were clean and tidy. People were observed cleaning their rooms and commented that they are encouraged to do this regularly. The deputy manager confirmed that staff share responsibility for keeping the communal areas clean. The registered manager stated that a new cleaning rota is in place that divides the home into zones giving staff responsibility for ensuring each area is clean and tidy. The laundry is situated in an external building. Infection control measures were observed to be in place. Colour coded mops and buckets are available for use. Staff complete infection control training and personal protective equipment is provided. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care is provided by a stable care team, which has access to good training opportunities, ensuring that people are protected from possible abuse. By maintaining staff numbers at their minimum level people living at the home will be able to have regular access to a range of social and recreational activities. The home exceeds the national minimum standards for care staff with a NVQ Award ensuring that the staff team have the knowledge and skills to support people living at the home. The outcome for this standard is excellent. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 23 Recruitment and selection procedures need to be improved to ensure that people living at the home are safeguarded from harm. Robust training systems are in place to provide staff with the knowledge and skills to meet the needs of people living at the home. EVIDENCE: People living at the home are supported by a mixed team of staff experienced in care and staff new to care. Observation of staff during the visits confirmed that they are accessible and approachable. Comments from relatives indicate that staff “work to encourage my mother to think more positively” and “I genuinely think the staff care about the residents”. This was supported by comments from staff saying that “the staff team is really good and everybody is always trying to do their best for the clients”. Over 78 of care staff have a NVQ award in care. This exceeds the standards. New staff confirmed that they have access to the NVQ programme once they have completed the induction programme. The Learning Disability Award Framework programme is also accessible to staff. All staff complete an induction programme, which includes a booklet to be completed in the home and training from TRACSCARE in ‘Understanding the client perspective’ and a clinical induction. The deputy manager had a copy of the new induction programme which is being cascaded to new staff. Comments from some staff indicated that the old induction had been less than satisfactory and they felt it could be more structured. Comments received from surveys from people living at the home, relatives and care staff indicate that at times staffing levels fall below the minimum of four staff required per shift. This then has a knock on effect on whether people can access activities. This was confirmed during the visits although some staff indicated that people have access to a range of activities during the week with the weekends being most noticeably effected by staff shortfalls. The registered manager said that bank and agency staff are used to supplement the team for planned absences. He also said that two members of staff are pregnant and it has been necessary to make sure that on future rotas they do not work the same shift due to changes in their duties. He acknowledged this had an impact on the ability of the teams to support people to go out. Risk assessments have been put in place. The home has a protocol in place should staffing levels fall below the stated minimum. The registered manager must also inform the Commission for Social Care Inspection under Regulation 37 when staffing levels fall below the home’s stated minimum of four. The files for three new members of staff were examined and were mostly satisfactory obtaining two written references and either a povafirst or CRB Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 24 check before employing staff. One person had several references written ‘to whom it may concern’. The home is recommended to request references from names provided on the application form. Reference requests need to also ask former care employers the reason why the person left their employ. It is also recommended that verbal contact be made with at least one of the written references to check them for authenticity. Records indicated that one person commenced work at the home with one written reference only. Staff must not be employed without two written references. The registered manager said that this had been picked up by TRACSCARE and that they had reviewed their recruitment and selection support to the home from Human Resources as a result. There also appeared to be gaps in employment history on some application forms. A full employment history must be obtained. A training plan is in place for 2006/2007 and staff confirmed that they have access to a range of training relevant to the needs of people living at the home. Staff said that they have recently completed training in dementia, diabetes and mental health. Each person has an individual training profile and copies of certificates of courses attended are maintained on their files. The pre-inspection questionnaire confirmed that training is planned in partnership with local colleges as well as being provided by TRACSCARE. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) 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. The registered manager has a clear developmental plan for the home that promotes the rights and best interests of people living there. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 26 The home’s quality assurance programme involves people living at the home in the review of services being provided. Systems are in place ensuring that the home provides an environment promoting the welfare and safety of people. EVIDENCE: Since the last inspection the manager has been confirmed as the registered manager for the home. He has completed a NVQ Level 4 Award in Care and the Registered Manager’s Award. He stated that he is also maintaining his mandatory training in areas such as infection control and medication. Staff indicated that he is accessible and approachable. The provision of a computer has significantly improved the home’s capacity to process records within the home without delay. During the inspection the registered manager and staff showed a willingness to comply with the Care Homes Regulations by effecting changes to records and practices as they were identified. Unannounced visits by the Responsible Individual take place on a regular basis and copies of the report produced are forwarded to the Commission. People living at the home are involved in six monthly quality surveys as well as taking part in an annual audit with TRACSCARE when representatives attend a focus group for all homes. A report is produced with identified action for each home for the next year. Additional audits are completed within the home. The last audit focussed on Individual Programme Planning and identified issues for action to be completed within a month. The registered manager confirmed that the home’s quality assurance plan identifies four key targets which they are already addressing. Health and safety systems are delegated to a senior member of staff. Health and safety audits are completed every 3 months. All tests for fire systems, water temperatures, fridge and freezer temperatures and hot food temperatures are done on a regular basis. A fire risk assessment is in place. The pre-inspection questionnaire and documents in the home confirm that servicing is in place for equipment within the home. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 27 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 3 43 X 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holly House And Oakfield Score 3 2 3 X DS0000016471.V320038.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1)(c) Requirement The Statement of Purpose shall provide people wishing to move into the home information about the full range of needs that can be met. People must be registered with a dentist so that they can access treatment and advice when necessary. When staffing levels fall below the required minimum for the home, the registered person must notify the Commission. This is so that the impact of any shortfalls can be monitored. Two written references must be obtained prior to new staff starting work. Written verification must also be obtained where a person has previously worked with vulnerable adults of the reason why they stopped working in that role. This is to safeguard people from possible harm. A full employment history for new staff must be obtained providing a full career history DS0000016471.V320038.R01.S.doc Timescale for action 30/05/07 2. YA19 13(1)(b) 30/05/07 3. YA33 37 31/03/07 4. YA34 19(1)(b) Sch.2.3,4 31/03/07 5. YA34 19(1)(b) Sch.2.6 31/03/07 Holly House And Oakfield Version 5.2 Page 29 and information about positions previously held in care. 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 YA34 Good Practice Recommendations The reference request form should ask former care employers to provide written reason for leaving former care positions. Verbal checks should be made to verify information supplied on references. Holly House And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 And Oakfield DS0000016471.V320038.R01.S.doc Version 5.2 Page 31 - 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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