CARE HOME ADULTS 18-65
Holly House and Oakfield 303 Gloucester Road Cheltenham Gloucestershire GL51 7AR Lead Inspector
Peter Still Unannounced 5 July 2005 09:30
th 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 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 Stationary 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 D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Holly House and Oakfield Address 303 Gloucester Road Cheltenham GLoucestershire GL51 7AR 01242 522404 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) TRACS Miss Tanya Walters Care Home 12 Category(ies) of PD Physical Disability Both (12) registration, with number MD Mental Disorder Both (12) of places LD Learning Disability Both (12) PD(E) Physical Dis. Over 65 Male (1) MD(E) Mental Disorder Over 65 Male (1) LD(E) Learning Dis. Over 65 Male (1) Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: That the PD(E), MD(E), LD(E) category refers to one named service user and will be removed when that service user leaves the home. Date of last inspection 12th January 2005 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 TRACS; 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. There is a large back garden with some outbuildings. The home has two vehicles. Residents also use taxis and buses. The home is close to the railway station. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. The deputy manager was present throughout the inspection. A tour of the premises took place and care records and policy documents were inspected. Four of the five staff on duty and four of the eleven residents were spoken to, with other residents being observed. No professionals or visitors came to the home during the inspection. What the service does well: What has improved since the last inspection?
Staff have developed specific responsibilities and said this is making a difference for residents. One member of staff said that they work well together and have built a very structured activities programme. This has resulted in residents being able to take part in a range of activities which has led to improvements in challenging behaviour and the happiness of residents who told the inspector that they really enjoy being able to go out from the home. The home now has seven drivers on the staff team which helps residents to go out on trips and locally within the community.
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 6 One member of staff said that using the Preparing for Review sheet is proving valuable in ensuring consultation with residents prior to their review, making them more meaningful and enabling Key Workers to advocate needs and wishes with and for residents. Items staff require to be typed, are currently dealt with by the TRACS main office and the turn around time has improved which is especially important with care plans which change frequently. A staff training plan is being developed and since the last inspection the inspector read evidence on training undertaken which has included: brain injury; Korsakoff’s syndrome and mental health. 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 and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users benefit from good admission and assessment practice that ensures that the home is able to meet their needs. EVIDENCE: Assessments were seen for two residents. Care needs are met through an assessment process that is carried out before a resident moves to the home. Residents have difficulty in making their own decisions and so advocacy and input from professionals and people important to the resident is vital. Not all references to the NCSC have been changed to CSCI and documentation needs to be checked further, the Client Charter being one example noted by the inspector. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 & 10 Staff hold a sound knowledge base and use systems well to ensure the views of residents are heard and their needs are met. The care planning system does promote the needs and choices of residents but further work is needed and the home is enthusiastic about the actions required. EVIDENCE: A form called ‘preparing for review’ is used by Key workers to ensure residents are consulted with, and their wishes and needs are clearly known prior to their care reviews, which they can attend. This is good practice and staff said they consider it to be valuable. Where agreed decisions have not been followed, the inspector was pleased to hear from a staff member that staff feel confident in challenging their colleagues and senior staff. The consequence of this is that things which are important to the resident are not left or forgotten. A resident told the inspector that they do attend their review meeting but they do not say much. As the care planning arrangements develop, the deputy manager was clear that they will constantly look at other ways of involving residents and ensuring that their needs are listened to. The inspector found individual files a little difficult to go through and some tabs may help. Two care plans were read and good review notes were seen. Some reviews were basic and need more depth, which the deputy manager is aware
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 10 of and will be rectifying as the care plans are reviewed. Whilst there are short term goals, the longer term aims should also be recorded. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 16, 17 Social activities are well managed and creative, led by a committed staff team, and are clearly enjoyed by residents. There is a good menu, which includes choices, if service uses wish. EVIDENCE: Staff have worked hard to ensure a varied and structured activities programme is offered, which meets the wishes of individuals and is in line with the care plan. Residents spoke enthusiastically to the inspector about the enjoyment they have from the programme and of the importance of being able to go out from the home. Staff spoke of the value of the structure and also the way it has helped to improve difficult behaviour. The inspector observed residents being relaxed, enjoying their environment and a feeling of being safe with the staff. Four residents talked to the inspector, providing this evidence. Visits to and from family were also talked about. One member of staff talked about the potential difficulties residents have in the community but that the “great links” the home has established with the local community has overcome this.
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 12 One member of staff told the inspector that it may help residents if not quite so much was done for them and that taking small steps to complete domestic tasks and taking more responsibility could help some residents. The inspector did notice that some rooms were very clean whilst others needed cleaning. The menu plan was read, where choice is offered and the kitchen and food store were also seen. Menus were considered to be good and well balanced and residents told the inspector that they enjoyed the food. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20 Residents receive good personal support by a staff team who know them well and can tune into their individual needs. The key worker system is also an essential aspect of the way care is provided. EVIDENCE: Concern regarding the checking of residents at night, raised at the last inspection has been resolved. The inspector talked to the deputy manager about the previous report and agreed issues which have now been resolved. The inspector observed staff working with residents and four residents were able to tell or indicate to the inspector that their needs are met in the way they prefer. Residents all said that they knew who to talk or go to if they needed support and this included both the manager and deputy manager. Staff showed clear respect for residents’ privacy, for example they knocked on bedroom doors and waited to be asked in before entering. Records show that the home promotes residents’ welfare in co-operation with families and health care professionals. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The current policy and documentation regarding the complaints procedure is not sufficiently comprehensive and limits the rights of residents. Whilst staff appear confident in their work and committed to the residents, the lack of training about vulnerable adults could pose a risk of abuse being undetected and harm being caused to residents. EVIDENCE: A poster providing details of how to make a complaint is provided for residents, however current policy was a little difficult for the inspector to extract and consequently may not be read by staff. It also indicates that complaints should be handled internally first, before giving the option for residents to go direct to CSCI or social services, although the poster says that they can take their complaint direct to CSCI if they wish. This is confusing and the deputy manager understood this and agreed to rectify it. All staff told the inspector that they would approach the CSCI if they felt it necessary. The inspector spoke to four staff and one had received recent training on the protection of vulnerable adults (POVA), with others saying they had not had this key training. Residents at this home are very vulnerable and quality POVA training is essential with reinforcement built into individual staff training programmes. The complaints file was seen and none have been recorded. Guidance notes are out of date and need revising. The inspector talked to the deputy manager about his plans for the future development of documentation and approaches with residents to ensure they
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 15 are listened to and decisions are acted upon and felt his enthusiasm will lead to good steps being taken in the near future. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 Whilst the building is old and has faults, the residents use the space well and have a number of different places to go within the building, which helps with the way they are feeling and what they wish to do. Problems with damp and some areas of poor decoration means that some parts of the home do not provide a satisfactory environment for service users. EVIDENCE: There is still evidence of a small amount of damp in a front bedroom, where a dehumidifier is being used. A flat roof above this may be the cause since a lot of water was seen and the drain may be blocked. The ceiling below a bathroom has a bulging area and needs investigation and decoration. Some bedrooms needed cleaning and the smoking room needs a deep clean. Whilst the room was tidy, the plastic of the conservatory room was very yellow and the smell from the room is very noticeable in the area outside. Some material is restricting the exit doors from being opened. The inspector has not seen doors tied up before and the safety of this should be considered further, with a letter to the CSCI either giving evidence that it is safe or steps being taken. It is important that the Fire Service be asked for advice about this. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 The numbers and skill mix of competent staff are sufficient to meet residents’ needs. EVIDENCE: Residents spoken to said or led the inspector to judge that they felt well supported by staff and felt safe in their care. During the inspection the inspector observed staff working well with residents who knew their individual needs. The inspector saw evidence of staff working well together as a team and a photograph album showed some of the interesting things they have done with residents. Five staff have completed their NVQ 2 awards in social care and have their certificates; five staff have completed their work and await their certificates; two staff have enrolled on the course. Staff references had been an issue at the previous inspection and this has now been rectified. Two staff files were seen and included two references. Five staff were on duty during the inspection, including the deputy manager and this was considered to be sufficient and in line with the levels agreed with the CSCI.
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42, 43 The home is going through the transition of a change in management and it is helpful that the current manager is handing over gradually to the deputy manager. Whilst a great deal of work is still required there are generally sound working practices in place which will ensure that the service continues to meet the needs of residents. EVIDENCE: In talking to the deputy manager about TRACS, the inspector understood that a company called Sovereign has taken over TRACS. The inspector was not aware of this and will check the Commission files. It is a requirement that any changes are communicated to the Commission so that any necessary steps can be taken. The inspector would be grateful if the Provider can also check whether there has been an exchange of communications about this. The current registered manager is now area manager for the organisation and is currently working two days a week at the home. It is essential that the deputy manager completes the application to become the registered manager
Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 19 and sends this to the CSCI swiftly. If the deputy is successful in his application it will be important for him to continue with his current open management style which empowers staff and at the same time provides staff with the clarity of his position as responsible manager and not simply a member of the team. His thoughts on this to the inspector were considered to be excellent practice but he will also need to remember to clearly balance his good team working approach with the significance of being the manager. A great deal of work is still required, which the deputy manager is aware of and whilst his delegation of responsibilities is very good, he will also need to ensure he sets aside sufficient personal work time to structure the work required and to maintain an overview of how it is moving forward. The inspector understands that the new manager will be well supported by TRACS and the regulation 26 visit reports evidence this. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 2 x x Standard No 22 23
ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 2 x 2 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Holly House and Oakfield Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 3 D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 21 yes 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 22 Regulation 22 (1) Requirement Timescale for action 21/10/05 2. 23 13 (6) 3. 3 17 4. 24 23 The registered person shall review the complaints poster to ensure that it reflects the homes complaints procedure, in that it makes clear that service users can take their complaint to external agencies at any time, rather than after the homes internal procedures have been followed first. The registered person shall make 21/10/05 suitable arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must 31/10/05 ensure that all documentation is revised to include reference to CSCI where necessary. The registered person must 31/08/05 obtain written confirmation from the Fire Officer that the practice of securing the conservatory doors is consistent with safe practice and forward this confirmation to the CSCI. Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Holly House and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 23 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 and Oakfield D51_D03_S16471_HollyHseOakfield_V236713_050705_Stage4_U.doc Version 1.40 Page 24 - 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!
