Inspection on 17/07/06 for Holly House (Beechley)

This inspection was carried out on 17th July 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly House (Beechley) 02/03/06

Holly House (Beechley) 07/11/05

Holly House (Beechley) 21/10/04

Holly House (Beechley) 06/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Holly House (Beechley) Harthill Road Liverpool Merseyside L18 3HU Lead Inspector Natalie Charnley Unannounced Inspection 17th July 2006 09:40 Holly House (Beechley) DS0000047937.V297182.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 (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly House (Beechley) Address Harthill Road Liverpool Merseyside L18 3HU 01325 351 100 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) beechley@schealthcare.co.uk Active Care Partnerships Ltd Mrs Anne Fitzpatrick Care Home 30 Category(ies) of Learning disability (20), Physical disability (10) registration, with number of places Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: Holly House is located in Liverpool and is within the Allerton area. The home is owned by a large organisation, which has similar homes both locally and nationally. The home is easily accessible by bus and car and is a 3-story house within large grounds. It accommodates up to 30 younger adults. Nursing and social care is provided by the home and the home cares for adults with a learning or physical disability. Accommodation consists of 26 bedrooms, 22 single and 4 doubles. 19 of the rooms have en-suite facilities. Other bedrooms have hand-washing basins. Due to the age of the building, continuing environmental repairs need addressing by the home. It costs from £850 per week to live at the home depending on needs Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 09:40 and left at 15:00.The inspector spoke to 5 members of staff, the home manager, 2 visitors and 6 residents. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager during and at the end of the inspection. Comment cards were left at the home for residents, staff and visitors to complete. The person in charge was also given an ‘inspection feedback’ card to complete regarding the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 6 Wound care needs to be improved to ensure that the correct dressings are used and that a consistent approach is always followed. The registered person must ensure that the home statement of purpose and service user guide are in a format suitable for residents, this is an outstanding requirement. The home must be able to demonstrate how they use the information that they have collected during the quality assurance reviews. Staff must be given mandatory training, and training on Protection of Vulnerable Adults. 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 (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Residents have a detailed assessment completed before moving into the home to ensure they are kept safe. EVIDENCE: Pre admission assessments were available on files for all residents, including the most recent admission to the home that moved in February. The assessments are comprehensive and detail what support residents need and what tasks they can do for themselves. Details are also taken on the past medical and psychological health. Some files also contain pre admission information from other sources such as social services, mental health teams and advocates which also help the home build up a picture of a residents needs before they move in. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Care plans are individual and outline the needs that service users have to ensure they receive appropriate care. Residents are given choice in all aspects of their daily life which promotes independence and Risks taken by residents are looked in detail and ensure that safety is maintained. EVIDENCE: All residents living at the home have an individual plan of care. Four of these were looked at during the inspection. As part of care planning, the home use ‘essential lifestyle plans’ which details how individuals can achieve their personal goals and admissions. These documents have been developed since the last inspection to be more ‘user friendly’, however, were only available on one of the files checked. Residents in the activity room showed the inspector that they were working on making these plans and were colouring them in and personalising them. All plans demonstrated that they were updated on a regular basis by staff. Risk assessments are available with care files and are specific to individuals. Core risk assessments are completed to cover falls, pressure ulcers and nutrition. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 10 Residents living at the home are supported and encouraged to make independent decisions. One resident stated, “we can really do what we want, but the staff are always there to help” and another commented, “I chose when to go to bed and who comes in to visit”. Residents complete a monthly feedback sheet that details what they have enjoyed and what they haven’t. This allows residents to act on their experiences to choose what they wish to participate in the following month. Residents also meet monthly in a forum to choose activities and to plan future developments at the home Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Residents participate in appropriate activities and maintain their links with the local community. Dietary needs of residents are well catered for with a balanced selection of food that meets the tastes of residents. EVIDENCE: Since the last inspection, the activity co-ordinator has left, and it was acknowledged by the manager that activities could be improved on. Two members of staff are currently responsible for running activities and plan a weekly schedule for residents. Residents spoke highly of the activities that they joined in with and one lady commented “I really enjoy the painting and colouring I do, staff have put my work up on display”. The home has a mini bus that takes residents on trips out; examples were given for recent trips out to a local restaurant and shopping at a local retail park. The home has specific policies in place that are available to staff that cover the needs of residents under different religions. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 12 The home has regular visits from various religious ministers, which residents stated that they enjoyed. One local church holds regular coffee mornings for the home and donates the proceeds to the resident’s funds. One resident currently has a work placement at a local day nursery and has been on interview panels for the day centre that she attends, 5 other residents also have day care placements in the local community. Residents confirmed that visitors are welcome at the home at any time and that they can meet in communal or private areas of the home. One visitor at the home used to live there and explained that he visits his friends on a regular basis and stated, “I am made welcome here by staff, I can stay as long as I like and still join in some of the activities”. The home uses a rotating menu that always offers a choice of 2 different meals. The chef is currently introducing a new system for recording all food temperature checks and cleaning rotas called “safer food, better business”. This will assist in ensuring the kitchen remains a safe place. Residents were all happy with the food provided at the home stating it was “nice” and “yummy”. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Residents are given choices on a daily basis and have their health needs monitored by the home. Medication practices are safe and have significantly improved to ensure the safety of residents. EVIDENCE: Observation at the home demonstrated that residents were offered choice in a variety of their daily tasks. This is supported by the residents forum where residents can offer their opinions and ideas, and by the ‘feedback sheet’, which is completed monthly. Details of residents choices, likes and dislikes are detailed within their essential lifestyle plan. Residents commented that they could decide where to have their meals, when to go to bed and what activities that they join in with. As the home employs qualified nurses, residents physical health is also closely monitored and recorded. Residents can access local NHS facilities and are supported to attend outpatients appointments by staff. Records of health care of kept in care plans and diaries and are well documented. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 14 Wound care records at the home were unclear. One resident was receiving regular wound care, however, records did not show that the home had involved the GP (general practitioner) or Tissue Viability Nurse. The residents wound had been dressed with different dressings by staff and there was no consistency in the approach. The wound records showed little improvement had been made and despite recent training, staff were unclear as to how to manage the wound. The manager must urgently address this. Medication practices have improved significantly since the last inspection. All medications are signed in and out of the home and guidance has been introduced, following advice from Commission for Social Care Inspection for the use of medications that are used as and when needed. There is now detailed information for staff on monitoring signs and symptoms in residents medical conditions and behaviours. This is an example of good practice. One resident has been encouraged to self-administer his own insulin injections, with view to living in the community. He has been supported to try this by staff. All medication records demonstrated that medications were being given as they had been prescribed. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The home has a good complaints procedure that protects the rights of residents. Staff have a good knowledge of adult protection procedures, however, formal training remains outstanding. EVIDENCE: The home has a complaints procedure that is displayed around the home. Residents spoken to were aware of how and who to make a complaint to. Advocates are available for those residents who are unable to speak up for themselves. No complaints have been received at the home or about the home since the last inspection. All staff have still not received training on adult protection, however, the manager stated that this was to take place over the next few months. Staff spoken to did know the details of the adult protection policy and were able to state how they would handle an allegation of abuse at the home. All staff working at the home had undergone appropriate character checks and trained nurses had received a PIN (personal identification number) check by the home with the Nursing and Midwifery council. This ensures that they are qualified nurses who are able to practice. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 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 the following standard(s): 24 and 30 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service The home needs continual monitoring of its environment to ensure it remains safe and suitable for residents. The home is clean and hygienic providing a safe and protective environment for residents EVIDENCE: A full tour of the building was carried out. Despite ongoing maintenance due to the home being in an old building, the environment is generally well maintained, however, it was identified that the staff toilet was broken. The home has substantial gardens that were being used by the residents. This area is well laid out and provides a stimulating place for residents to sit or participate in activities. During the last inspection, it was identified that the laundry room was not suitable for staff and residents to use. This has not been addressed, and has now become an urgent matter. The registered provider must inform the Commission for Social Care Inspection as to how this requirement is to be fulfilled. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 17 Residents stated that they were happy with their environment and commented that “I have a nice bedroom” and “my room is full of my own stuff, it makes it feel nice”. All areas of the home were clean and tidy and despite the inspection being on a very hot day, the home was well ventilated and cool. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service. The home has sufficient numbers of staff employed to ensure the safety of residents. Staff training is not up to date, which may leave residents at risk, however, staff could show they knew how to look after the residents and were aware of their needs. EVIDENCE: The home employs trained nurses and care assistants to care for residents. These staff are supported by activity staff, cleaners, a chef, a laundry assistant and a handyman. The staff rotas show that the home employ enough staff to provide the care needed by residents. The home is also used by local universities for teaching student nurses. Staff commented that they had all received a full induction before starting work and felt that they were able to access all the relevant policies and procedures that they needed. Care staff are supported by the home to complete their NVQ’s (National Vocational Qualification), and stated that they felt that they had the knowledge to provide a good standard of care. Two trained nurses were able to demonstrate that they had undertaken recent courses in venepuncture (how to take blood samples), wound care and Huntington’s disease. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 19 Staff training records showed that not all staff were up to date with mandatory training, however, the manager stated that new training was starting on July 27th to address this. Observation of staff showed that they were skilled and confident in dealing with residents living at the home and residents felt staff were “very nice” and “like mates”. Staff files checked showed that all checks had been carried out to ensure that staff are safe to work with vulnerable adults. Evidence was also available to show references had been taken up and that regular supervision was taking place. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The home seeks the needs of staff, relatives and residents. however need to show how they plan to address concerns to improve service. The home maintains the health and safety of staff and residents at all times, protecting them from harm. The home is well run and efficient. EVIDENCE: The deputy manager of the home has recently left, and the current registered manager is due to leave her post at the end of August. Both of these posts are currently being advertised internally and externally. Staff and residents were fearful of what was going to happen at the home over the next few months and were sad that the managers were leaving. Discussion with residents and the questionnaires returned from residents showed that they liked both managers and found them very approachable. Residents join in with the running of the home via the residents forum. Minutes from these meetings were seen and showed positive interaction from the residents, staff meetings are also held on a regular basis. Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 21 The home sent out questionnaires in January 2006 as a way of monitoring quality of the service, the surveys were shown to the inspector. There was no evidence to show what the home had done to address concerns raised such as residents not happy with ‘the security in the home’ and ‘people wandering in and out of bedrooms’. The home must produce an action plan to address these comments and feed them back to the residents who use the service. Relatives questionnaires were also seen and contained comments such as “ it’s a happy home”, “he could go out a little bit more”, “there should be more activities” and “keep up the good work”. Accident reports at the home were well recorded and all safety certificates were up to date. Staff all receive regular fire drills and the facilities manager has recently completed an environmental fire risk assessment. Policies and procedures regarding health and safety issues are in place and regularly updated. Holly House (Beechley) DS0000047937.V297182.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 3 X Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 23 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 YA1 Regulation 4(1) Requirement The registered person must ensure that the home statement of purpose and service user guide are in a format suitable for residents and that details of the Commission for Social Care Inspection are included Remains outstanding from last 2 previous inspections 2 YA19 13(1)(b) The registered manager must 01/09/06 ensure that staff follow wound care protocols correctly and use dressings that are only prescribed to individuals. Tissue viability nurse input needs to be sought for the individual highlighted during the inspection. The registered person must 01/10/06 ensure that the laundry room is suitable for staff and residents to launder their clothes. Remains outstanding from last 2 previous inspections The registered person must fix the staff toilet Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 24 Timescale for action 01/10/06 3 YA24 23(1)(2) 4 YA35 18(1)(a) 5 YA35 24(1) The registered person must ensure that all staff are given mandatory training, including POVA training (Protection of Vulnerable Adults) The registered person must ensure that they formulate an action plan following any quality assurance assessments 01/11/06 01/10/06 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 YA11 Good Practice Recommendations The home may wish to develop a provision of a rehabilitation kitchen so residents can have the opportunity to learn and use domestic skills Holly House (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 (Beechley) DS0000047937.V297182.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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