CARE HOMES FOR OLDER PEOPLE
Holly House (Kettering) 79/83 London Road Kettering Northants NN15 7PH Lead Inspector
Irene Miller Key Unannounced Inspection 11th January 2007 11:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Holly House (Kettering) Address 79/83 London Road Kettering Northants NN15 7PH 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) 01536 414319 01536 503191 Mr Banesh Laxmilall Bhatoolall Mrs Zenaida Bhatoolall Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are 5 persons of category OP already in the home. No person falling within the category DE (E) can be admitted where there are 26 persons in the category DE (E) already in the home. The total number of service users in the Home must not exceed 26. 2. 3. Date of last inspection 8th August 2005 Brief Description of the Service: Holly House Care Home provides personal care and support for up to 26 older people within the category of Dementia DE (E), to include up to 5 older people within the category OP. Mr and Mrs Bhatoolall are the registered providers of the Home, with Mrs Bhatoolall registered as the Manager. Holly House provides accommodation on three floors; the home is a conversion of a large detached residential property with accommodation within the ground, first and second floors. A passenger lift and stair lift provide access to the first and seconds floors for people with limited mobility. Holly House is situated close to Kettering Town Centre, and there is easy access to a range of community services and facilities. Service users healthcare needs are met by the community health care professionals The accommodation provides 8 single bedrooms, (6 with en-suite facilities) 9 double bedrooms, four communal sitting and dining areas, and an accessible enclosed garden. The current weekly fee is £348.55. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The primary method of inspection used was ‘case tracking’ that involved selecting four residents and reviewing the care that they received through inspection of the written information available on their care, such as the care plans (a care plan sets out how the home aims to meet the individual residents personal, healthcare, social and spiritual needs). Discussions took place with residents, staff, visitors, the registered manager and registered provider of the home. The inspector spent two hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes service history and the last two inspection reports. The inspection took place over a period of approximately six and a half hours during which the inspector spent two hours observing the care of four residents, this period of observation was carried out within the homes main lounge between 12 noon to 2 pm, in addition policies and procedures and records in relation to staff recruitment, complaints, and general maintenance and upkeep of the home were viewed. The registered manager Mrs Zenaida Bhatoolall and the registered provider Mr Banesh Bhatoolall were available at the home throughout the inspection. What the service does well:
The registered manager promotes individualised (person centred) care, and there is a high commitment to staff training to equip staff with the skills to deliver high quality dementia care to ensure that the resident’s health, personal, social and emotional needs are met. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 6 The home cares for residents who have varying communication skills and residents were observed to be very in touch with their emotions, smiling and engaging with staff, each other and the activities that were taking place. The staff instinctively responded to resident’s who had little verbal communication by reading non-verbal body language. During a two-hour observation period residents were observed to chat with staff, each other and visitors, a small group of residents were observed playing dominoes, with the support of staff and a visitor. Daily living activities were promoted, a small group of residents were observed to participate in helping staff to folding up laundry, sheets and towels, some residents were observed singing and dancing, reading magazines and colouring in pictures, whilst other residents were observed to passively watch the activities taking place, staff were sitting beside residents offering emotional and practical support. Staff recognised the importance of ensured that the residents pride in their appearance and self esteem was promoted, one resident was observed brushing their hair and reapplying their lipstick and had a personal hand mirror available. Within the care plans there was information on resident’s individual hobbies and interests, daily notes recorded what activities resident chose to do on a daily basis. Risk assessments were in place to include pressure ulcer risk assessments and falls risk assessments, where bedside rails were in use, the risk assessment addressed the possible hazards that the equipment may present in relation to their suitability and compatibility for the individual resident. For a resident who was at risk of falls and the use of bedside rails assessed as inappropriate, the registered manager had arranged for other safety equipment to be in place such as a pressure mat to alert the staff when the resident was out of bed, and in need of assistance. What has improved since the last inspection?
Improvements had taken place on the quality of the care plans; the care plans looked at had sufficient instruction and guidance for staff to follow on the provision of care. A programme of activities was in place and there were records of activities individual to each resident. Developments had taken place on the residents individual risk assessments the risk assessments looked at had instruction and guidance for staff to follow to minimise identified risks. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 7 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 (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 (Standard 6 is does not apply to this service) Quality in this outcome area is good. Residents can be assured that their needs are assessed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre assessments of needs were available within the care plans seen. Prospective residents and their families are encouraged to visit the home, prior to making any decision about moving in. The introduction is informal and is an opportunity for a prospective resident to sample what life is like in the home and to meet other residents and staff. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 & 11 Quality in this outcome area is good. The care plans ensure that resident needs are identified, and appropriate care is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and individual risk assessments looked at, demonstrated that improvements had taken place in this area. The information contained within the care plans was detailed and individualized (person centred) identifying the resident’s current health and personal care needs. Support available from healthcare professionals such as the district nurse and general practitioner and there were records of treatment and action taken to address changes in the resident’s health, there was records of resident’s weights, which were closely monitored within the care plans. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 11 Risk assessments were in place to include pressure ulcer risk assessments and falls risk assessments, for one resident who was at risk of falling out of bed the manager had arranged for bedside rails to be in use, the risk assessment addressed the possible hazards that the use of bedside rails may present in relation to their suitability and compatibility for the resident. For another resident who was at risk of falls, the use of bedside rails was assessed as inappropriate as their presence could have created a greater hazard, in this instance the registered manager had arranged for a pressure mat to be in place to alert the staff when the resident was out of bed and in need of staff assistance. The storage and administration of resident’s medication was sample checked and was well managed. There was information available within the care plans of support available from the residents General Practitioner, district nurse, and community psychiatric nurse. Staff were observed treating residents in a respectful and courteous manner. Residents were addressed by their preferred name. Residents said that they were very happy with the care they received at the home, the registered manager and the registered provider promote a person centred philosophy that fully respects the resident’s rights to privacy, dignity and independence. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 & 15 Quality in this outcome area is excellent. Person centred care is promoted and in general life within the home matches the residents expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a two-hour observation period residents were observed to move about independently, other residents who required staff support to be mobile were observed to receive support from staff. Residents were observed chatting with staff, other residents and visitors, a small group of residents were observed playing dominoes, with the support of staff and a visitor. Daily living activities were promoted, a small group of residents were observed to participate in helping staff to folding up laundry, sheets and towels, some residents were observed singing and dancing, reading magazines and colouring in pictures, whilst other residents were observed to passively watch the activities that took place, staff were sitting beside residents offering emotional and practical support. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 13 Staff recognised the importance of ensured that residents self esteem was promoted, one resident had access to personal grooming equipment, and was observed brushing their hair and reapplying their lipstick and had a hand mirror available. The home cares for residents who have varying communication skills and residents were observed to be very in touch with their emotions, the staff instinctively responded to resident’s who had little verbal communication by reading non-verbal body language. Within the care plans there was information on resident’s individual hobbies and interests, daily notes recorded what activities resident chose to do on a daily basis. One resident was observed gaining great comfort from holding a teddy bear, the resident clearly got a feeling of self fulfilment from this sensory activity and the staff recognised the import role that the teddy played in giving the resident comfort and a sense of well being. The main kitchen was viewed, and food safety systems were followed, the cook was knowledgeable of the resident’s nutritional needs, dietary requirements, and food preferences. Many of the residents required full supervision and practical assistance during the meal times, and during the lunchtime meal the staff were observed providing support with sensitivity to individual residents needs. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. Residents and their representatives can be assured that any complaints or concerns they may have will be listened to and acted upon, and that effective systems are in place for their protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and records of concerns and complaints were looked at the Commission for Social Care Inspection had not received any complaints about the home since the last inspection visit. Staff training had been provided on the protection of vulnerable adults, the registered manager had recently received some information on abuse awareness training that was available on line through Northants County Council and the home had a copy of the Northants Inter Agency Policies and Procedures on reporting abuse should the need arise. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. Residents live in a home that is generally well maintained; however a lack of checks to safety equipment has the potential to place vulnerable residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a limited tour of the building the home appeared well maintained, clean and hygienic. There were records available of maintenance checks to the fire, electrical, gas and water systems. Bedrooms viewed had been personalised, pressure-relieving equipment and moving and handling equipment were seen to be available. Within one of the bedrooms viewed bedside rails had been fitted to a divan bed, the type of equipment was appropriate for the type of bed, however on
Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 16 closer examination of this safety equipment it was noted that one of the telescopic bars was not operating correctly, this was pointed out to the registered manager and the registered provider during the inspection, and the registered provider immediately made arrangements to ensure the equipment was made safe for use. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 & 30 Quality in this outcome area is excellent. The staff team are trained and competent to do their jobs, this ensures that residents receive high quality care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there was sufficient staff on duty to meet the needs of the residents, however it may be of consideration to review the number of staff available over the lunchtime period as it was noted that during the lunchtime period that many residents required full staff assistance. The staff training records covered mandatory training on health and safety, fire, moving and handling and food hygiene, as well as specific dementia care training on understanding the different types of dementia, person centred care, communication needs and managing challenging behaviour. Staff employed from oversees are recruited through an employment agency specialising in providing staff for the care sector, in addition to interviews undertaken by the agency, the registered provider conducts telephone interviews to ensure that staff are proficient in speaking English, and are suitable to work at the home.
Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 18 The staff records seen demonstrated that the recruitment and supervision procedures are thorough and robust. Dementia care training had been provided for all staff to include training on the person centred philosophy and the improvements to the quality of the information contained within the care plans had been a direct result of the training that had taken place. Staff training had been provided on end of life care and bereavement support for relatives the training had been provided in partnership with a local funeral director. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35 & 38 Quality in this outcome area is good. The ethos leadership and management style of the home ensures that resident’s health safety and welfare are promoted and protected This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and registered provider had in-depth knowledge of the needs of the residents living at the home and are well respected by residents, staff and visitors. There is an open and inclusive atmosphere within the home, when speaking with staff they said that they feel supported, and that training opportunities were made available.
Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 20 During the inspection the registered manager and the registered provider were observed communicating and interacting with residents and staff and visitors in a relaxed and professional way, it was evident that residents felt comfortable and valued within the home. Staff meetings are held on a regular basis the registered manager firmly uphold the values of person centred care, and are committed to further improving the management systems and the outcomes for residents living at the home. Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13 (4) (c) Requirement Bedside rails must be inspected on a regular basis and records kept of inspections. Timescale for action 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holly House (Kettering) DS0000012819.V325488.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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