Inspection on 08/08/05 for Holly House (Kettering)

This inspection was carried out on 8th August 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Holly House (Kettering) 15/07/08

Holly House (Kettering) 11/01/07

Holly House (Kettering) 28/02/05

Holly House (Kettering) 01/07/04

Holly House (Kettering) 08/03/04

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

CARE HOMES FOR OLDER PEOPLE Holly House 79 - 83 London Road Kettering Northants NN15 7PH Lead Inspector Sheila Smith Unannounced 8 August 2005 at 10.30am 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 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 D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holly House Address 79 - 83 London Road Kettering Northants NN15 7PH 01536 414319 01536 503191 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) Mr Banesh Laxmilall Bhatoolall Mrs Zenaida Bhatoolall CRH 26 Category(ies) of DE(E) x 26 Dementia over 65 registration, with number of places Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. Date of last inspection 28th February 2005 Brief Description of the Service: Holly House Care Home provides personal care and support for up to 26 older people (OP) within the category of Dementia DE (E), to include up to 5 older people within the category OP only.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, with a lift and stair lift serving the first and second floors. Situated close to Kettering Town Centre, there is easy access to a range of community services and facilities. Community health care professionals meet all health care needs. The Home is a conversion of a large detached residential property with ground first and second floor accomodation.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. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents, and upon their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 3 residents and tracking the care they receive, through review of their records, discussions with them, and with the care staff, and observations of care practices. The inspection took place during a weekday, over a period of 6.5 hours and was carried out on an unannounced basis. Communal areas, and some bedrooms were visited. A selection of care records, and essential records of the home were reviewed. A number of the residents were spoken to as part of the inspection process. The Owner and the Registered Manager were present during the inspection. The Commission had received a number of comment cards from residents, relatives, and a visitor, prior to the inspection. In the main the comments recorded were positive and praised the home and the staff for the way in which the care is provided. What the service does well: The home is clean, well maintained and has a happy calm atmosphere, where the residents, some of whom have severe dementia related conditions, are well cared for, and appeared to have developed good relationships with the Owner, the Registered Manager and the staff. Residents spoken with, highly commended the staff, and feel that they are able to talk to them about anything, and that any concerns raised will be dealt with in a professional way. Residents are encouraged to maintain their independence for as long as possible and to maintain links with relatives, friends and the community. A Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 6 party had been arranged the day before the inspection, attended by relatives and friends. Meals were nicely presented, and the mealtime during the inspection was a relaxed and happy time with staff sensitively assisting those who required help to eat their meal. All fire records were kept up to date and regular fire training is provided for the staff. What has improved since the last inspection? What they could do better: The pre admission assessment, and the care plans would benefit from containing more information that gives detailed instruction and guidance to the staff in the provision of care and support to the residents. The daily records should be a ‘pen picture ‘ of that individual residents life in the home. Currently the records are not written every day, and do not provide an overall description of the person. Staff and residents would benefit from detailed risk assessments that identify risks and provide instruction for staff in how to manage or minimise the problem. Little progress has been made in providing detailed risk assessments regarding uncovered radiators, although the Owner said that he is arranging for covers to be installed shortly. The interests of all residents are not always recorded through the information gathering process at the time of admission, and as a consequence staff may only have limited information on which to base any planning of activities to suit the individual resident. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 7 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 D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5. Little progress has been made in the admission procedure to ensure that there is a detailed assessment prior to people moving into the service. Without this there is not assurance that care needs will be met EVIDENCE: The statement of purpose was viewed during the inspection. This did not contain all of the information outlined in schedule 1of the Care Standards Act 2000. The missing items were discussed with the owner, and the manager, who agreed to review the document. The Statement of purpose is issued to all prospective residents and has been given to all existing residents and their families. In the files examined during the inspection, there was little evidence that a full assessment had been made prior to admission and no evidence of residents or relative’s input into the assessments. (This is the subject of a requirement) Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 10 All prospective residents are invited to visit the Home and are encouraged to move in for a trial period before deciding to move in on a more permanent basis. The Home does not allow unplanned admissions. During the inspection a visitor was welcomed and shown around the home by the staff, and the Owner spent time talking and reassuring him regarding a possible admission of a relative. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10. The health care needs of the people in the home are met although the care plans were not up to date. EVIDENCE: All care plans examined contained risk assessments covering areas such as the risk of falls, nutrition and pressure sores. The case tracking indicated that in some instances more care needs to be taken to ensure that all areas of need identified in the daily report are transferred to the care plan. Sufficient detail of the actions required should be included for the plan to become a proper working tool for the staff. For example one plan indicated the need for supervision with bathing but the actual details of the intervention required by staff were not recorded. Another plan indicated the need to monitor nutritional intake, but no guidance was recorded as to how this should be achieved. A care plan indicated that the resident displayed aggressive behaviour; this had not been followed with a risk assessment, or guidance for staff in how to deal with the situation. (This is the subject of a recommendation) Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 12 During a tour of the home it was noted that many of the residents did not have access to a call bell when in their own bedrooms. A plan of care must be made available to staff and recorded in the individual care plan. (This is the subject of a requirement) Residents are registered with five GP practices within the town, and the Manager said that the home received good support from health care professionals. There was evidence within the files that professionals were involved with health care needs, for example notes of General Practitioner and Chiropodist visits. Dentist and optician appointments are arranged on a regular basis or by request. Residents receive support from the Community Psychiatric Nurse. Residents confirmed that the home contacted the Doctor if they were ill. Medication is stored appropriately in a locked cupboard .The Home has a contracted Pharmacist and a pre-packed blister system is used. Medication is delivered weekly to the home in NOMAD cassettes, and staff dispense from these. Staff administering medication have received training. Medication Administration Record sheets were observed to be completed correctly, and appropriate records were maintained in relation to receipt and disposal of medication. A medication disposal record is maintained and signed by the receiving pharmacist. Advice was given to the Registered Manager to develop a system of stock control, as it was noted that there was excess stock of some medications kept in the cupboard. From a discussion with a member of staff, and observations made during the inspection, about how the residents needs are met, it was evident that the staff have a sensitive approach to the provision of personal care, and are aware of privacy, dignity and independence issues. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15. Activities are not arranged to suit the individual wishes of the residents but group social activities are managed well and provide variation and interest for people living in the home. EVIDENCE: As stated in the last inspection report and in this report the interests of all residents are not always recorded through the information gathering process at the time of admission, and as a consequence staff may only have limited information on which to base any relevant individual planning of activities. The Registered Manager said that group activities take place every day although records were not available to evidence this. (This is the subject of a recommendation) During the inspection ball games and other games were taking place. The home does not have an activity co-ordinator employed, therefore the organisation of activities is the responsibility of the staff, and may be reduced in favour of other important care tasks. Outside entertainers are engaged on a regular basis, and the residents had enjoyed an afternoon tea party, with their families and friends the day before the inspection. From the discussions with staff and residents visitors are welcome in the home and can be seen in private. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 14 Residents were given sufficient time to eat their mid day meal in an unhurried manner, and staff offered assistance in eating where required, which was carried out discreetly, sensitively and individually. The dining tables were laid with, appropriate cutlery and condiments. The home operates a two week menu and although the meal served on the day of the inspection was different to that stated on the menu, nevertheless looked nutritious and appetising, consisting of cottage pie, and three different kinds of vegetables, followed by rice pudding. The cook said that she knew the residents who preferred other food than that stated on the menu, and would offer an alternative, and indeed was preparing a different tea for a resident allergic to eggs. Advice was given that all food prepared that is not included on the menu should be recorded. The Registered manager should consider whether there are ways she can offer residents a real choice of menu on a daily basis. Residents were very positive in their comments regarding the food, one describing it as ‘ top-hole’ and another as ‘wonderful’ Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The complaint and protection process within this home is adequate and sufficient to protect residents EVIDENCE: All Relatives/visitors comment cards confirmed that relatives are aware of the homes complaints process, but had not had course to use it. The preinspection questionnaire, and the records held by the Commission of Social Care Inspection confirmed that no complaints had been received, since the last inspection. Residents spoken to confirmed that they were aware of the complaints procedure and that they would complain to Mr or Mrs Bhatoolall if they were unhappy with the service provided. The home has a policy on adult protection and prevention of abuse, and staff spoken to, were clear regarding the action they would take if they suspected abuse in the home, although had received no specific formal training. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 The environment provides comfortable surroundings and is maintained to an acceptable standard. EVIDENCE: The areas viewed on this inspection were furnished to a reasonable standard and general hygiene and domestic maintenance was good. Bedrooms contained personal possessions and screens are provided in shared rooms. All of the bedrooms have call bell points although none of the residents have been assessed as able to use them. There was no evidence that individual risk assessments had been carried out in this respect and no individual plans of night time care was seen in the care plan. Resident’s bedrooms are situated on three floors and although window restrictions have been fitted to all upstairs windows some of the windows had an additional safety feature. The Owner agreed to take further steps to ensure that all of the windows were made safer. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 17 Communal areas contained curtains, and furniture that was in good condition, although one carpet in a hallway required attention. Decoration was satisfactory. All of the rooms are centrally heated, although guards have not yet been fitted to the radiators. The Owner said that in response to earlier inspections he was now negotiating the required covers to be installed. The Home is close to local amenities and is in keeping with the surrounding residential area. The kitchen area was tidy, with work surfaces clean, and all perishable foodstuffs appropriately refrigerated. Kitchen equipment, such as the cooker, refrigerator, and freezer were suitable in capacity for the needs of the residents The location of the laundry facilities was appropriate in relation to food storage, preparation, cooking and eating. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29,30 The procedures for the recruitment of staff are robust and provide the safeguards to offer protection to people living in the home EVIDENCE: Two staff files were examined during the inspection that indicated that references, Criminal Reference Bureau checks and checks against the Protection of vulnerable adults lists are carried out, before employment is offered. A work permit examined was in date. Newly appointed staff receive an induction programme over the period of the first week of employment. Further training includes statutory training in First Aid, Manual Handling. Fire and Food Hygiene. The Registered Manager is confident that over 50 of staff will have obtained National Vocational training by December 2005.Staff have also received training in caring for people with dementia, and challenging behaviour. The Registered Manager is arranging training in Protection of vulnerable adults. Relationships between staff and residents were seen to be satisfactory. All residents interviewed made many positive comments about the staff, and these were reflected in the comment cards received from visitors and relatives. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 19 There are three to four members of staff on duty during the day and two waking members of staff during the night. The home’s current staffing hours exceed the recommended minimum set out by the residential forum. Staff and residents both state that staffing levels were adequate, this was further supported from relative’s comments within pre-inspection comment forms. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38. The management of the home is effective and provides staff with leadership guidance and support. EVIDENCE: Mrs Bhatoolall meets the standards for Registered Managers as set out, and has completed the National Vocational Qualification level 4 in management, and the Registered Managers award. There are clear lines of accountability in the home, and staff spoken to were sure of the management structure and responsibilities in the home. There is a proactive approach to the management of safe working practices with training provided for staff. Staff spoken to were aware of their responsibilities in relation to Health and Safety, and said that their training was regularly updated. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 21 Four problems were raised during the inspection regarding health and safety, and discussed with the Owner; these concerned the covering of radiators, the additional restrictions to windows on the second floor, the safety of a hall carpet, and risk assessments for residents not capable of ringing a call bell. The Owner agreed to ensure that the issues would be dealt with. Meanwhile a requirement to issue a risk assessment regarding the uncovered radiators and forward it to the office of the Commission of Social Care Inspections has been re-issued. A detailed discussion was held with the Registered Manager as to how the present residents risk assessments covering nutrition, and pressure sores may be extended to cover other risks identified, such as leaving the home. Risk Assessments must clearly identify the risk, the action to be taken to minimise this risk and who is responsible for this action. (This is the subject of a recommendation) Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 2 Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 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 3 Regulation 14 Requirement All prospective residents must be assessed in line with standard 3.3 of the National Care Standards Act 2000 Risk assessments must be carried out on all uncovered radiators and a subsequent plan put in place to cover or replace those where service users may be at risk. This information must be forwarded to the Commission for Social Care Inspection by the given date( A previous timescale of 28-03-05 has not been met) Written plans , must be developed,to supervise residents, who are in their rooms without access to a call bell Timescale for action 30/09/05 2. 26 13 30/09/05 3. 7 15 30/09/05 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 7 Good Practice Recommendations The care plans should be developed to include sufficient instruction and guidence for staff in the provision of care. D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 24 Holly House 2. 3. 12 38 A programme of activities should be provided to meet the residents individual assessed needs The current residents risk assessments should be developed to include instruction and guidence to staff in how to manage and how to minimise any identified risk. Holly House D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB 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 D C51 C08 S12819 Holly House (Kettering) V234144 080805 Stage 4.doc Version 1.40 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. 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!