CARE HOMES FOR OLDER PEOPLE
Holly Lodge Gaskell Road Bucknall Stoke on Trent Staffordshire ST2 9DW Lead Inspector
Rachel Davis Announced 14 June 2005 09:00 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 Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Holly Lodge Address Gaskell Road Bucknall Stoke on Trent Staffordshire ST2 9DW 01782 303952 01782 302187 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) Mrs Shirley Harrison and Mr George Littleton Mrs Shirley Harrison Care Home 12 4 2 12 Category(ies) of DE(E) registration, with number MD(E) of places OP Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7 December 2004 Brief Description of the Service: Holly Lodge is a residential care home offering 12 places; four of these may be for service users with mental frailty. Holly Lodge is a two-storey purpose built establishment, it is situated in a residential area of Bucknall, affording service users the opportunity of maintaining links with the neighbouring community. It is well placed for the local amenities and the home has the facility of a main bus route. Both the exterior and interior of the property are very well maintained, it is exceptionally clean and the décor is set to a very high standard. The service users are offered easy access to all areas of the home by the use of grab rails and a lift. All bedrooms meet the required sizes set out by the national minimum standards and are equipped with suitable fixtures and fittings. The bathrooms and toilets are well located and offer appropriate equipment and facilities. Communal areas are spacious and comfortable; the lounge area has doors opening onto a large conservatory overlooking a mature and well-kept garden. Patio areas with seating are available and easily accessed. Satisfactory car parking is available.
Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 5 hours. A partial tour of the home was undertaken. Four service users, two staff, a visitor, the registered manager and deputy manager were spoken to in depth. Case tracking of two care plans was undertaken. Some staff records were examined and observation of planned activities took place. The inspector ate lunch with the service users and observed the senior staff administer medication appropriately. Ten questionnaires were retuned to the inspector from a cross section of people including service users, relatives, local media and support workers. No requirements were made at this inspection. Two good practice recommendations should be considered. What the service does well:
Holly Lodge is highly respected within the community and surrounding areas. The registered manager and deputy manager have continued to promote the excellent quality of care delivered within the home. The management hold strong values and continually promote the view that the home is run in the interest of the service users; the Commission can confirm that there was sufficient evidence to endorse this. Staff at the home generate a friendly, professional and consistent approach, this is both comforting for the service users and welcoming for visitors. Being small in registration and size, the home is able to provide a homely and friendly environment. People who use the service said that they were very happy with the care they received. ‘It’s such a lovely home’, ‘the staff always have a smile on their face’, ‘I love living here’ and ‘the food is excellent’, were some of the comments service users made. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 6 Privacy and dignity are upheld within the home, direct observation, service users comments, information from visitors and staff practice confirmed this to be so. Staff were heard offering choice and enabled the service users to make decisions and as many choices as they were able in their daily lives. The home continues to strive for excellence, this is not only demonstrated in practice but also in written format. Care planning and reviews, risk assessments, supervision records, medication administration records, day-today operations and recruitment procedures are all of a robust nature. Medication procedures are as required and the home liaises with the General Practitioner and pharmacist to seek advice as and when necessary. The home is kept exceptionally clean and is a credit to all the staff, service users said, ‘it is always like this, I have a beautiful room, it is so clean and tidy.’ Holly Lodge has a commitment to National Vocational Qualification (NVQ) and training for the staff. Over 50 of staff have the award, all staff have received the necessary mandatory training and training in specialist areas is also in place. Fiona Harrison, the deputy manager, has recently completed the Registered Managers Award. What has improved since the last inspection?
The home has met the one requirement made at the last inspection; no requirements were made on this visit. The deputy manager has ‘added’ to the risk assessments as and when a new situation arises; this ensures the safety of staff and service users is continually improved upon and maintained. The deputy manager has completed the Registered Managers Award since the last inspection; Fiona is a skilled, competent, experienced deputy manager and now holds the required qualification to further demonstrate her abilities. The home is enrolling for the Investors in People Award at the end of this month. The exterior and interior of the property are being repainted during July. Since the last inspection two new boilers are in place. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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 Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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) 1,2, 3, 4 and 5. All of the information about the home is clear and concise and is used by prospective service users to help them choose a residential home that is right for them. Service users said they had a full assessment and a trial period to ensure the home could meet their needs. EVIDENCE: Questionnaires received from relatives and visitors spoken to express their continued satisfaction with the home and the lovely care staff. One of the many positive responses received from a relative was: ‘ we are so very happy and pleased to have found a truly home from home, nothing is too much trouble and the care and consideration by everyone is excellent.’ The inspector is aware of the changes being made to the homes Statement of Purpose and Service User Guide and is confident that both documents will exceed the requirements. Holly Lodge also produce a newsletter twice a year containing informative and factual information relating to the home, services offered, inspections and special events.
Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 10 The contract of residence has been amended and is fully compliant with legislation; all relevant information required by the service user is in place to ensure that they are aware of their rights. On admission, personal care, mobility and medication needs were documented along with mental state, social interests and carer/family involvement; service users relatives/representatives are also included in this procedure. Each service user and their relatives are fully informed prior to admission that the home has the capacity to meet their needs. Evidence was seen to verify that any specialists’ needs were arranged as required. One service user, who has not lived at Holly Lodge very long, stated that ‘I don’t know what they could do to make it more welcoming here, they will do anything for me.’ Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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, 9and 10 Individuals personal care needs are met by knowledgeable and well-trained care staff who make sure the service users are comfortable, happy and safe. Medication is well managed and the systems in place safeguard the service user. EVIDENCE: Care plans, daily records, reviews and risk assessments are of a high standard and individualised to evidence ongoing consultation with service users, families and other healthcare professionals where appropriate. The health care section of the care plan evidenced that needs were closely monitored and medical professionals contacted when necessary, suitable recording of body weight, nutritional needs and skin integrity were in place. Staff observed had a knowledgeable and positive attitude towards service users and feedback from service users was very encouraging about their relationship. ‘ There are never any moans or grumbles, they don’t whisper behind your back’, was one of the comments made.
Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 12 A suitable Medications Policy and Homely Remedies policy are held within the home. The medication administered and the systems in place were observed by the inspector and were of a very good standard. The staff spoken to had a sound knowledge and understanding therefore ensuring service users were protected from harm. The local pharmacist offers regular advice and provides a written report every three months. Risk assessments are carried out on both a personal and environmental basis to reduce potential accidents. The deputy manager undertakes an individual risk assessment for each service user so that the risk of potential accidents is either removed or reduced. The risk assessment is reviewed on a six monthly basis, or if circumstances change, and is added to if any hazards present themselves at a later date. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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, 14 and 15. Worthwhile activities and stimulation fro service users are in place, this provides daily variation and interest for people living in the home. It was obvious from the comments and observations made that the home has a relaxed welcoming atmosphere where people are encouraged to continue with their individualised lifestyle. EVIDENCE: The home has a robust activities programme arranged over the week to meet the needs and capabilities of service users. Service users spoken to confirmed that they especially enjoyed reminiscence, board games, cards and bingo. A number of service users still access the local community, they are encouraged to maintain and forge links and exercise choice and control of their lives. One regular visitor confirmed that Holly Lodge was ‘great! - the general atmosphere is always lovely, everyone is very well cared for.’ Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 14 Visitors comment cards also verified the open and inclusive atmosphere, ‘I have been visiting Holly Lodge for years and throughout that time the care and atmosphere has, in my opinion, been exemplary.’ As part of the inspection process lunch was taken with the service users. Staff provided appropriate sensitive support where required, they were friendly and unobtrusive throughout the meal. A varied menu is available for service users with alternative meals where needed. Menus are not cyclical and records are kept as required. Drinks and snacks are readily available. All staff working in the kitchen have a Food Hygiene Certificate. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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) 18 Measures are in place to protect service users from abuse, including robust recruitment, staff training and a sound knowledge of the appropriate procedures to follow. EVIDENCE: Policies, procedures and training are in place to protect service users from abuse. Staff spoken to were aware of the procedures to follow. The home operates a safe system of working and ensures that strict recruitment procedures are adhered to. Service users confirmed they were aware of who to speak with if they had any worries and those spoken with added that they would have no hesitation in doing so. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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, 21, 22, 23, 24, 25 and 26. The standard of the environment within this home is excellent providing service users with an attractive and homely place to live. EVIDENCE: A partial tour of the environment was undertaken during this inspection of all of the communal areas, some bedrooms and the laundry and kitchen areas. The home is exceptionally clean and the staff are commended on this. All areas are in a good state of repair; the manager confirmed that the exterior of the property was being repainted this summer. The bedrooms are provided with the required storage facilities and service users are offered a key to their bedrooms. The laundry is shortly being redecorated, suitable washing machines and dryers are in place, all service users spoken to commented that the laundry
Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 17 was undertaken regularly, bedding changed weekly and clothes were returned pressed, and beautifully clean. Equipment was made available to service users, dependent on their needs; bath hoists were serviced 6 monthly as required. It was evident that the disposal of incontinence waste was being dealt with appropriately thus ensuring service users are not at risk from cross infection. The home confirmed that they will purchase foot operated pedal bins as requested by the Commission. Liquid soap and paper towels should be considered in all communal areas. Latex gloves should be replaced by non latex or nitrile gloves to eliminate the possibility of allergic reactions. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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 and 30. All staff were suitably trained to carry out their duties, the homes recruitment practices are in line with the National Minimum Standards. EVIDENCE: Holly Lodge has a robust recruitment procedure that ensures that their staff are suitable to work with vulnerable people. Staff files examined showed that thorough pre employment checks are carried out. Criminal Records checks had been undertaken in all instances, the home also ensures there is evidence to confirm that the staff are both physically and mentally fit for purpose. Staff files and discussions revealed that the establishment undertakes induction training promptly so the staff are guided and given the confidence to undertake their role. The content and procedures for induction training were seen and are extensive. The home is committed to offering care staff a National Vocational Qualification (NVQ2). Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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 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, 32, 33, 36 and 38. The management team have a clear development plan and vision for the home, this is effectively communicated to the service users, staff, relatives and significant others. EVIDENCE: There was evidence to confirm that appraisals and supervision were an integral part of the homes work ethics. All staff involved in the inspection process confirmed that they received individual supervision and attended regular team meetings. Both the registered manager and the deputy manger are committed to ensuring that the best quality of care is offered to each individual, everyone
Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 20 spoken to confirmed that their daily lives were varied and they were empowered to live the life they chose. The health, safety and welfare of staff and service users are protected. The registered manager ensures that all maintenance work, repairs, annual checks, mandatory training, testing of equipment and regular fire drills are undertaken. The appropriate insurance certificate is in place alongside the homes registration certificate. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 4 4 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4
COMPLAINTS AND PROTECTION 4 x 4 4 3 4 3 3 STAFFING Standard No Score 27 x 28 x 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 4 4 4 4 x x 4 x 4 Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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. 2. Refer to Standard 26 26 Good Practice Recommendations The home should purchase latex free disposable gloves. All recepticals used for incontinence waste disposal should be foot operated. Holly Lodge E51 E09 S8238 Holly Lodge V215551 140605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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