Inspection on 16/01/09 for Holly Lodge

This inspection was carried out on 16th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly Lodge 05/01/07

Holly Lodge 04/11/05

Holly Lodge 05/05/05

Holly Lodge 24/02/05

Holly Lodge 07/09/04

Holly Lodge 16/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Holly Lodge Old Hospital Road Pewsey Wiltshire SN9 5HY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Holly Lodge Old Hospital Road Pewsey Wiltshire SN9 5HY 01672569950 01672569952 hollylodge@whct.co.uk/mandymaloret@whct.co .uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: White Horse Care Trust care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: No more than 18 service users with a learning disability at any one time No more than 4 service users with a learning disability, aged over 65 years of age at any one time The staffing levels set out in the Notice of Decision dated 12 August 2003 must be met at all times Date of last inspection Brief description of the care home Holly Lodge is registered to provide nursing care for 18 younger people with multiple disabilities. As a condition of registration four service users may be over the age of 65 years old. The home was purpose built in 2003 for the service users group currently living in the home. The home provides a good standard of accommodation suiting the needs of the residents. All 18 bedrooms are single with an en-suite facility. The home is divided into three units with six service users living in each unit. Holly Lodge is situated in the town of Pewsey in Wiltshire. White Horse Care Trust manages the home. The registered manager is Amanda Maloret. The current fee range is 1,150 pounds to 2,400 pounds a week. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 4 18 Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: As part of this inspection, the homes file was reviewed and information provided since the previous inspection considered. We also received an annual quality assurance assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. The site visit of Holly Lodge took place on Friday 16th December 2009 between 9:20am and 4:10pm. One regulatory inspector performed the inspection but this person is referred to as we throughout the report, as the report is made on behalf of Care Homes for Adults (18-65 years) Page 6 of 34 the Commission for Social Care Inspection (CSCI). The manager was on duty for the inspection. During the site visits, we met with two residents, two visitors and observed care for ten residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for four residents, one of whom had been recently admitted, across all parts of the home. As well as meeting with residents, we met with two registered nurses, six carers, the housekeeper and the cook. We observed a lunch-time meal and activities taking place in the sitting rooms. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records and complaints records. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 34 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be supported by the individualised approach in admissions to Holly Lodge Evidence: Holly Lodge has information about the services it provides, which is regularly up-dated. At the time of the inspection, which was unannounced, the manager reported that the homes Statement of Purpose and Service Users Guide were being revised, to more clearly reflect the services provided by the home. They have agreed that they will send us a copy of the information, once it is no longer in draft form. During the inspection, we met with two people who had been admitted during the past six months. The people we met with were not able to describe their admission process to us. We also met with two relatives, who reported that when their relative was admitted to the home, they had been given plenty of opportunity to find out about the services offered by the home, including comparing services from other homes, prior to their relative being admitted. One relative reported we came here and liked it and another we dont regret choosing here. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Three staff spoken with were able to describe the admission process to us. They reported that as well as obtaining assessments from previous care providers and other professionals, the home also performed their own assessments. As well as an assessment by the manager, the manager of the unit the person was to be admitted to, staff on the unit and an assessment of how the person would fit in with the other residents were also performed. This was supported by the homes annual quality assurance assessment, where they stated that existing residents would have the opportunity to express their wishes in any decision about a new person moving in. One person who had recently been admitted had a full assessment from their previous care agency, including assessments from a range of healthcare professionals involved in their care and an assessment from their previous placement. This persons current file showed that the home were gradually getting to know them, so that some assessments and plans were in outline only, whilst others had been completed in more depth. We spoke with staff on the unit where this person had been admitted and they were able to describe a flexible admission process, which involved the person coming into the home for short periods at first, followed by longer periods in the home. Staff reported that plans about how the person visited the home had been based on the persons individual needs and included discussions with their previous care provider, to ensure that the admissions process was tailored to meet the persons individual needs. All residents had a copy of their contract in their folder. Contracts are also available in pictorial formats, to support residents. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home will be respected as an individual and supported in exercising choice, according to their own need, in an environment where assessments of risk are fully considered. Evidence: The people who live in Holly Lodge all have complex nursing and care needs. Nearly all the residents had physical disabilities as well as learning disability needs. Some residents needed support due to complex and/or unstable epileptic conditions, some needed artificial supports to maintain their nutrition, including tube feeding systems and some experienced additional mental health needs, including early onset dementia. Despite caring for people with such profound needs, it was clear that staff understood the importance to people who were living in the home in being supported in their individual needs and making choices. One relative described the excellent care in the home. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: All people living in the home had very detailed assessments of need. Where needs were identified, detailed care plans were developed, to direct staff on how these needs were to be met. One of the residents we met with had complex needs relating to communication, as they had limited or no speech. Their care plan detailed how the person reacted to eye contact and smiling, so that staff could ensure that they were able to communicate effectively. Another residents care plan detailed how they presented themselves when they needed the toilet. During the inspection they were observed to show such behaviours and staff promptly took action to ensure that the individuals needs were met. We noted that care plans and assessments were reviewed regularly. We discussed the needs of people who lived in the home with a range of carers, including residents key workers. Staff reported on the effective key worker system in enabling them to support people. Staff spoken with knew residents needs in detail and knew how to report any changes in residents conditions. One resident was observed to not to want to eat their lunch. The carer tried a range of different methods to support the resident, in accordance with their care plan. Then documented what had happened and ensured that the issue was reported to the next shift. Staff worked with residents, supporting them in participating in home life where possible. One member of staff was heard discussing with a resident how they wanted to spend their day. The housekeeper reported on how they involved residents in menu planning. One resident spoken with knew which carer was in charge of their unit on the day we visited. All residents had detailed risk assessments on file. This enabled them to live the life they preferred, where the risks were reduced as much as possible. One of the residents met with clearly enjoyed going out of the home as much as possible. They had full risk assessments on their file about this. These were regularly reviewed. Some of the residents could be at risk if there were not sufficient staff available to support them. To reduce this risk, staff reported that they always made sure that other staff knew where they were, including if they left the unit for a longer or shorter period. This was observed to take place in practice. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported within their individual needs, in maintaining appropriate lifestyles, both within and outside the home. Evidence: All residents have plans in place relating to their social and cultural needs. These plans showed that some residents went out of the home on a frequent basis. One residents care plan stated that they were to go out of the home each day and described the activities that they were to pursue when they did so. Care plans also included significant matters for the resident such as if they preferred a female or male carer for personal care. Where practice of a particular cultural activity was important to the person, including practice of a religion, this was documented. There were clear systems in the laundry to ensure that residents own clothes were returned to them. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: All of the bedrooms visited were highly individual in tone, reflecting the persons likes and preferences. The home owns three forms of transport suitable for the client group. Records showed that these are regularly used for group or individual activities. Staff reported that they regularly reviewed what was available in the community and involved people in going to activities appropriate to them. Where residents were able to, they used external community services, such the hairdresser. One resident had their own bank account and a member of staff described how they supported them in going to the bank to withdraw money. One persons records showed that they had been supported in having a holiday in a sea-side resort during the summer. Where residents remained in the home. Staff worked with them to provide activities. On one unit, a carer was supporting a resident in putting on make-up, which the resident described as fantastic. On another unit, a carer was observed to support a resident in a game involving counting and another a carer was discussing what was on television with a resident. We observed a mealtime and met with the cook. Meals are generally cooked from raw ingredients. When we visited the kitchen, we were able to see good quantities of fresh vegetables and fruit. One resident was on a special diet. The cook was fully aware of how to meet this persons needs. The housekeeper reported that she uses a range of sources to provide ideas on menu development, including the internet. Residents eat at tables in their individual units and staff sit and eat with them. Staff plate up meals individually for residents, to provide people with the type and size of meals that they prefer. One resident reported I eat well. Whilst staff tried to re-enforce the normality of mealtimes, they were observed to note when residents needed support. For example one resident started to feed themselves with a knife. A carer very promptly noted this and the person was supported in feeding themselves more safely. People were given appropriate aids when they needed them and were supported in their use. Where people needed to be fed by staff, staff sat with them, observing the person to ensure they were swallowing safely. Where residents were artificially fed by tube, it was noted that tube feeding equipment was discrete and not obvious, so as to support the normality of the environment. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be provided with appropriate personal and healthcare support. Systems relating to administration of medicines are largely safe, but attention is needed to certain aspects of documentation. Evidence: Most of the people who live in Holly Lodge have complex needs for personal and healthcare support. We observed staff supporting residents with complex needs throughout the inspection. One resident experienced an epileptic fit. A member of staff remained with the resident as their condition improved after the fit, supporting them and making observations of their condition, including full and accurate records. Staff were aware of the importance of privacy for residents. On one of the units, staff were observed to knock on a persons door whilst they were using the toilet in their en-suite facility and await an answer before entering. The importance of ensuring this type of privacy was also documented in the individuals records. One residents record indicated that they could at times show complex behaviors. They Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: had very clear care plans, including night care plans, about these behaviors and how they were to be managed. Assessments and care plans were written in nonjudgemental language. Staff spoken with were aware of actions to take and these were observed to be followed during the inspection. Where residents needed supports with activities of daily living, they had care plans in place, for example relating to their needs to eat or drink. Where residents were assessed at being at risk of pressure ulcers, they had care plans in place to direct staff on how risk was to be reduced. Care plans used generalistic wording such as regularly, relating to needs for changes of position. As good practice, care plans relating to prevention of risk of pressure damage should state how often the person needed their position changing, in measurable terms. Where residents needed their conditions monitored, the home maintained records, for example for what the person had eaten and drink. Most records were very clear, however a few of the records of fluids drunk by residents had not been totaled every 24 hours and this is needed, to ensure that the person has been able to drink enough to prevent risks of dehydration. Some residents had complex medical needs. Where this was the case, it was clear that advice from relevant healthcare professionals was sought. Where a healthcare professional had given the home advice, their directions were put in the residents notes and all staff signed and dated to state that they had read them. Staff spoken with understood the interventions needed. For example where a speech and language therapist had directed on how much thckening agent a resident needed in their drinks to be to swallow safety, staff spoken with were fully aware of this need. One relative reported that the slightest little thing, they see to [the person] and another that they appreciated that weve met the doctors here. Residents are prescribed a range of medicines to manage their medical conditions. Where a resident is prescribed a drug which can affect their activities of daily living, such as an apperient, painkiller or mood altering drug, care plans are drawn up. These are regularly evaluated, so that the effectiveness of the intervention can be assessed. Where a person was prescribed a topical cream, there were care plans to direct staff on actions to take to meet the persons need. Each unit has its own medicines trolley but there is a central cupboard for Controlled Drugs and medicines which need to be stored in a refrigerator. There were full records as required relating to Controlled Drugs. During our visit, two registered nurses were checking in all the medicines which had been received from the pharmacist. The home has systems relating to drugs sent for disposal, including full records of drugs which had been refused, spat out or dropped. Where drugs had a short expiry date, the date of opening is placed on the container. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The home has had issues relating to medication errors, which they have reported to us. They have reviewed systems for administration of medicines, to reduce risk. This included the registered nurse not taking the medicines trolley round, but performing each administration individually, checking the record in the office, taking the medicine to the resident, checking that they have swallowed it and then signing the record. This was observed to take place during the inspection. However some registered nurses reported that these new systems had not yet been followed by all staff. We observed that whilst most medicines administration records had been completed, this was not the case for all records. A registered nurse reported that where records had not been completed, the registered nurse had probably forgotten to sign the medicines administration record. If the record is not completed, the home cannot evidence that the resident has been given their prescribed medication and it also indicates that the registered nurse was not following the homes own polices and procedures on administration of medicines. Some residents needed homely medicines, such as cough medicines. Where the home were giving residents such medicines, they maintained records of what they had given and how often they had been needed. However the home does not have an agreed protocol with residents GPs for use of such medicines and this is advised, so that all people can be assured that such medicines have been given with the full knowledge of the residents GPs. This is particularly where such medications may affect an existing medical condition or use of a prescribed medication. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their views listened to and will be safeguarded, however some improvements are indicated in documentation of complaints. Evidence: Holly Lodge has a complaints policy, which is displayed in the main entrance area. A pictorial version of the complaints procedure has also been issued to all residents. In their annual quality assessment, it was reported that the provider also has a video to reinforce how to use the complaints procedure. They also reported that all staff were aware of the procedure and knew how to implement the internal postcard system for complaints. Residents were not able to discuss with us how they brought up complaints and matters of concern. Staff reported that generally issues of concern would be raised with the persons key worker, who could then ensure that the persons concerns were addressed. We have had no complaints made to us about the service since the last inspection. The home maintains a complaints register. We looked at this register and only one matter had been recorded since the last inspection. The record stated the circumstances of the complaint, however whilst the record documented how the investigation was conducted, there was no evidence on file to support this, such as statements from staff. It also did not state how the individual was responded to, although the manager Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: was fully aware of and able to report on all the circumstances relating to the matter. No safeguarding referrals have been made about this home since the last inspection. All staff spoken with were aware of their responsibilities under the local procedure and were able to describe how individuals cared for in the home could be placed at risk by their individual behaviors. Records showed that all staff have been trained in safeguarding and are regularly up-dated. Incident records showed that all complex behaviors between residents or from residents to staff are documented and statements taken where relevant. When indicated, following a resident showing complex behaviors, care plans were revised and external supports sought. In order to safeguard residents financial interests the home has an invoicing system for residents moneys. Residents who are going out of the home are able to access a petty cash system and the amount is then debited from their individual account. There was evidence that all financial transactions relating to residents are regularly audited as part of monthly visits by the provider and also during financial audits. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home will be supported by a clean, homely environment which meets their needs and where necessary equipment relating to disability and healthcare is provided. Evidence: Holly Lodge was built with the needs of the current client group in mind. One relative reported that they were impressed that everything is purpose-built. All resident accommodation is on the ground floor. Holly Lodge is divided into three separate units, which are run separately and have their own support facilities such as laundries, sluice rooms and kitchens. All of the bedrooms are large and able to be arranged flexibly, so that the needs of individual residents can be met. For example where residents have complex nursing needs, there is ample space on both sides of the residents bed. Windows are of a height where residents can see out from a sitting position and windows go down to the floor, to provide additional light and interest. Staff reported that maintenance was promptly available when needed, including an out-of-hours service for emergencies. A wide range of equipment is provided for residents, including ceiling hoists. Residents have assessments of their seating and mobility needs and relevant equipment such as Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: wheelchairs are provided, following physiotherapy and occupational therapy advice. The manger reported that if a person needed a particular type of equipment, either on admission or subsequently, that she has no difficulty in obtaining it from the provider. The home has its own attractive patio garden area, which is fenced in and safe. A variety of planting, garden ornaments and colourful wind chimes are provided, to provide an stimulating, attractive area. There is one central function room and a Snoozelum room, which can be used by anyone in the home. All of the units have their own sitting/dining room. Furniture is domestic in tone and looked comfortable. The dining areas all had linoleum floors and the seating areas were carpeted. The dining room floors are deteriorating, which detracts from the homely atmosphere and it is recommended that they are replaced before they deteriorate further. We met with the housekeeper, who manages the domestic staff and cook. The housekeeper has clear cleaning schedules which are regularly reviewed and monitored to ensure quality of service. The home was clean throughout, including difficult to reach areas such as behind tumble dryers, bases of hoists and undersides of toilet rails. One relative reported that the home was always spotlessly clean. Staff were observed to follow principals for prevention of spread of infection. They were observed to wear gloves and aprons when indicated and dispose of them properly. One carer was observed to carefully cleanse their hands before handling tube feeding equipment. Items such as non-slip bath mats were stored clean and dry. One carer spoken with, who was doing the laundry, showed a very good understanding of the principals of prevention of spread of infection relating to the laundry. This was particularly good practice, as the persons first language was not English and they reported that they had not worked in the home for a long period. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by a competent team of staff, where training is supported and staff are fully supported in their roles. Residents could be put at risk by the staff recruitment process, where not all required pre-employment checks have taken place. Evidence: The manager reported to us that the home now has a stable team of staff, with a normal turnover. This was supported by the homes annual quality assessment. Records showed that agency staff are not used. Staff generally work on one of the three units, although they will also work in other areas when needed, to cover for sudden shortages, such as staff sickness. The home maintains very clear records relating to training. All staff spoken with reported that training, including National Vocational Qualifications were encouraged and supported. One carer reported that they could read training plans and indicate what they wanted to be involved in. Recent training has included dementia, bereavement, dysphagia and epilepsy. Records also showed that staff have been trained in specific areas such as how to use particular manual handling equipment relating to an individual resident or how to manage tube feeding systems for individual residents. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: We met with two members of staff who had recently been employed. They reported that they had felt fully supported during their induction period. One senior carer reported that a new employee would be allocated to a person to work with, who would gradually show them what needed doing, allowing the person to perform more and more roles, as they became more confident. Induction programmes comply with guidelines and had been fully completed. Staff work fully supervised until their police checks have been returned. This was shown by discussions with staff, our observations and reviews of records. We looked at records relating to three new employees. Improvements are needed in the recruitment system. One of the newly employed people showed significant gaps in their employment history. There was no written evidence that this had been probed. Another newly employed person had only one reference on file, the other reference was a to whom it may concern reference, which had not been directly sourced. Such references are not acceptable. In order to protect people, the home must ensure that the recruitment of new staff is fully carried out and that all required pre-employment checks are completed. All of the people had a photograph on file, but all were photocopies of passports and as such were not clear. The standard application form requests the referees occupation, not the capacity known in and for one newly employed person, the occupation stated for the referee did not clarify why this person was to be approached for a reference. The home does not use an interview assessment record and this is recommended, to ensure that the principals of equal opportunities have been fully complied with and to identify a new employees strengths and weaknesses, before employment. As Holly Lodge is a care home with nursing, at least one registerednurse is always on duty. Records seen did not provide evidence that two of the registered nurses had continued their registration with the Nursing and Midwifery Council (NMC) after November 2008. Discussions with the head office indicated that they have performed checks and were able to verify that all registered nurses had continued their registration, however as Holly Lodge is a care home with nursing, they need to be provide evidence that at all times, there is a registered nurse on duty who is able to practice in accordance with NMC Guidelines. Discussions with staff and records showed that all staff are regularly supervised and have an annual appraisal. All staff spoken with reported that they felt supported. One person commented that if they identified training needs or areas where they felt training needed to be developed, they could put this forward and they knew they would be listened to. Care Homes for Adults (18-65 years) Page 25 of 34 Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holly Lodge is run in an effective manner by an experienced manager, who is supported by the provider. The principals of health and safety are largely followed, however there are two areas which need attention, to more fully eliminate risk to residents. Evidence: Holly Lodge has an established, experienced manager, who is qualified in her role. The home has a clear management structure. This means that staff knew what their roles were and how to ensure that matters are passed on to relevant people in the organisation. One person is in charge of each unit and all staff report to them about the condition of residents. One registered nurse is in charge of the building on a dayto-day basis and they coordinate systems to ensure that residents needs are met. There is a housekeeper who is responsible for management of the domestic staff, the cook, the ordering of foodstuffs and cleaning equipment and chemicals. The home is regularly visited by a manager from the providers and a report is made. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Reports showed that these visits happen on an unannounced basis, on different days of the week and at different times. This person meets residents and staff when they visit and makes notes of a range of matters, including where matters need attention. The home is additionally visited by trustees from the provider and they also draw up a report. Regular quality audits take place, where comments are received from a range of persons, including relatives and healthcare professionals. The home produced a detailed annual quality assurance assessment and submitted it to us as part of this inspection. Clear records of accidents and incidents are made. These are reviewed and action taken where relevant. Staff are regularly trained in mandatory areas relating to health and safety, including fire safety and manual handling. During the inspection we observed staff performing manual handling several times, they did this safely and in accordance with guidelines. Staff were observed to inform residents of what they were going to do at all times and were keen to allow residents to help themselves as much as possible, within their own abilities. For example, they supported one resident in taking off the sling of their hoist when they had completed moving them. We looked at the fire log book and noted that the homes policy was that checks on the fire alarm needed to take place on a weekly basis. However the record showed that the last fire alarm test had been on 13/12/08. All other fire safety checks were correctly carried out in accordance with the companys policies. We noted that where oxygen was prescribed for a resident, correct warning signage was used and that there were safe systems for the storage of oxygen. Several of the residents were assessed as needing safety rails on their beds. Where this was the case, risk assessments were completed. These were regularly reviewed. Some bed rails were integral to the beds, others were supplied separately. The home has some profiling beds, which go down to the floor, but not all beds are like this. The use of such beds reduces the need for safety rails, as people can have their bed lowered down to the floor and crash mats, rather than safety rails used to protect them from injury if they roll out of bed. Where residents had non-integral bed rails, there was evidence that these were checked. However some of the bed rails were observed to be loose in their fixings, which has the potential for risk to residents. This had not been noted in records and staff were not aware that this was a risk. In order to ensure that residents are protected from the risks presented by safety rails, the home need to ensure that staff are trained in all areas of risk associated with their use and to ensure that all are safely used. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 All medicines administration records must be fully completed at the time the person is given their medication. This is to provide evidence that the resident had been given their medication as prescribed and if they have not, why this is. 27/02/2009 2 34 19 References for new employees must be directly sourced. To whom it may concern references must not be used. In order to assess a prospective member of staffs suitability for their role, a minimum of two satisfactory references are needed. Where references are not directly sourced from the referee, it is not possible to assess if the reference is genuine. 27/02/2009 Care Homes for Adults (18-65 years) Page 30 of 34 3 34 18 There needs to be a record in the home at all times to provide evidence of registered nurses current registration with the NMC. Where a person is employed as a registered nurse, the employer can only employ them as such if they have clear evidence that the person is currently registered with the NMC as a registered nurse. 27/02/2009 4 34 19 Where a prospective 27/02/2009 member of staff has gaps in their employment history, these must always be probed and evidence of why the person has such gaps be retained on file. An employer needs to know all of a prospective employees past working history to assess if they are suitable for their role. Gaps in employment history need to be probed, to ensure that these gaps do not indicate an unsuitability for their role. 5 42 24 The home must always comply with its own polices and procedures on checking of the fire alarm system. Checks on fire alarm systems are needed to ensure that the system will function as anticipated in the event of a fire. If checks are not carried out in 30/01/2009 Care Homes for Adults (18-65 years) Page 31 of 34 accordance with the homes established protrudes, there is a risk that people will not be advised in the event of a fire. 6 42 13 The home must set up 27/02/2009 systems to ensure that staff are fully trained in the use of bed safety rails and that checks ensure that bed rails are used safely at all times. There is a well documented risk associated with the use of bed safety rails. Therefore if they are indicated, staff must be aware of the risks associated with such equipment and how to carry out checks in a safe manner. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 19 19 All fluid balance charts should be totalled every 24 hours. Care plans relating to changes of position for people who are assessed as being at risk of pressure ulceration should be measurable and avoid works such as regularly. A homely medicines protocol should be drawn up and agreed with residents GPs Where complaints have been investigated, there should be a full audit trail retained on file and all known matters should be documented in full. The flooring in the three dining areas should be replaced. An interview assessment tool should be used when interviewing staff. The application form should be amended so that the referees capacity known in, rather than occupation can be shown. Photographs of staff should be clear so as to be able to be Page 32 of 34 3 4 20 22 5 6 7 28 34 34 8 36 Care Homes for Adults (18-65 years) used as proof of identity. 9 42 More profiling beds which go down should be provided when indicated, to further reduce the use of bed rails. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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