Inspection on 26/11/08 for Holly Lodge Residential Home

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly Lodge Residential Home 09/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Holly Lodge Residential Home 8 - 10 Station Avenue Bridlington East Yorkshire YO16 4LZ     The quality rating for this care home is:   one star adequate 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: Jean Dobbin     Date: 2 6 1 1 2 0 0 8 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. that people have said are important to them: They reflect the things 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 37 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 37 Information about the care home Name of care home: Address: Holly Lodge Residential Home 8 - 10 Station Avenue Bridlington East Yorkshire YO16 4LZ 01262678508 F/P01262678508 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Michelle Lee Name of registered manager (if applicable) Mr Simon Peter Sellars Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Holly Lodge consists of two adjacent detached properties. The smaller of the two properties provides accommodation for up to six people who require a more independent environment and the main building accommodates thirteen people. All the people have been assessed as having a mental health problem. Holly Lodge is conveniently situated for all main community facilities including the public transport network. The registered managers office is located in the smaller of the two properties. Both properties have three floors. The main building has a stair lift providing access to the upper floors. Ramped access is used to the main entrances. Peoples private accommodation consists of 7 single and 6 shared bedrooms. Emphasis is placed on providing social care and emotional support for people although some people do require some physical care. The main aim of the home is to help people recover their self-esteem and confidence and develop their independent living skills. The Statement of Purpose, service user guide and the latest inspection report, written Care Homes for Adults (18-65 years) Page 4 of 37 19 Over 65 0 care home 19 Brief description of the care home by the Commission for Social Care Inspection, are displayed in the home, for people to look at. The current weekly fees to live at Holly Lodge are £323. Additional charges are made for chiropody and hairdressing, and personal items like newspapers and toiletries. Care Homes for Adults (18-65 years) Page 5 of 37 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: one star adequate 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: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Holly Lodge, to staff and to other professional people who visit the home. 10 were sent to people at the home, and all were returned. 10 were sent to health care and social care professionals and 5 were completed and returned. 5 were sent to staff at the home and 3 were returned. Care Homes for Adults (18-65 years) Page 6 of 37 A telephone conversation was held with one health care and one social care professional, to ask their views about how the home runs. A visit to the home by one inspector, which lasted about 8 hours, from 9am to 5pm. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Holly Lodge. Information about what was found during the inspection was given to the registered manager at the end of the visit. We did this inspection with an expert by experience who spoke to people who are using this service. An expert by experience is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The assessment of peoples needs, carried out before people move to the home could be written down. This could show that all aspects of their support needs and personal goals have been discussed properly to check that they can be met if they choose to live there. Although care staff know and understand people well, more detailed information about peoples capabilities and personal goals could be written down. This would help staff to identify how these are to be built on, or worked towards and make it easier to check whether these have been achieved. Working towards individual goals helps to promote peoples independence, a feeling of self-worth and provides people with choice and control. Care Homes for Adults (18-65 years) Page 8 of 37 The records showing how peoples personal monies are managed within the home needs to be more robust, so that the paper records tally with the actual monies. This would show that peoples finances are being looked after properly. There could be a review of peoples leisure interests and what sort of things they would like to do. This includes contributing to the day to day running of the home, if this is what people want to do. Personal care plans could be written to show that peoples total health needs are being addressed, both to show that the care is being provided and also to inform staff that the care they provide is the right care. The way medicines are managed in the home could be improved, so that drugs are always given in a safe and recommended way. This would help to protect people from possible harm. Any allegation made by a person living at the home could be promptly reported to the local authority, so that they, as the professionals with responsibilities to look into these matters, can be satisfied that the person is not being harmed. The way people are recruited to the home needs to be more robust so that only properly vetted people are employed, so that there is no risk to the people living there. The way prepared food is stored could be improved so that it is easy to check when food needs to be discarded because it is no longer fit to eat. This would help to protect people from potential harm. If you want to know what action the person responsible for this care home is taking 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 37 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 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are looked at to make sure they can receive the right support if they choose to move there, however this assessment is not formally recorded to show that this is always being done thoroughly. Evidence: The manager said that people arent admitted to the home without their needs being assessed so that he can be satisfied that the staff have the skills to provide the right support. One person confirmed that they visited the service with their specialist nurse and was able to look round and speak with other people living there. They said they stayed for about two hours. The care records looked at contained a comprehensive assessment of the persons needs, which had been completed by a care manager. These care records, however, did not contain a written assessment completed by the manager. The manager explained that his assessment of the persons needs is translated into a Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: service user plan, which is written as a result of the assessment visit. People should only be admitted after he has completed a full assessment, and this needs to be written down, to show that it happened. This assessment needs to demonstrate that he has looked at all aspects of the persons needs, including their strengths and abilities. And also how they are likely to get on with the other people living there and how individual risk is to be managed. A discussion was held with the manager about a person-centred approach and how this could be achieved. Three people living there had completed their surveys themselves. These all said they were asked if they want to move to the home and two said they received enough information about the home, so that they know about it before they moved there. Each person has a service user guide in their room, providing information about the home, although one person said they had never bothered to look at it. Care Homes for Adults (18-65 years) Page 12 of 37 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. Whilst care staff know peoples individual preferences, choices and aspirations well, the records relating to these are not very detailed so they cannot always evidence how these choices are being supported. Evidence: Two service user plans were looked at in detail as part of the assessment process, and another two were looked at briefly. These describe the care and support people need to stay in charge of their own lives as much as possible. People spoken with said that they knew they had a service plan. Those looked at contained some signatures, showing their agreement to what had been written. Others spoken with said they knew they had a plan, but were not particularly interested in it. These plans were reviewed regularly with the individual and a key-worker is assigned to support them on a day-to-day basis. Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: Some service plans have been in place for many years, and a stable workforce, who know people living there very well, means that these records do not always contain a great deal of detail about peoples preferences, goals and aspirations. For example one person said they wanted to help around the home and they said that they kept their room tidy, stripped their bed and put their clothes away after they had been washed and ironed. This was not recorded in their service plan. The manager could look at more ways that this individual could be included in helping in the home. People do not use the kitchen as the manager says this would pose too much danger for some of the people who live there. However people should be allowed to take responsible risks as part of everyday living, in order to promote and maintain life skills. People should be encouraged to help with the day to day tasks in the home including their laundry, as part of everyday life. Three people spoken with said they would like to do a bit more around the house. People living in the smaller building have been assessed as being able to live more independently. Whilst one person keeps their own breakfast items in their room, the kitchen did not have the equipment to enable people to make a hot drink. The manager introduced these items in the days following the inspection. The manager looks after the personal monies for more than half the people at the home. These are securely stored in individual purses. Many choose to have their money as a daily allowance. Receipts are kept if staff buy an item for an individual, although these receipts are not stored in a way that makes them easy for authorised people to check. Records are kept of the money taken each day, and both the individual and the senior person sign a record sheet. One persons money was checked against their paper record. These totals didnt tally, as the person had between one and two pounds extra, compared with what the paper record said they should have had. The manager needs to have a system where checks are carried out to make sure records agree with the actual amounts, so that he knows that the records accurately reflect the amounts of monies he holds. Whilst one person said they had a lockable drawer in their room, another said they didnt, but also said that this didnt matter to them. Care Homes for Adults (18-65 years) Page 14 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live the life they choose in many ways, and generally enjoy their meals, however staff at the home could be doing more to develop their life skills and make their lives more stimulating. Evidence: No-one living at Holly Lodge undertakes any paid or voluntary work. A few people attend classes in the community like a sewing group and a bingo group, but people generally occupy themselves. One person said that they used to attend art lessons and cookery classes, but these have closed down. Another used to attend baking classes, but this too has finished. The manager says that staff spend evenings with people talking and playing board games. One person confirmed that people played Scrabble on an evening, but added I go to bed early because Im bored. They also commented though that their mood was low at this time. Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: People spoken with on the day of the visit were keen to give their views about the home. One person said I like it here. I like going out to the shops and the cafe. I do all sorts really. People generally though would like more things organised for them. One person explained that the home used to organise day trips, but that doesnt happen any more. They said they would like the home to start organising events again, or for things to happen in the home. The manager sometimes brings his dog to the home and two people commented positively about that. The manager explained that the home has to work within the financial constraints, set by the local authority. And people generally choose to spend their own money on personal items, leaving nothing for social activities. He also explained that one person who lived at the home until quite recently received a higher level of funding. This meant that all the people living there benefitted from the higher staffing levels at that time. And now this person has left the home, the staffing numbers have had to be adjusted again. This impacts on the level of support and supervision that can be provided in the community. One person said they liked living at Holly Lodge, but would like to get out more. They cant go out independently though and they said there arent enough staff to take me out. Some people are involved with the local church. One person is a churchwarden and another attends their church each week. One persons service plan describes their religion as Salvation Army, but the record does not say how this belief and interest is being supported. Family and friends are welcome anytime. One service file looked at contained correspondence from an independent advocate. The manager needs to make sure that all people who have minimal family support are offered an advocate so that they have someone who can speak out for them if necessary. People can get up, go to bed, mix with others, or keep to themselves, as they choose. Cooked breakfasts are available until 10am, with cereals after that. People said they liked the meals provided, but would like to have more say in the menu choices with some saying they would like more chips. One person said they went to the chippie three or four evenings a week, because they liked the food from there. The plan for the meals that week is not displayed, so people cant look forward to their Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: favourite meal. The days menu is displayed on a white board in the kitchen, so people have to look through the hatch from the dining room to see what they are going to eat. People should be being actively supported to help plan, prepare and serve the meals. This could also include ordering or buying some foods from the supermarket. Some people help the manager with the shopping. One person said the food is lovely. It is home cooked and Ive put weight on. The meal on the day of the visit was home made mince pie, cabbage, mixed vegetables and potato. Everybodys meal was plated up for them, with the gravy being offered separately. The dessert was pineapple upside down cake and custard. There is no formal meal choice, but the cook said that staff knew peoples likes and dislikes, so would prepare alternative meals if necessary. Care Homes for Adults (18-65 years) Page 17 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples mental health and physical needs are well managed, however the record keeping underpinning that care needs to be more detailed and written in a person centred way. The way medicines are managed in the home may be putting people at risk of harm. Evidence: People spoken with on the day of the visit said that staff were available to help them when they needed. Both male and female staff are employed at Holly Lodge, so that people have a choice of who to speak with, or get help from. Some service plans are long-standing, however care staff know peoples needs very well. These plans describe peoples personal care needs, but they arent written in a way that recognises and encourages people to do as much as possible for themselves. One plan said that the person needs help, but doesnt describe what help they need, and what they can do for themselves. This does not promote peoples life skills. People are able to go out independently into town and staff support them to buy their Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: own clothes and toiletries as necessary. A chiropodist and hairdresser visits the home, though it would be good practise for people to visit these services in town, with support if necessary, as anyone else would do. Some people said however that they liked these people visiting them at home. There are very good links with health care professionals and those surveys returned speak highly of the way peoples mental health care needs are managed. Comments include I feel they give a very high standard of care that would be difficult to improve on. And individualised approach to care. Always empathic to needs of individuals, and maintaining client dignity. The manager showed a good understanding of how changes in medication can affect peoples behaviours. One of the care staff explained the triggers that can bring on one persons behaviour that challenges the service, and how that behaviour is managed so that the person becomes calm again. Some people manage their own health care, by making their own appointments with health care professionals. Others receive support from a member of staff. The records relating to peoples physical health needs though, need to be in more detail, so that all staff are providing a similar level of support. One person has been diagnosed with a serious illness earlier this year. Although they have support from a specialist nurse, there was no reference to how staff could provide emotional support, as they come to terms with this diagnosis, without the support of family and friends. Although the person had been given information about their illness there was no evidence that they had been given the chance to talk about their worries for the future. Another person has a chronic illness for which the community nurse provides support. The care plan for managing this needs to be in more detail, informing staff of what to look for, to indicate that the person may be becoming unwell. A detailed plan of care will ensure the person receives safe consistent care. Medication systems were looked at and some serious shortfalls were noted. Medication used by the home is dispensed by the pharmacist into a monthly bubble pack, which staff, who have attended training, pop out into medicine pots for people to take. Nobody at the home currently looks after any of their their own medication. One person doesnt look after their own medicines, yet regularly stays away from the home, and then they are given their medicines to look after. The manager explained that the person doesnt manage this well, and sometimes returns home less well, Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: because the drugs havent been taken correctly. Although the manager tells us he has discussed this with their doctor he must discuss this again with health care professionals, the pharmacist and the persons care manager to see if this can be better managed, in order for this person to maintain their independence, but also be kept safe. Details about these discussions need to be written down. Another person was prescribed a new pain-killing drug about four weeks prior to the site visit and which was to be taken regularly. When new medication record sheets were started, about two weeks later this prescription was not copied on to the new record sheet, so for ten days they hadnt received this drug. This was discussed with the manager and rectified immediately, however the manager must urgently introduce a way to make sure this doesnt happen again. Regular checks are not routinely carried out to make sure drugs are being given and signed for, as prescribed. The number of actual tablets need to be carried forward from the old to the new medication record sheet so that checks can be done to make sure the actual number of tablets agrees with the number worked out on the medication sheet. One person is prescribed a drug which is to be stored in the fridge before its opened, but when in use is to be stored at room temperature. This guidance was not being followed and the item was being stored in the fridge. This person may well need this drug for the rest of their life, and the home should consider buying a small fridge, with an integral minimum and maximum thermometer, which can be locked, rather than keeping it in the domestic fridge. Prescribed creams and ointments were being stored in a drawer in an area of the home, which was accessible to the people living there. If people cannot keep these creams in their own rooms then they need to be stored securely and the manager addressed this on the day of the visit. People should be supported though to keep their own creams in their room, and to apply them themselves, whenever possible. If a prescription needs to be added to a medication record sheet then the details must be signed and dated by the individual who has written it. It is also good practise to have a second person checking and signing the prescription as this would help to reduce the risk of it being written incorrectly. All these shortfalls need addressing to protect people from harm. Care Homes for Adults (18-65 years) Page 20 of 37 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. People are confident that complaints will be addressed properly and staff are alert to the need to keep people safe at all times. Evidence: The complaints procedure is displayed in the hall and people spoken with and the survey reponses all said that they would tell someone if they were unhappy about something. The manager also provides a copy of a printed complaints form in various parts of the home, so that if people prefer they can write down their concerns and then give them to a staff member, rather than having to speak about them. Most people said they would speak to Simon (the manager) or their key-worker and all said that a complaint would be sorted out properly. One person has complained three times in the past year about incidents that have happened at the home. The manager has records to show that these have been investigated properly and the individual has signed their agreement to this. However one complaint included allegations against two members of staff. Although the manager tells us this was looked into properly and the incident was discussed with the staff involved there is no record of the discussion in the carers supervision notes. The manager explained that the individuals mental illness causes behaviour that challenges the service, by complaining about other peoples behaviours. Following this site visit the manager referred this allegation as a safeguarding alert, so that this Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: information is shared with the local authority, who have the lead responsibility in keeping people safe, so that they can decide if the individual is being protected from harm properly. All the staff attend training in Safeguarding Adults, and the need to keep people safe. One person spoken with was very clear about reporting anything they hear or see in the course of their work, which may be abusive behaviour. They said they would tell the manager immediately, as people have the right to be treated properly. Two safeguarding referrals have been made to the local authority in the last year. The manager referred promptly and appropriately and worked well with outside agencies to ensure systems were introduced in order to help to keep people safe and prevent similar incidents happening again. The recruitment process at the home is not robust. One staff member was working at the home before their full police check was available to look at and had gone out into town, unsupervised, with a person from the home. Recruitment checks are in place to make sure unsuitable people do not work with vulnerable people. (see Staffing and Management and Administration) Care Homes for Adults (18-65 years) Page 22 of 37 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. The service users are provided with suitable accommodation that meets their needs. Evidence: Holly Lodge is two adjacent detached houses, each with three floors. The larger property has ramped access and houses the main kitchen, dining room and two communal lounges, one of which is a smoking room, as well as the laundry facilities. The staircase has a stair lift and there are bedrooms on the first and second floors. There is at least one toilet and wash hand basin on each floor, with bathrooms on the first floor. The home was noted to be generally clean, warm and homely, but some areas look tired and in need of redecoration. Peoples rooms had been decorated very individually and contained some items that meant something to the individual to make it seem like home. One person was eager to show their room, which had been decorated how they wanted it, and of which they were clearly very proud. The shared rooms had privacy curtains and one person confirmed that staff routinely used them. The personal rooms looked at were a good size. One person had a double bed, and another had a settee in their room. Another person had a computer and access to the Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Internet as well as a large collection of books. One personal room though was noted to be very cold. The person, who spends a lot of time in their room, said that oil filled radiators had been provided, as the room didnt have central heating, but that they didnt like them. After discussion with the manager he is organising a different way of keeping the room warm, though this should have been addressed prior to this visit. The second property is slightly smaller and people living there have been assessed as being more independent. People have their own front door key and several choose to have a key and keep their own room locked. An intercom system is used so that people can summon help if necessary, as these individuals are encouraged to be as independent as possible. One person said they stripped their own bed every two weeks and took it to the laundry area to be washed but had never, in their life, done their own washing. People eat their meals in the dining room of the larger property and spend time in that building as they choose, particularly as the smaller property does not have a dedicated room in which to smoke. The smaller property has a kitchen but the facilities currently provided do not encourage independent living. There is a large outside space at the back of the home and the gardens are tidy and maintained. There is outside seating at both the front and the back, so that people can sit and watch the world go by. The manager makes sure that appropriate aids are available and used to make sure that people living and working in the home are protected against infection. One member of staff spoken with said the home never ran short of cleaning equipment and disposable gloves. The laundry area was noted to be clean and tidy. Care Homes for Adults (18-65 years) Page 24 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and feel valued, but recruitment systems need improving to keep people safe. Evidence: Holly Lodge has a stable staff team and several have worked at the home for a number of years. The manager has two assistant managers which means a senior person works at the home every day. The manager states that generally there are two carers, a cook and a cleaner working each morning, two carers and the manager in the afternoon and two carers in the evening. There is one waking carer at night and a second person, who sleeps between 12 and half 5 at the home and is available to assist if necessary. The manager added that he has a caring role in the morning and carries out management duties in the afternoon. People spoken with liked the staff. One person said theres enough staff and I get on with them well. The ten surveys completed by people living at Holly Lodge said that staff always or usually treated them well, and listened and acted on what they said. Staff provide primarily emotional support for people living there, although they are alert to other more practical or hands-on care. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: On the day of the inspection visit one carer was cooking the lunch and another was working in the home, beside the manager. The second carer though seemed to also spend much of the morning in the kitchen. As people living there arent allowed into the kitchen, this meant that people were generally left to occupy themselves. This way of working was discussed with the manager, who explained that he would have been working more in the home if the site visit hadnt taken place, so would have been more available for both the people living there, and the staff. Care staff at the home wear a uniform however people generally require supportive and emotional care, rather than personal care, so some people may see this as a barrier to partnership working. Two members of staff talked of the training they had attended in the last year. They said the manager supported them to access training that was appropriate to the needs of the people living there. All staff have recently attended training in dementia awareness so that they have more understanding of the specialist needs of people with this illness. One was able to explain how one individual, who has behaviour that challenges the service is supported and what sort of triggers may bring about this behaviour. More than half the care team at Holly Lodge have achieved a minimum National Vocational Qualification Level 2 in Care. People are more likely to be supported in a safe, consistent manner by people who have a good understanding of their roles. Only one recruitment file was looked at. This person had completed an application form, however their employment history included two gaps. Whilst the manager could explain one of these gaps, there was no written evidence that these gaps had been explored at interview. Both written references were dated after the individual started working at the home. The manager said that verbal references had been received prior to the individual being deployed, but again there was no written evidence of this. These checks need to be carried out in a robust way to make sure unsuitable people are not employed in a care setting. The same person started work after a PovaFirst check had been completed to make sure they werent already barred from working in a care setting because of a previous offence. The complete police check was not yet available to look at. The manager said this person does not work unsupervised; however they were in the town that afternoon with one of the people from the home. These regulations are in place to make sure vulnerable people are kept safe, and not complying with them is putting people at risk of harm. (See Concerns, Complaints and Protection and Management and Administration) Care Homes for Adults (18-65 years) Page 26 of 37 Care Homes for Adults (18-65 years) Page 27 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an enthusiastic and knowledgeable manager. However some aspects of the way the home operates needs improving, to make sure it is being run in the best interests of the people living there and that peoples well being is always promoted. Evidence: There is a very experienced and enthusiastic manager at the home, who has held that position for over 20 years. He has completed extra training to give him more knowledge and skills to help him in his role. One professional commented in their survey that I do know that the manager has a very good level of skill, knowledge and experience. He showed in conversation that he had a very good knowledge of peoples individual strengths and needs and how changes in peoples mental health affected their behaviour. People living at the home, who were spoken with all said he was always available to speak to and would always help them to sort any problems out. Their responses suggested that he was well liked and very easy to speak with about any Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: aspect of their life. The manager has a quality monitoring system in place, where each year he asks people at the home, their family and visiting professionals to provide written comments on how the home runs. Comments received from relatives and health care professionals earlier this year speak very positively about how the home is run, and the support people receive. Those from people living there were also satisfied. Whilst seven out of ten surveys sent to the home as part of the inspection process were completed with the help of a care worker those also reported that they were satisfied with how the home operates. Very different responses however were provided when people were spoken with individually on the day of the visit. The manager needs to determine whether a different system to a written survey would provide more meaningful information about what people think about the home. Comments from these surveys are looked at to see if changes need to be made as a result, and an action plan is put together. These records are available to look at. The manager also carries out his own checks on how the home is running, though such as medication processes are only reviewed once a year. The home uses an external fire safety company and health and safety company who visit the home twice a year to check that the systems in place at the home remain satisfactory. Recruitment processes however are not robust and the manager needs to have better systems in place to make sure people are vetted properly before they start working at the home. And also if the full police check for an individual is not available to look at, then the individual must not be working unsupervised with people living there. These systems are in place to keep people safe and not following them may be putting people at risk of harm. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practises by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Staff surveys and records confirmed that staff attend these compulsory training sessions, in order to keep people safe. A sample check of the gas safety certificate and fire safety checks show that the home is well maintained. However the fridge contained prepared foods that were not labelled, so it was unclear how long they had been there and whether they were still safe to eat. These items were labelled immediately, but the manager needs to monitor that this is always done, as this will help to keep people safe. Care Homes for Adults (18-65 years) Page 29 of 37 Care Homes for Adults (18-65 years) Page 30 of 37 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 31 of 37 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 2 14 There must be written 08/05/2009 evidence that an individuals total needs, including their aspirations and capabilities have been discussed and the person should be encouraged to sign that they agree with whats written down. This is so that peoples needs can be properly looked into and that they are likely to fit in if they choose to move there. 2 16 16 People must be consulted 08/05/2009 with, to find out the type of activities they would like to see and how the home can support them with maintaining their interests. Staff must be more available to speak with people so that these issues can be looked into informally. These comments then need to be looked into to see if any can be organised by the home. Care Homes for Adults (18-65 years) Page 32 of 37 This will show that the home is being run in peoples best interests and their individual needs are being catered for. 3 20 13 Medicines must always be 08/05/2009 stored as recommended by the manufacturer, and given as prescribed. Audits must be carried out regularly to make sure this is always happening. This will ensure that people are receiving their drugs as they are prescribed. 4 20 12 There must be a plan put in 08/05/2009 place to make sure the person identified in the inspection is able to receive their drugs, as prescribed, whether they are in, or away from the home. This will ensure the drugs can effectively treat the medical condition for which they are prescribed 5 23 12 Any allegations of abuse 08/05/2009 must be promptly reported to the local authority so that they can look into the allegation and satisfy themselves that the person is not at risk of harm. The commission also needs to be notified of these events. This will help to ensure peoples safety is being protected. Care Homes for Adults (18-65 years) Page 33 of 37 6 23 17 The manager must make 08/05/2009 sure that financial records accurately reflect the personal monies held at the home on peoples behalf. Checks should be carried out to how that these records remain accurate. This will show that peoples monies are being looked after properly. 7 34 19 People must be properly vetted before they start working at the home. This includes checking any gaps in the persons employment history and obtaining two written references. If people work at the home after a PovaFirst check is completed, but before the full police check is available to look at, the individual must not be left on their own with a person living at the home. This will contribute to keeping people safe. All prepared foods must be covered and accurately labelled to show when they were prepared. This would help to indicate when they should be discarded, in order to protect people from harm. 08/05/2009 8 42 13 08/05/2009 Recommendations Care Homes for Adults (18-65 years) Page 34 of 37 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 6 The service user plan could place a greater emphasis on the persons strengths and how these can be built on. This should include life skills and how the staff will work with the individual to enhance those skills. The service user plan should place a greater emphasis on the persons strengths and how these can be built on. This should include life skills and how the staff will work with the individual to enhance those skills. People need to be assessed as to whether they are at risk of harm if they do any tasks in the kitchen. If the risk is assessed as too high, then this needs to be written down and recorded in their service plan. Staff at the home could seek out learning opportunities and social events in the community and provide this information to people so that they can decide whether this is something they may be interested in becoming involved with. People could be encouraged to be involved in the planning and serving of meals at the home, as this would improve their social skills and enable them to contribute more to the meal choices. Peoples service files could be written in a more person centred way, emphasising the things that people can do for themselves. This would help to ensure they receive the same level of support from different carers. Handwritten entries and changes to the medication record sheets should be accurately recorded and detailed. This makes sure that the correct information and dose is recorded so a person receives their medication as prescribed. The manager should consider buying a lockable drugs fridge with an integral minimum/maximum thermometer so that there is a secure place to store drugs needing to be kept cool. The temperature of such a fridge needs to be monitored and recorded each day to demonstrate that drugs are being kept at the correct temperature. There could be more consultation with people about the day-to-day running of the home and the meals that are provided. This must be done in a way that is comfortable for people who may have had to make few choices and decisions in their lives.This will help to ensure that the home is being run in the best interests of the people living 2 6 3 9 4 12 5 17 6 18 7 20 8 20 9 39 Care Homes for Adults (18-65 years) Page 35 of 37 there. Care Homes for Adults (18-65 years) Page 36 of 37 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). 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