Inspection on 08/11/05 for Holly Tree Cottage

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly Tree Cottage 18/10/07

Holly Tree Cottage 20/02/07

Holly Tree Cottage 26/05/05

Holly Tree Cottage 12/10/04

Holly Tree Cottage 04/06/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Holly Tree Cottage 243 Berrow Road Berrow Burnham-on-Sea Somerset TA8 2JQ Lead Inspector Ms Jane Poole Unannounced Inspection 8th November 2005 09:40 Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holly Tree Cottage Address 243 Berrow Road Berrow Burnham-on-Sea Somerset TA8 2JQ 01278 788008 01278 787939 enquiries@homes-caring-for-autism.co.uk www.homes-caring-for-autism.co.uk Somerset HCA Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Paul Thomas Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Upstairs bedrooms must only be used for service users who are physically mobile. 26th May 2005 Date of last inspection Brief Description of the Service: Holly Tree Cottage is registered with the Commission for Social Care Inspection to provide care for up to 7 people who have a learning difficulty. The house itself is a large detached property set close to public transport links and within walking distance of a shop and public house. All bedrooms are for single occupancy and all have en suite facilities. Communal areas are located on the ground floor; these consist of a dining room, a lounge and conservatory area. The home is owned by Somerset HCA Ltd, the responsible individual is Shirley Smith and the registered manager is Paul Thomas. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a 5.5 hour period. The inspector was able to spend time talking with staff and service users and to observe care practices in the home. The registered manager was not available at the time of this inspection but other members of the management team made themselves available throughout the day. What the service does well: What has improved since the last inspection? Since the last inspection the care plans have improved. These have been completed by the home’s staff and are personal to the individual. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 6 Staff no longer wear uniforms and therefore service users are able to integrate much more easily into the community when out in groups. The recruitment process in the home has also improved and all new staff are checked against the Protection Of Vulnerable Adults register or have full Criminal Bureau checks before they commence work. The procedures for administering medication have been changed and all staff have received additional training in this areas. Staff felt that the new system was robust and minimised the risk of mistakes. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4. The pre admission process for new service users is excellent. Needs are fully assessed and there are ample opportunities to meet staff and service users. EVIDENCE: The statement of purpose continues to reflect the services offered in the home. Service users and their representatives are able to visit the home to meet staff and other service users before making a decision to move in on a permanent basis. The inspector was able to meet with, and view records of, the most recently admitted person. A full assessment had been carried out by the home to ensure that they were able to meet their needs. Training materials, to assist staff to further understand the needs of the new service user, had also been made available. The service user stated that they had visited the home on more than one occasion, had had meals with service users, joined in with activities and stayed overnight before deciding to move in. There was evidence in the home that when a new service user is referred the staff consider not only their needs but the needs and wishes of the existing group. Minutes of a service user meeting showed that everyone had been Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 9 given the opportunities to raise any concerns about the new person joining the group. The service user stated that they had been made very welcome at Holly Tree Cottage by staff and service users. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Service users are able to make choices about all aspects of their day to day lives. The care plans have improved and now give clear information about individual needs and wishes. EVIDENCE: Since the last inspection staff have worked hard to create very personal care plans for each service user. The inspector viewed two personal files. Care plans seen were very personal to the individual and gave information on all areas of daily life. There is space on the care plans for staff to write additional information as needs and wishes change. Daily records are also maintained. Some service users have a reward system and the documentation in respect of this is unclear which could lead to confusion for staff and service users. This was discussed during the inspection. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 11 The inspector was able to spend time in the home talking to staff and service users and observing care practices. It was apparent that service users are involved in all decisions in the home. Service users stated that they choose how they spend their time and agree activity programmes. One person is able to go out without staff supervision and was fully aware of any restrictions in place in respect of this. The inspector noted that issues of risk are discussed with service users when planning activities and that staff consider the positive issues of risk taking as well as the negative. There are ample opportunities for service users to express their views and be involved in the day to day activities in the home. During the day, service users assisted with chores around the house, including preparing lunch. The inspector observed that one service user requested that a particular member of staff worked with them and this was agreed. There are regular service user meeting and minutes showed that this is an opportunity to share information and discuss issues. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Service users take part in a wide range of leisure activities in line with their expressed interests and abilities. Staff work flexibly to enable service users to access community facilities during the day and evening. EVIDENCE: As previously stated service users are involved in household tasks, which enables them to learn and develop independent living skills. Service users stated that they assist with cooking meals, cleaning their rooms, shopping and laundry. One service user attends college full time, one person has a part time job and other people attend further education, including arts and crafts and music, on a sessional basis. All service users have activity programmes, which involve a high level of community involvement. People stated that they went horse riding, swimming, shopping, go-karting, cycling and walking. Leisure activities also include Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 13 attending social clubs and pubs, going to the pictures and to local events. Staff work flexibly to ensure that service users are able to attend events in the evening as well as the day. Service users stated that the night before the inspection they had been to the local carnival. Service users told the inspector about a camping holiday to Cornwall that they enjoyed in the summer. The inspector observed that people moved freely around the communal areas of the home and were able to spend time alone in their rooms if they chose to. The home has two vehicles and also uses public transport. Since the last inspection the staff have stopped wearing uniforms, which enables groups to integrate more easily into the community. Service users keep in touch with family and friends by telephone and visits. The inspector noted that service users were able to use the office phone to communicate with family. All post is delivered to service users unopened and staff offer assistance with correspondence if requested. Many of the service users have regular breaks away from the home with family members. All meals are cooked by the care staff and service users. There is a four week menu that gives a wide variety of meals. Service users stated that they are able to have an alternative at any meal. All service users who expressed an opinion stated that the quality of food in the home was very good and that they received ample portions. The inspector noted that hot and cold drinks were available throughout the day. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Service users have access to healthcare professionals in line with their individual needs. All staff have now received additional training in the administration of medication and the procedure has been changed to minimise the risk of mistakes being made. EVIDENCE: All service users have their own en suite facilities and there is a communal bathroom on each floor. Care plans give details of the level of assistance required with personal care. There are male and female care staff, which enables people to have a choice of the gender of the carer who assists them with intimate personal care. All service users are registered with a local GP and other healthcare professionals appropriate to their individual needs. Records are maintained of all appointments and kept in individual personal files. All service users have a lockable cupboard in their room where medication is stored and dispensed from. Individual Medication Administration Records are also kept in private rooms. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 15 Since the last inspection all staff have received additional training on the administration of medication and the procedure has been changed to ensure that two staff administer and sign each time medication is given. The inspector viewed the MAR charts and found them to be correctly signed when administered or refused. Some medication is given on a PRN basis and the inspector did not see clear guidelines with MAR charts as to when it would be appropriate to give these medications. Currently no one living at the home administers their own medication. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. The home have taken reasonable steps to minimise the risk of abuse to service users. There appears to be an open and inclusive atmosphere in the home that enables people to raise concerns with staff or managers. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Staff spoken to were aware of the ability to take serious concerns outside the home and stated that they would feel comfortable to do so in appropriate circumstances. Service users stated that if they were unhappy with any aspect of their care they would approach a member of staff. All service users have access to family members or independent advocates outside the home. The home is not a financial appointee for any service user but small amounts of personal allowance are kept in the home. Each person has a locked tin and individual records are kept. All service users have personal bank accounts. Since the last inspection the home have changed their recruitment procedure and all staff now have a Protection Of Vulnerable Adults check or full enhanced Criminal Records Bureau check before commencing work in the home. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 17 Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 & 28. Holly Tree Cottage provides a comfortable home for service users. EVIDENCE: Since the last inspection the home have redecorated some areas giving it a younger more modern feel. Minutes of service user meetings give evidence that the service users were involved in the choices of colour. All bedrooms are for single occupancy and all have en suite facilities. One service user showed their room to the inspector, this had been personalised to reflect their own tastes. All communal areas are located on the ground floor and are accessible to all. There is a dining room, lounge and conservatory. Outside there is a pleasant secure garden. Holly tree cottage is located in a quiet residential area and is within walking distance of shops and a pub. There is easy access to public transport links. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 19 On the day of the inspection all areas seen by the inspector were clean and fresh. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 & 35. The home is effectively staffed to meet the needs of the service users. Staff appear positive and enthusiastic in their roles. EVIDENCE: There is a clear staff structure with each shift having a shift leader who allocates work and ensures the smooth running of the shift. In addition to the shift leaders there is a care manager and a junior care manager who work across all shifts and give direction and support to staff. Staff stated that there is always a senior member of staff on call. All service users are funded according to their level of need and the staff support which they require. Staff spoken to stated that there is always adequate staff on duty. Now that the home is full they have increased the night staff hours to two waking staff instead of one waking and one sleeping in. Although the home has been open for less than two years they have already undergone many changes in management. Staff stated that this had been confusing and demoralising at times. The staff team and care manager should be congratulated that they have continued to offer a person centred approach to care and remain motivated and enthusiastic with service users. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 21 There are 18 care staff employed at the home, 6 have National Vocational Qualifications in care and a further 7 are working towards this. There is a clear career structure in the home with care managers and junior care managers having the opportunity to undertake the Registered Managers Award. (NVQ level 4) Staff spoken to were happy with the training in the home. In addition to NVQ’s staff undertake training specific to the needs of the service users and health and safety issues. Some staff recently attended a conference on Autism in Sheffield, which they found very enjoyable and beneficial. The care manager and junior care manager are currently reviewing the induction training in the home to ensure that it is robust and informative for new staff. The inspector viewed the recruitment files of three recently appointed staff. They contained all items required by the National Minimum Standards and give evidence of a thorough recruitment procedure. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39 & 42. The quality assurance systems in the home would benefit from being expanded. EVIDENCE: The registered manager of the home is Paul Thomas who was not available at this inspection. In addition to the registered manager there is a newly appointed manager and a care manager. Staff spoken to stated that the current management team were open and approachable. There are regular staff and service users meetings where people are able to share information and make suggestions about the home. The home is currently up dating their policies and procedures to ensure that they are appropriate to the home. These will be viewed in detail at the next inspection. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 23 Action has been taken to minimise environmental risks and the possible challenging behaviour of some service users has been considered when furnishing the home. The home is fitted with a fire detection system. The fire log shows that the system is tested regularly by outside contractors and alarms are tested weekly by staff. The emergency lighting is not regularly tested and a system must be put in place to ensure that this is carried out. Staff stated that they received training in fire safety during their induction and practiced evacuation weekly when the alarms are tested. All staff must receive regular up dates on fire safety and prevention. Appropriate certificates are in place in respect of the gas and electrical installation and portable electrical appliances. The environmental health department visited the home on the 20th October and made no recommendations. The inspector did not see evidence that the home regularly seeks the views of interested parties outside the home. There are regular service user meetings and questionnaires have been sent out to some service users to gauge their feelings about the service offered. The home should now expand their quality assurance systems to include all current service users and interested parties outside the home. Up to date certificates of registration and insurance are displayed. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 3 4 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 4 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 3 X X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holly Tree Cottage Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X 3 2 X X 2 X DS0000058862.V261615.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA39 Regulation 25(1)(3) Requirement Timescale for action 28/02/06 2. YA42 The manager must ensure that there are effective quality assurance systems in place which include the views of interested parties outside the home. 23 The manager must ensure (4)[a][c][d] that:• Emergency lighting is regularly tested. • All staff receive regular training in fire prevention and safety. 30/12/05 Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard YA6 YA20 YA23 YA40 Good Practice Recommendations The rewards systems used in the home should be clearly outlined in care plans, including dates for review. Guidelines should be available with Medication Administration Records in respect of the use of PRN medication. The whistle blowing policy should be displayed in the home. The homes policies and procedures should be reviewed to ensure that they are appropriate to the home. Holly Tree Cottage DS0000058862.V261615.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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