Inspection on 05/09/05 for Holly Tree Lodge

This inspection was carried out on 5th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly Tree Lodge 06/11/08

Holly Tree Lodge 11/12/06

Holly Tree Lodge 20/01/06

Holly Tree Lodge 24/02/05

Holly Tree Lodge 15/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Holly Tree Lodge 122 Spring Road Kempston Beds MK42 8NB Lead Inspector Linda Cappello Unannounced 05 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holly Tree Lodge Address 122 Spring Road Kempston Beds MK42 8NB 01234 266391 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Saravanamuttu Sivapalan Lorraine Adibi care home 14 (14) Category(ies) of LD - Learning Disability registration, with number of places Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to seven service users may be aged over 65 years 2. Service users at 01.08.03 with a physical disability may continue to be accommodated whilst their needs can be met. No further service users with mobility problems may be admitted without suitable adaptations to the building. Date of last inspection 24th February 2005 Brief Description of the Service: Holly Tree Lodge is a care home registered for up to 14 adults who have a learning disability, some of whom also have physical disabilities. To improve the rooms available for residents, the home has reduced the use of shared rooms and now accommodates up to 12 people. The registration provides for younger adults and also for seven service users of retirement age. The home also provides day care for the majority of service users. The home is situated in a pleasant residential area of Kempston, close to local amenities and a short car journey away from Bedford town centre. The accommodation comprises a main building for nine persons, four of whom share double rooms. Three bungalows designed to promote a more independent lifestyle are located in the grounds. The bedrooms in the main house are situated on each of the two floors and access to the first floor is via a staircase. A stair lift is to be fitted shortly. Each floor has a bathing facility that has recently been refurbished. The shower on the ground floor has also been adapted for use by people with physical disabilities. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 4 hours during the afternoon. The care of three residents was tracked, which included looking at their care records, speaking with the residents and staff on duty, visiting their bedrooms, bathrooms and the other rooms they used in the house. All of the residents who were at home during the inspection were also spoken to and some also invited the inspector to see their bedrooms. The manager and deputy manager were present throughout the inspection. The inspector was grateful for the help that everyone gave during the inspection. What the service does well: Holly Tree Lodge gives the people who live there a very good opportunity to become as independent as they can, with the support of staff. The residents are able to join in a lot of different activities and go to colleges, day centres or work placements. There is a very good day centre in the home where residents can enjoy doing arts and crafts. The home involves the residents in lots of ways, for example, some residents recently helped to interview new staff and there are regular meetings where residents can put forward their ideas about meals and activities. The residents can help with the shopping and to prepare the meals and the food is healthy and interesting. When residents need help from staff, they have been able to say how they would like the help to be given and it is all written down in their care plans. The plans have got lots of pictures so that they are interesting to look at and the residents have enjoyed being involved with staff in writing their plans. The staff receive good support from the management of the home and they all work hard to make sure that the residents enjoy living at the home and that they are kept safe. The home has a very experienced manager who keeps up to date with new ideas about supporting people with learning disabilities. She is going to find out what the residents, their relatives, the staff and other people (like doctors, nurses and social workers) think about the way Holly Tree Lodge looks after people and then write a report. This will be a good way for the owner and manager to see if there any things they can improve on. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 standard(s) 1,5 The information about the home gives good detail about the way the home provides care and it is in an easy read format which means that residents can make use of it. EVIDENCE: The Statement of Purpose has been updated so that it gives good, current information about the way that the home provides care to people. The Service User Guide and Contracts have been developed, with the help of residents, into a format which contains pictures and symbols and the text is in easy read. This means that each service user can have a copy which is individual to them and which they can understand. The home is registered to accommodate up to 14 people but is reducing the use of shared bedrooms so that each resident has a sufficiently large bedroom. The home can currently, therefore, accommodate 12 people. Nine people live in the main house and there are three bungalows in the grounds at the rear of the home where people who can be semi-independent can live. One of these bungalows was vacant at the time of the inspection. Some of the residents have problems in addition to a learning disability and the owner should consider applying for a variation to the registration conditions to reflect the revised number of residents and the type of residents that the home can admit. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 9 The standards which relate to the assessment and admission of new residents were not assessed on this occasion as there had been no recent admissions to the home. The manager is careful to only admit people who have been assessed as being able to benefit from living in the home. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9, The care plans have been developed with the involvement of residents so that their needs are clearly set out. Residents are encouraged and supported to make decisions, to take risks and to participate in the running of the home so that they are confident, involved and able to achieve their full potential. EVIDENCE: The care plans for three residents were examined in detail during the inspection. The manager had been developing new care plans for all the residents and two of the care plans examined were in the new format. These have been developed with the close involvement of residents and they have chosen the pictures and symbols which highlight the different aspects of the plans, so that they mean something to them. The residents have enjoyed this process and the good quality of the care plans reflect their involvement. The plans clearly set out how the residents are to be looked after, with careful detail about the routines they wish to be followed during the day. This level of detail means that all staff can be certain of the needs of each individual. The plans include details of how specialist help will be provided and refers to additional help needed such as specialist equipment. The plans also focus on Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 11 people’s abilities and the sorts of events which might make them anxious so that their emotional health can be promoted. Each of the residents has an allocated key worker and those spoken to knew who their keyworker was and what they are responsible for doing. The two youngest residents are being introduced to person centred planning and the initial work by one resident was shown to the inspector. This was focusing on the positive things about her, like her good sense of humour and what her dreams are. The residents are supported to make decisions about their own lives as far as is possible, and where this is not possible this is recorded in the care plans. The manager is working hard to find ways to encourage and support residents who are able to, to manage their own medication and has introduced a workbook system to develop their skills and confidence. She is planning a similar approach to support residents to manage their own money. There is a wide range of age group within the home and the manager has recognised that it is important to find different ways of meeting their needs. She is, therefore, exploring ways of introducing the younger residents to others in the community to offer mutual support and friendship. The manager has introduced many ways in which the residents can participate in the running of the home. Residents have recently been involved for the first time in interviewing new staff. During the inspection a new member of staff arrived for her first shift and a resident remembered exactly what questions she had asked her during the interview. Residents meetings are held and many aspects of life in the home are discussed, including the menu and ideas for activities. Residents are supported to take risks in pursuing as independent lifestyle as they can. Risk assessments covering relevant aspects of individual’s lives were seen, including accessing the community. Where residents need to use buses for the first time, for example, they are helped to become familiar with how to do this and the risk is assessed appropriately. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 standard(s) 11,12,13,15,16,17 Staff seek out opportunities in the community so that residents can enjoy fulfilling and interesting lives and provide good opportunities in the home for creative work. Residents benefit from being involved in the planning and preparation of nutritious meals. EVIDENCE: The home works very hard to make sure that all the residents lead interesting and fulfilling lives. There is a strong focus on encouraging residents to achieve as high a level of independence as is possible for each individual. The management and staff explore all possible opportunities in the local community for the residents to get involved. For example, the residents recently went to the opening of a new community facility nearby and some, who are interested in cooking, are to get involved in the café there. The home has a very active day care programme and there are examples of the art and craftwork they have achieved throughout the home. This is of a highly quality, showing imagination and strong commitment. The residents were justifiably proud of the wall hangings, collages and pots they had made. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 13 During the inspection, a group of residents were enjoying working with the activity organiser on a project. Residents also participate in other activities in the community. Some go to a local college on one or two days a week. One resident told the inspector she is going to be continuing with her sewing classes and showed some cushions she has made and described some outfits she has made. She is also hoping to do some work on computers next term. Other residents attend local day centres because that is what they have chosen to do. Some residents have also been supported and encouraged to go to work placements one or two days a week. One resident spoke about working in a local charity shop. Residents are also enabled to attend the church service of their choice. Relationships with families are encouraged and supported and the management and staff ensure that relatives are fully involved in the home and with plans for residents. One resident is being sensitively supported to maintain a relationship with a boyfriend. A resident who had been part of the group for many years passed away recently and the home was actively involved in planning the funeral and supporting the family, staff and residents. A book of remembrance with poems, photos has been created and residents’ memories her were sensitively included. The home actively respects residents’ rights and responsibilities in their daily lives. Staff were seen to be knocking on residents’ bedroom doors before entering and residents were able to lock their bedrooms if they wished to. Staff were observed to be interacting with residents throughout the inspection and those residents who had chosen to have a quiet afternoon were able to sit in their rooms but with the support of staff when needed. Residents are involved in planning the meals in the home but are being helped to recognise that meals must be healthy and nutritious. The home has sought advice from a dietician and has implemented her recommendations. All residents who have special dietary needs such as those with diabetes or high cholesterol have specific plans aimed at ensuring that their diet is suitable. The home is also introducing some vegetarian meals and have found that these have been well received. All meals are prepared from fresh produce and the residents are involved in shopping locally at a variety of different shops. Residents are able to prepare their own meals if they wish to. The way that breakfast is served was raised at the last inspection and this has now been changed to more of a buffet style so that residents can help themselves. Each resident’s daily food intake is noted to ensure that they are each eating a balanced diet. The dining room is also the activity room and the style of furnishing has previously been raised as an issue. More domestic style dining furniture would be an improvement. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 standard(s) 18,21 Careful attention is paid to they way in which personal support is provided so that residents’ preferences are respected. Issues relating to ageing and dying are dealt with sensitively so that residents can be reassured as to their future. EVIDENCE: The way in which residents want their personal care to be provided by staff has been written into care plans, in conjunction with the residents. This ensures that the residents’ preferences are known to staff and the routines in the mornings and evenings are written out in detail. Staff are aware of the need to give residents privacy when personal care is being provided. Residents are encouraged and enabled to do as much of their personal care for themselves as is safe and appropriate. Prompts to attend to personal appearance were observed to be given sensitively. Residents are also encouraged to chose their own clothing and accessories such as jewellery. There are two male residents in the home and their views have been sought about the gender of staff delivering personal care as all of the permanent staff are female. Although the home has tried to recruit male carers they have not found any staff who are suitable. The male residents have expressed their preference for female staff to provide their personal care. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 15 Residents who require specialist equipment are appropriately assessed and specialist help and support is sought. A stair lift has recently been installed to assist one resident. The views of residents in relation to terminal care and death have been sought, in conjunction with relatives and these views are recorded in care plans. The home aims to continue caring for residents as long as is possible as their needs change. For example, staff are being trained in dementia care to better meet the needs of ageing residents. Following the recent death of a resident, the home have sought advice from a psychologist and are going to undertake some work on bereavement issues. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 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 standard(s) 23 The home has good policies, procedures and training in place so that residents are protected from abuse. EVIDENCE: The home has a robust policy in relation to protecting vulnerable adults and all staff receive the relevant training as a matter of priority. Residents have also been involved so that they know their rights and when to ask for help. The home has good processes in place to ensure that residents’ money and valuables are protected. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 17 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 standard(s) 24,25,26 EVIDENCE: The main house provides accommodation for 9 residents and there are 3 selfcontained bungalows in the grounds. The house was clean and tidy on the day of the inspection. Since taking over the home in 2003, the providers have invested in ongoing improvements to the home. On the day of this inspection, contractors were painting the exterior of the building. New windows and exterior doors have recently been installed throughout the home. Many areas of carpeting and flooring have been replaced recently and there are plans to continue this process. A recent visit by the Fire Officer had raised some issues but these had all been addressed by the time of this inspection. Four bedrooms in the main house were visited and 2 of the self contained bungalows. They were found to be spacious, airy and personalised to the resident’s individual taste. Each room had appropriate furnishings and the rooms were lockable. The four residents who still share bedrooms have confirmed at reviews that they enjoy the company of the person they share with. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Service users benefit from well-supported and supervised staff. EVIDENCE: Staff are receiving regular formal supervision from senior staff in which issues such as personal development and training needs are discussed. Informal supervision also takes place as necessary. The manager works hard to ensure that the staff are working in accordance with the philosophy and ethos of the home. All staff were observed to be interacting very well with residents during the inspection and there was clearly a comfortable, trusting relationship. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40 Residents benefit from a home which is well run by a competent manager. The views of residents will underpin the review of the home. The home’s policies protect the residents’ rights and best interests. EVIDENCE: The registered manager has substantial experience in managing services for people with learning disabilities and has completed her Registered Manager’s Award. She ensures that she is aware of the latest good practice and developments by researching on the internet and publications and by joining local development groups. The manager is working towards developing an effective quality assurance system for the home and is currently preparing suitable questionnaires for staff, residents, relatives and other professionals such as nurses, GPs and social workers. She plans to collate the results into a report which will be published annually in the Spring. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 20 The home’s policies are kept under constant review to ensure that they remain relevant and reflect current good practice. Staff have to make themselves familiar with all policies as part of their induction. Holly Tree Lodge I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 21 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 x x x 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x x x Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holly Tree Lodge Score 3 x x 3 Standard No 37 38 39 40 41 42 43 Score 3 x 2 3 x x x I51 S42607 Holly Tree Lodge V239144 050905 Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 17 Good Practice Recommendations The dining room furniture should be reviewed with a view to making it more domestic in style. 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