CARE HOMES FOR OLDER PEOPLE
Hollybank 27 Park Road Southport Merseyside PR9 9JL Lead Inspector
Mr Paul Kenyon Unannounced Inspection 24th January 2006 16:15 X10015.doc Version 1.40 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 Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hollybank Address 27 Park Road Southport Merseyside PR9 9JL 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) 01704 530748 Mrs Ann Mallinson Mrs Ann Mallinson Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16), Terminally ill (2) of places Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 16 OP and up to 2 TI Date of last inspection Brief Description of the Service: Hollybank is a privately owned Care Home providing nursing care for 16 older Service users. The Registered Provider and Registered Manager is Mrs Ann Mallinson. Hollybank cares for 16 Services and accommodation comprises of 10 single bedrooms with 1ensuite and 3 double bedrooms with 1 en suite. On the day of the inspection there were 15 service users resident. The home is registered to take 2 service users with palliative care needs although no service users have received this specialist care of late. Hollybank is situated in a quiet residential area of Southport close to the town centre, local amenities, the beach, Hesketh Park and access to local public transport. The home consists of a four-storey building with a large garden at the front and small patio to the rear. The home has a passenger lift and wheelchair access. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held this inspection year (April 2005 to March 2006) and was unannounced. The inspection included a tour of the premises, an examination of various records relating to the care offered in the home and discussions with those who live there. In total the inspection lasted three hours. Hollybank is a Registered Care Home with nursing providing care and support to individuals who have nursing needs. For the purposes of this report, individuals living there are referred to as patients. Discussions were held with six patients as well as a relative who was visiting at the time. Four patients gave a detailed account of their experience of Hollybank whereas two others provided more general information. A number of National Minimum Standards for Older People were used to assess the quality of care provided at Hollybank and the standards used are identified within the report. What the service does well:
The service is good at ensuring that patients and their representatives have the opportunity to confirm the contents of care plans. The service is good at ensuring that patients have privacy and this was borne out by comments made by individuals during the inspection. The service is good at enabling visitors to be received by patients in privacy. The service is also good at ensuring that patients can choose how their financial affairs are dealt with as well as providing information in respect of external advocacy services. The service provides nutritional and wholesome food as well as a choice and takes the preferences and health needs of patients in respect of food into account. The premises are clean, hygienic and free of offensive odour. The premises are well maintained and home-like in appearance. The dependency levels of patients determine staffing levels and these are determined and reviewed on a regular basis. The service ensures that
Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 6 Registered Nurses are on duty at all times during the day and night. The service has given care staff the opportunity to attain National Vocational Qualifications (NVQ) and provides mandatory as well as other training on a regular basis. The service has an experienced Registered Nurse in charge of the running of the home and refers to an external and independent agency for the measuring of the quality of care it provides to patients on an annual basis. Comments from patients during the inspection included: ‘They give every consideration and I am extremely grateful’ ‘I have my privacy and the home respect this’ ‘They give me total respect’ ‘Food is very good and I get a choice of meals-there are some food I do not like but they will give me an alternative’ ‘I am as happy as I can be’ ‘My room is very warm’ ‘I am looked after and carers are good’ ‘Food is good’ ‘As a visitors I am made to feel welcome, staff are approachable, I am happy with the care my relative receives and I am greeted like an old friend by staff’ ‘The home is very nice and I have no complaints’ ‘I get my privacy in my single room’ ‘Staff are helpful and respectful’ ‘The home is clean and comfortable’ ‘I was given the independence to deal with my own financial affairs’ ‘I get regular drinks but if I need anything, they get it for me’ What has improved since the last inspection?
A requirement at the last inspection highlighted the need for evidence to be produced that residents or their families had had the opportunity to confirm the content of care plans. A sample of care plans taken during this inspection noted that in all cases, care plans had been signed by residents or their representatives. The service has subsequently provided information to confirm that all nursing staff in the home are currently registered. The service has also provided information since the last inspection to confirm that it has current home insurance.
Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 7 A good practice recommendation was raised at the last inspection to ensure that staff were aware of the home’s policy and procedure in dealing with abuse allegations. This has been done with staff having the opportunity to receive abuse awareness training. 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. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards in this section were measured during this inspection. Standard 3 was measured at the last inspection and was met. Standard 6 is not applicable to Hollybank at present. EVIDENCE: Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 10. Standards 8 and 9 were measured at the last inspection and were met Patients and their representatives have now had the opportunity to confirm the content of care plans. Individuals benefit from a service that promotes their privacy and dignity. EVIDENCE: A requirement at the last inspection highlighted the need for care plans to be signed by patients or their families to confirm that they agree with the contents of the care plans. A sample of ten care plans was examined and found to include signatures in all. The home has a number of shared bedrooms. In all cases, screens are available which enable privacy between occupants when personal care is being given. During the visit, one screen was being used in one shared room. One patient was being assisted to bathe by a member of staff. The bathroom door remained closed during this time. All toilets were noted to have locks fitted to ensure more privacy. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 11 The nature of the home is such that only fifteen people live there and the turnover of people is generally low. As a result, no clothing is marked except smaller items of clothing given that staff are aware of which clothes belong to which people. In total five patients offered views about their experiences in the home. All were asked about the degree to which their privacy was respected and whether they felt that they were treated with respect. Without exception all patients confirmed this to be the case and comments included: ‘I have my privacy and the home respect this’ ‘They give me total respect’ ‘I get my privacy in my single room’ ‘Staff are helpful and respectful’ Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 and 15. Standard 12 was measured at the last inspection and was met Residents benefit from continued community contact and are able to exercise choice over their lives. Residents have their nutritional needs met and are provided with wholesome food. EVIDENCE: The visitor’s book was examined and suggested that a number of visitors come to the home to meet with their relatives. The Inspector had the opportunity to speak with one relative. They confirmed that they have their own times for visiting and that staff were aware of this and enabled them to meet their relation in private. Comments form this relative included: ‘As a visitor I am made to feel welcome’ ‘I am greeted like an old friend by staff’ Other individuals were asked about the degree to which they had their independence maintained. One person confirmed: ‘I no longer deal with my finances, this was my choice and the home was not involved in this’. Another confirmed that ‘my family deal with all that’. Another person confirmed that ‘I could bring my own furniture in when I came to live here’.
Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 13 Information is available to contact a local and independent advocacy service although there was no evidence that anyone had used this at present. Patients who spoke with the Inspector were positive about the food provided: ‘Food is very good and I get a choice of meals-there are some food I do not like but they will give me an alternative’ ‘Food is good’ ‘I get regular drinks but if I need anything, they get it for me’ A menu is on display and suggested that lunchtime provides a cooked meal with tea being lighter. The nutritional needs of patients are identified within care plans. Only a handful of patients currently require assistance with eating or softer diets. The cook attends an annual course known as ‘Creative Cooking and this provides information on how to prepare and present softer diets. Information was available in the kitchen to suggest this was occurring. The cook also prepares some softer diets in advance which as then frozen for future use. The freezers were noted to be well stocked with a local supermarket being used for this purpose. The kitchen is domestic ion scale yet is well equipped and reflects the numbers living in the home. The cook has also recently attained an Intermediate Food Hygiene Award and a certificate was available to confirm this. There s no dining room at Hollybank with meals either served in the lounge or within bedrooms as preferred. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Standard 16 was measured at the last inspection and was met. Service users are protected from abuse in the main through the availability of policies and procedures and staff training. The home must provide its Local Authority procedure for inspection and for reference. EVIDENCE: A requirement at the last inspection highlighted the need for the service to obtain a copy of the Local Authority procedure for dealing with allegations of abuse. This has not yet been obtained despite the efforts of the Manager. This remains as a requirement in this report. A good practice recommendation was raised at the last inspection in respect of staff signing the home’s own procedure for dealing with allegations of abuse. All staff have undertaken abuse awareness training and now should be aware of steps to take in the event of an allegation being made. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents live in a well-maintained environment that is clean, hygienic and free from offensive odour. EVIDENCE: A tour of the premises noted that the home presents as a home-like and well decorated environment. The size of the home lends itself to this home like atmosphere. Patients commented that ‘I am pleased with my room’ and ‘the home is very clean and comfortable’. Refurbishment of the building is ongoing with plans to redecorate rooms and re-carpet them with minimal disruption to individuals. A record of past and future refurbishment is available. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 16 A laundry is available in the basement area separate from food preparation areas. The laundry contains an industrial washer and drier. No offensive odours were noted in any part of the building during the inspection and all areas were noted to be clean and hygienic. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Standard 29 was measured at the last inspection and subsequent action to address a requirement relating to proof of registration for nursing staff has been taken. Patients receive care from a service that takes their levels of dependency into account when determining staffing levels. Individuals also benefit from receiving care from a well-qualified and trained staff team. EVIDENCE: A staff rota is available. This indicated that a Registered nurse is on duty during all times of the day and night. All patients’ dependency levels are monitored on a three-monthly basis in order to determine where care has significantly changed and the needs of individuals have increased. Evidence was available to suggest that this monitoring of dependency levels was carried out for all individuals. The registered nurses use their experience of patients within the home to anticipate any changes in dependency levels. Evidence suggests that dependency levels are generally medium with staffing levels reflecting this. Evidence was available to suggest that all care staff except for one person had attained NVQ Level 2 with some having attained NVQ Level 3. Training certificates were available and these suggested that mandatory training continue with other specialist training either being received for planned for the next few months. Specialist training received has included:
Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 18 Intermediate Food Hygiene Certificate with credit (attained by the Cook) Creative Cooking (for older people) Protection of vulnerable adults training Manual Handling Fire Awareness Catheter Care Planned training includes further health and safety courses and Drug Awareness. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 35. Standard 38 was measured at the last inspection was met. Patients benefit from receiving support within a well managed environment and from having their views listened to by independent sources. Patients benefit from having their financial affairs being dealt with independent people in line with their wishes with no home involvement in such matters. EVIDENCE: The Manger of the home is also the Owner and is also a Registered Nurse. Te Owner is also included within the rota on a daily basis. The Owner has been in charge of the home for a number of years and has the necessary experience in supporting people with nursing needs. She has enrolled on an NVQ Level 4 course and anticipates that this will be completed in 2006. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 20 The home uses an independent and external individual to assess the quality of care provided in Hollybank. This process occurs on an annual basis and has just been completed. The process included gaining the views of staff, patients and families as well as an examination of policies and procedures within the home. The home has been responsive to requirements generated at previous inspections and facilitated discussions between patients and the Inspector during the visit. The home is not involved in any financial affairs of any patients. Two individuals confirmed that they had transferred responsibilities for their finances to family members out of choice. Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 13 Requirement The Local Authority procedure relating to the referral of allegations of abuse must be available for staff reference Timescale for action 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hollybank DS0000017242.V279914.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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