CARE HOMES FOR OLDER PEOPLE
Hollybank House Chesterfield Road Oakerthorpe Derby DE55 7LP Lead Inspector
Stuart Hannay Key Unannounced Inspection 28 February 2007 09:30 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 House DS0000002172.V328565.R01.S.doc Version 5.2 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 House DS0000002172.V328565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hollybank House Address Chesterfield Road Oakerthorpe Derby DE55 7LP 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) 01773 831791 Miss Margaret Ann Bradley Alison Jane North Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 4 places for PD over 50 years which are included within the PCN registration 20 places for PCN - Not to exceed Date of last inspection 20th July 2006 Brief Description of the Service: Hollybank House provides for up to 40 older persons, including nursing care for up to 20 older persons and up to 4 service users with physical disabilities aged over 50 years. The original house, formerly a private dwelling, was converted and extended for the purposes of registering as a care home. Accommodation is organised over two floors, with access to the first floor via stairs and a shaft lift. There is choice of communal lounge and dining space to the ground floor and adequate numbers of bathrooms and toilets with adaptations to assist those service users with mobility problems. There is level access to the gardens. There are 24 single bedrooms and 9 double, including 3 single and 2 double rooms, which have en suites. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted for 6 hours. Seven service users, two relatives and two carers were interviewed to obtain their views about the service. A check was made of the environment and the following records were checked: staff training, fire safety, service users’ care plans, quality assurance and staff recruitment records. A check was made of the storage and recording of medication. The inspector also had lunch with the service users. What the service does well:
There was a relaxed and friendly atmosphere at Hollybank House and many of the service users were sitting in the various lounges talking and generally enjoying each other’s company. Service users said that the staff were ‘marvellous’ and ‘great’ and staff were observed speaking to them in a friendly and respectful manner. Service users said that the routines were flexible and there was no sense of regimentation. Most people liked the food provided and were happy with the choices available each day. They felt that they were well looked after by the staff and that their personal care was provided in a sensitive and dignified manner. Staff members interviewed demonstrated a good understanding of the service users’ needs and what they needed to do to support them. All the service users spoken with said that their family and friends were made welcome and relatives spoken with confirmed this. The medication system was well managed. Care plans were informative, they contained risk assessments and all the plans checked had been regularly reviewed to ensure that the information was up to date. Staff said that their managers were approachable and supportive and felt there was a good team at the home. Staffing levels were well maintained and there were adequate staff to meet the needs of the service users. The home’s owner visits the home on a weekly basis. There is a high percentage of staff with an NVQ Level II qualification and staff training was generally well managed. The home was clean and there were no unpleasant odours in any of the communal areas. No major health and safety issues were noted during the inspection, equipment was well maintained and major systems had been serviced.
Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 7 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 House DS0000002172.V328565.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of the service users had been made prior to them coming into the home, ensuring that the staff were able to meet their needs. The staff team had received a range of training to ensure that they understood the needs of the service users. EVIDENCE: There was a Statement of Purpose, which described the range of services available and identified at whom these services are targeted. Three care plans checked contained a range of assessments completed by the staff at the home or by other professionals. The service users felt that their health and personal care needs were met and the care plans identified what help they needed. Service users and one relative interviewed confirmed that they had been able to visit the home prior to moving in. The home provides respite care but does not provide an intermediate care service.
Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were care plans in place,appropriately completed which identify what help and support service users needed and ensure that the health and personal care needs are met. EVIDENCE: Three service users’ care plans were checked. They identified health and personal care needs and each service user had a treatment plan based on these assessments. The treatment plans guided staff on what action to take to meet the identified needs and there were daily recordings to show what staff had done. The plans had been reviewed on a monthly basis to ensure that the information and guidance was still valid. There was information about the service users’ social and recreational wishes but more detail was needed in some of the plans to show how staff would meet these needs. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 10 There were records of contact with opticians, dentists and chiropodists and records to show that service users had regular baths or showers; the people interviewed said that they could choose when to have a bath. The care plans contained risk assessments and these had been regularly reviewed. Seven service users spoke with the inspector about the home. Most were able to clearly say how they felt about the service and all said that the staff treated them in a respectful and friendly way. Visitors spoken with confirmed that they always found there to be open and friendly atmosphere within the home. Service users said that bathroom, toilet and bedroom doors were closed if they were receiving personal care and staff knocked on doors and waited for an answer before walking in. Medication was securely stored and there were systems in place for receiving the medication into the home. There were medication administration (MAR) sheets for each service user; these recorded the type of medication, the dosage and how it was to be administered. There were reasonable stock levels in the home. Generally, qualified nurses were responsible for giving out medication, however for the service users who were not receiving nursing care, some non-nursing staff were able to administer medication. These staff members had been assessed as competent in this task. Records were kept of each time the medication was given. The system had been checked by the home’s pharmacist on a regular basis. Controlled drugs were safely stored and there were two signatories for the administration of controlled drugs. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable activities were provided at the home and visits from relatives and friends encouraged to ensure that service users interests and needs are met. Service users said that the food was good and they were offered plenty of choice; special dietary needs and preferences were recorded in the individual care plans to ensure people received appropriate nutrition and foods that they liked. EVIDENCE: Seven service users were interviewed. Most of the people were able to say that they felt well cared for and that staff looked after them well. All service users spoken with looked clean and were dressed in clean, age appropriate clothing. The home had dedicated staffing hours for activities and service users said that they did quizzes and played board games with them. Some service users said they went out to the pub with relatives or with staff and that there were outings, for example to Chatsworth, in the summer. They were happy with the activities provided. All the service users spoken with confirmed that there was a choice of meals everyday and there was plenty to eat. Risk assessments had been completed
Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 12 in the care plans for service users’ nutritional needs and special diets were provided if necessary. The care plans checked contained information about their personal preferences with regard to food. The inspector ate lunch with some of the service users and the meal was served in a pleasant, relaxed atmosphere. Two relatives were interviewed. They said that the home made them feel very welcome and they could drop in at anytime they wanted. Both people interviewed said they were kept up-to-date with information about their relations. The service users said that there were no strict routines in the home and that they could negotiate what time they wanted to get up or go to bed. The care plans checked contained information about service users preferences with regard to personal care and these coincided with what people said in interview. Service users felt that they were consulted by the home about issues relating to their care. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a complaints procedure in place together with safeguarding adults procedures which allow service users to raise any concerns and reduces the risk of harm to vulnerable service users. EVIDENCE: The home had a complaints procedure and kept a log of complaints received. There were details of investigations and the outcome was recorded. No complaints were recorded since the last inspection. Two staff interviewed had both had training on adult protection and the recognition of abuse as part of their NVQ qualifications. They were aware that there were procedures in place and of their obligation to report any concerns to the relevant authorities. No recent adult protection issues had been raised at the home. Service users interviewed said that they would not be frightened about raising complaints if they felt it was necessary and staff felt that there was a very ‘open’ atmosphere at the home which promoted the welfare of the service users. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable and generally well maintained enabling service users to live in a pleasant environment. EVIDENCE: The home was clean and tidy on the day of the inspection. The communal areas were ‘homely’ in appearance and despite the need to create space for the use of wheelchairs, the home did not feel institutional. Most of the service users rooms were checked. These were highly personalised with photos and ornamentation. The carpet in the lounge areas and on one corridor was marked and worn. The home has applied to register an extension to the home, creating a number of extra rooms to ensure that most of the service users would have a single room if they wished. The lounge and corridor carpets need to be replaced after this work is done, or sooner if there are any major delays to this work.
Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were qualified and experienced in working with this group of service users; they understood their needs and had received training to ensure they could care properly for them. EVIDENCE: There is at least one registered nurse on every shift in addition to the manager, who is also a nurse. On day shifts there are between 5 and 7 care assistants on the various shifts and at night there is one registered nurse and 3 care assistants on every shift. Staff and service users interviewed felt that these numbers were sufficient to provide the physical, personal care and social needs of the service users. The rotas checked confirmed these numbers had been maintained. The recruitment records of 2 staff were checked. Both contained suitable applications and references. POVA and Criminal Records Bureau checks had been carried out on the applicants and neither had any convictions and neither were recorded on the POVA list as being unsuitable to work with vulnerable adults.
Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 16 Two care assistants were interviewed. Both were qualified to at least NVQ Level 2 in care and had undertaken a range of training related to the needs of older people. They were able to describe the needs of the service users. They had undertaken statutory training in moving and handling and fire safety and both were able to describe the procedures to follow in the event of a fire. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Line managers were supportive and approachable and staff felt able to report any concerns to them about service users,resulting in a good level of care to the service users . There were effective health and safety systems in place to minimise the risk to service users and the building was safe with no obvious risks to service users. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 18 EVIDENCE: The manager is a registered nurse and is currently undertaking an NVQ Level 4 in the management of care. She has significant experience in working with this group of service users. Staff, service users and one visitor interviewed said that she was very approachable. Service users said that they would have no hesitation in reporting any concerns to her and staff said that she was always responsive to any concerns or queries they had about service users. Service users said that they felt the staff took their feelings and wishes into account. The fire records were checked. There was regular training and drills for staff. The alarm system had been checked regularly, however the checks had not been done on a weekly basis every month. Repairs had been carried out promptly. The fire alarm system and the fire fighting equipment had been serviced by an external company. The passenger lifts and the hoists had been regularly serviced. A system of formal staff supervision and appraisal has now been established. More detail was needed on the supervision records to record what was covered in the session and any action agreed. Two care assistants interviewed said that they had had annual appraisals but had not received regular 1:1 supervision sessions. The home had introduced a quality assurance system to monitor policy and practice and the senior staff were working through this to assess their work. The records checked during the inspection were fully completed and stored appropriately. There were no major hazards noted in the home, however the service users did have unrestricted access to the laundry and downstairs sluice area and the home needs to assess the risks associated with this, particularly for the service users with dementia. Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 19 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 2 Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 20 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. 2. Standard OP19 OP36 Regulation 23 2 (b) 18 Timescale for action Worn and damaged carpets must 01/09/07 be replaced following the building work. The registered persons must 01/07/07 ensure that care staff received formal supervision at least six times per year in accordance with that specified under NMS 36.3 older persons document. Supervision records must be more detailed and record details of staff training and staff practice. The home must complete a risk assessment regarding service users having unsupervised access to the laundry room. Weekly tests must be carried out on the fire alarm system. 01/06/07 Requirement 3. OP38 13 (4) (a) 4. OP38 23 (4) (c) 01/05/07 Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 21 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 OP7 Good Practice Recommendations The care plans should include more detail of service users wishes regarding activities and information on how staff will help them to do these. All staff should have an up to date individual training and development assessment and profile/plan as agreed with them. An annual development plan should be in place for the home, informed by formal quality assurance and auditing systems and in consultation with staff and residents. 1. OP30 2. OP33 Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 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
© 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 Hollybank House DS0000002172.V328565.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
