Inspection on 09/07/08 for Hollybrook House

This inspection was carried out on 9th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollybrook House 07/01/09

Hollybrook House 18/07/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Hollybrook House 85 Silver Road Norwich Norfolk NR3 4TF Lead Inspector Lella Hudson Unannounced Inspection 9th July 2008 10:00 Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 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 Hollybrook House DS0000069241.V368180.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 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. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hollybrook House Address 85 Silver Road Norwich Norfolk NR3 4TF 01603 767578 01603 611620 hollybrook@swantoncare.com www.swantoncare.com Swanton Care and Community 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) Mrs Victoria Shucksmith Care Home 43 Category(ies) of Learning disability (15), Mental disorder, registration, with number excluding learning disability or dementia (43) of places Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Hollybrook House provides care and support to up to 43 adults with mental health needs, some of who may also have learning difficulties. The resource consists of a main house catering for up to 12 people and a series of shared houses and flats that offer the opportunity for more independent living. Hollybrook House is located within walking distance of Norwich city centre. Fees are £307 - £1600 per week but are agreed on an individual basis dependent on need. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is NO STAR. This means that the people who use this service experience POOR quality outcomes. This report contains information gathered about the Home since the last Inspection in July 2007. It includes information provided by staff from the Home, such as the completed Annual Quality Assurance Assessment and through notifications to the Commission. It also includes information gathered during an unannounced visit to the Home which was carried out on the 9th July 2008 between 10am and 6pm. None of the surveys sent to the Home for residents and staff were returned to us. There were 34 residents living at the Home on the day of the visit. The Registered Manager is on sick leave. During the visit we looked around the accommodation, inspected records, spoke to staff and residents, observed staff supporting residents. We also spoke to the Operations Manager and to Jim McCready who is a registered Manager of another Home owned by this organisation and who is currently providing some management support to this Home (referred to as the acting manager throughout this report). The organisation has recently completed building new accommodation which includes offices and fourteen individual flats as well as additional communal space and a new, large kitchen. The organisation is currently applying for registration with the Commission for this new accommodation. What the service does well: The Home provides accommodation in a variety of settings, including a large house, smaller houses and individual flats which gives residents a choice of accommodation depending on their needs and preferences. One of the residents said that he really likes living there as he can “…have my own space and staff help me if I need it”. The cook provides a choice of meals which meet the residents nutritional needs and which the residents enjoy. One of the residents said “….meals couldn’t be better”. Some residents told us that staff are available to talk to if they want to. Hollybrook House DS0000069241.V368180.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. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 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 Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. An appropriate procedure is in place to ensure that adequate assessments are undertaken EVIDENCE: There have not been any new admissions to the Home since the last Inspection. However, the organisation has procedures in place to ensure that suitable assessments are carried out prior to someone being offered accommodation at the Home. Details of this are stated within the Annual Quality Assurance Assessment (AQAA). Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The information within the care plans is not sufficient to ensure that the residents needs are met in a consistent way Residents are not fully involved in making decisions about issues that affect them and confidentiality is not always maintained EVIDENCE: We saw two of the care plans for residents living at the Home. One of the care plans contained a lot of information about the person concerned and there was evidence of it having been reviewed on a regular basis. There was no evidence of the resident having been involved in the process of developing the care plan. When we asked the resident about his care plan he said that he knew that it existed but didn’t know what was in it. Although the care plan contains a lot of information the actual plans for providing care to meet the residents needs are not detailed enough to ensure that this is provided Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 10 consistently. For example, it states that staff should ‘observe for signs of stress’ but there is no information about what signs staff should look for which are individual to this resident. It also says to ‘encourage activities’ but with no details about who is going to do this, when it should be done or how it should be done. The care plan contains an assessment of risk relevant to the resident. It considers issues that used to be considered particular risks to the resident in the past as well as those considered to be the current risks. There are then plans in place to manage the risks. The other care plan that we saw was very sparse with little details about the individual needs of the resident, nor consideration of how potentially serious risks should be managed. The acting Manager said that the resident had destroyed their care plan and so one had been put together on a temporary basis and was going to be developed further. Whilst this may have been unavoidable the actual information that is available about the residents needs and risk management is not satisfactory. There are significant risks for the resident and for staff which staff need to have information about in order to be able to provide support in a consistent way to the resident. The staff who spoke to us told us that they are aware of the care plans and that they are encouraged to read them during their induction. They said that they find them useful and that they are told when changes are made to care plans. The information provided by the Home to us about the care plans was contradictory as the AQAA states that the care plans and risk assessments are detailed but the Operations Manager had identified during a recent monthly report that there were still care plans in need of reviewing and updating. Some of the residents have particular needs with regard to communication due to their mental health needs or learning disabilities and the care plans do not contain enough information about this to enable the staff to be able to effectively communicate with all residents. Although the AQAA states that staff have received training with regard to mental health there is no evidence on the training records of this having taken place and the staff who spoke to us have not received this training. Some of the staff who spoke to us were enthusiastic about supporting the residents to have choice about how they live their life and are aware of the importance of promoting independence. However, with the lack of a permanent Manager and the fact that the two assistant managers have only recently been appointed means that there is a general lack of guidance and clarity for staff about how the service should be provided. Residents told us that they make their own choices about basics such as when they get up and go to bed but that they are not involved in any kind of Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 11 decision making that affects the running of the Home. The acting Manager said that residents meetings will soon be reinstated at the Home as they have not taken place lately. In one of the monthly reports completed by the Operations Manager it was noted that one of the residents had been upset as window restrictors had been fitted to his bedroom window as they had been fitted to all first floor windows with no consultation with residents or individual risk assessments being carried out. The administrator is responsible for maintaining the records relating to the system in place for looking after residents money for those who are not able to do so for themselves. The money is kept in a central account which is managed by the organisation and cheques are provide when requested by the administrator. Records are kept of expenditure and of money given to residents. Residents are encouraged to sign to confirm receipt of money wherever possible. There was a suspected theft at the Home in January 2008 and the police advised that the system for looking after residents money should be improved. These improvements have taken place and there is now a more secure system in place. Staff sign a copy of the confidentiality policy when they start work at the Home and a copy is kept on their personnel files. Staff who spoke to us were aware of the need for confidentiality but also said that it can be difficult as there is a shortage of places in which staff can discuss issues confidentially and be sure that they are not being overheard by other residents. The acting Manager has recently had a lock fitted to the door leading to the small office in the main house so that residents are not able to have easy access to the office. Although the office is supposed to be locked at all times when staff are not in there this second door provides additional security. The acting Manager is currently dealing with a situation in which a resident has alleged that confidentiality has been breached. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents are not supported to take part in meaningful activities on a regular basis and they are only helped to exercise choice and control in a limited range of issues affecting their lives Residents receive an appealing, balanced diet but the dining arrangements are institutionalised EVIDENCE: The AQAA states that the residents are supported to take place in a variety of activities, including work placements and college courses. It also states that residents are encouraged to take part in household tasks and that cooking sessions take place. During our visit to the Home and through discussions with residents and staff we found little evidence that this takes place apart from for a few of the residents. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 13 The activities co-ordinator has left the Home and not yet been replaced although recruitment is taking place to replace this member of staff. The staffing levels are currently not sufficient to enable activities to take place on a regular basis. Residents said that there is little to do unless they want to walk into the city to meet friends or go shopping. The residents who are independent with regard to going to the city are able to get there easily, either by walking, or through the use of public transport which is easily accessible from the Home. However, there are a lot of residents who need staff support to take part in any meaningful activities and they are not receiving this on a regular basis at the current time. Some of the residents do attend external activities, such as working on a farm or attendance at a more formal day service but the majority of residents do not have arrangements in place to do this. One of the care plans that we saw does include information about the interests and hobbies that the resident has and states that staff should encourage him with these but there are no details about how this should be done, when or by whom. One of the residents said that they like the fact that they are not encouraged to take part in group activities but others said that they would like to be able to take part in activities. The organisation are aware of the need for improvements in this area and have made money available to the staff for them to buy equipment so that activities and games can take place at the Home as well as to pay for admission to places such as the cinema. The provision of activities had been discussed at the staff meeting which had taken place the day before our visit to the Home. Two of the staff who we spoke to were very enthusiastic about this and had a good understanding of the importance of providing meaningful activities to people, particularly those who have mental health difficulties. They said that craft equipment and games had been purchased the day before our visit. They spoke enthusiastically about starting a gardening group and had arranged for some of the residents to go to the cinema later that day. The staff mostly work 12 hour shifts, from 8am to 8pm and this can place restrictions on activities taking place during the evenings although staff did say that they could make special arrangements to accommodate this. There were only four staff on duty on the day of our visit and one of these was on his induction and was shadowing other staff so could not be counted as part of the staffing arrangements. This number of staff on duty does not enable staff to have time to support many residents in an individual way to take part in activities or to provide support to residents to maintain independence with regard to household tasks such as cleaning and cooking. There are televisions in all of the individual flats and the residents mostly have their own CD and DVD players if they wish to have them. There is a communal Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 14 lounge in the main house which residents from all over the site come to use. The organisation purchase four different daily newspapers for the residents to read. Residents were trying to watch the television in the lounge and asked the staff if they could turn it up as the remote control could not be found. It was not possible to turn the television up any louder and apparently the remote control had been lost for several days. None of the staff knew if anyone had done anything about replacing this and so the residents were left with a television which was difficult to watch due to the low volume. One of the care plans that we saw contained information about the residents family and the arrangements in place for them to maintain contact with them. Staff said that residents are able to have visitors and that this varies depending on the residents circumstances. One of the residents said that they would be going home to stay with family later that week. One of the residents told the acting Manager that the communal telephone, which is located in the hallway of the main house, was not working and had not been for some time. The acting Manager arranged for the resident to have the use of the office phone and said that he would arrange to have the other telephone mended. The staff said that they do not wake residents up or tell them when to go to bed. They also said that residents are able to choose how they spend their days. The majority of the residents were seen to spend the day in one of the smoking areas or watching television. The majority of the residents have mental health difficulties and we observed that those residents with good communication skills or those with behaviours which were challenging to staff received the most input from the staff. The exception to this was the two staff who planned a trip to the cinema which included some residents who do not normally go out. Staff said that the residents who live in the individual flats are supposed to carry out their own cleaning but that the domestic staff do clean the flats if needed. Some of the residents would need a lot of support to carry out their own cleaning and the current staffing levels mean that the individual support is not available to all those residents who would need it. The individual flats and the houses known as ‘Mousehold’ all have kitchen areas, some with newly fitted cookers. However, none of the residents are supported to do their own cooking. The residents laundry is sent out to an external laundry company and so residents are not supported to do this for themselves either. The residents are all offered a key to their bedrooms/flat and this was confirmed by residents who spoke to us. The staff said that they visit the flats each morning to ensure that the residents are alright and to see if they need anything. Staff were seen to go in and out of the main house, Mousehold houses and individual flats on a regular basis throughout the day. The majority of staff did not knock on doors prior to entering. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 15 The current arrangements for the residents at mealtimes is that all meals are prepared by the cook in the kitchen in the main house. There is seating for about 12 residents in the newly furnished dining room next to the kitchen and all other residents take their meal on a tray back to their own flat/house. They all walk with trays of hot food outside for varying distances to access their own flats. They have to do this whatever the weather. There is a large new, commercial, kitchen in the new accommodation but we were told by the Operations Manager that the arrangements will still be the same with residents having to come to collect their meals on a tray. This situation is institutionalised and it is not pleasant for the residents to have to carry trays of food outside in all weathers. The cook has only worked at the Home for a few months. He is enthusiastic about his role and understands the importance of providing food which is healthy but which the residents will enjoy. He has reviewed the menus to make them more healthy. The cook has a good knowledge of individual residents likes and dislikes as well as any particular dietary needs. During the visit one of the residents asked him to prepare some soup and bread for her at a set time and he agreed to do this. Another resident said that he is always offered good vegetarian options which meet his preference to have vegetarian food. Residents are offered a choice from the menu and are asked each day to make a choice about the next days menu so that the cook is able to plan. However, residents said that if they change their mind or if they wish to have something else then the cook is always flexible. One resident said “….meals couldn’t be better”. There are hot and cold drinks available in the communal dining room and in the individual houses/flats so that residents can help themselves. They are offered fruit, biscuits and snacks mid morning, mid afternoon and during the evening but are not able to access these at other times. Residents told us that they enjoy their meals. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the residents are not met consistently and the way in which medication is managed means that the residents are at risk EVIDENCE: As previously mentioned in this report, the care plans are not detailed enough about the personal and healthcare, including mental health, needs of the residents to ensure that these are met in a consistent way. Staff said that that they provide very little assistance with personal care and that this is only provided in certain circumstances when a resident requires it. One of the staff who spoke to us had a good understanding of the importance of good personal hygiene, particularly when residents wish to take part in activities within the community and to be accepted as part of the local community. Wherever possible, personal care is provided by staff of the same gender as the resident. The care plan for one of the residents has not been Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 17 updated to reflect that there are reasons why male staff should not offer support with personal care or to be alone with the resident. The residents are all registered with the local GP practice and some also see health/social care workers from the local mental health service. The residents have mental health needs or learning disabilities but the staff have not received appropriate training for this. The AQAA states that staff have received training with regard to mental health but the four staff who we spoke to have not received this and there is no mention of it within the training matrix. The complaints record includes details about at least four complaints made by staff or residents that refer to staffs lack of understanding or ability to manage situations relating to residents mental health needs. The Operations Manager said that two staff are due to attend Training the Trainers course for Non Aversive Psychological and Physical Intervention training which they will then provide to all the staff. However, there is a need for staff to also attend training about mental health so that they have a good understanding of the specific needs of the residents. Staff told us that they learn about the needs of the residents and how to deal with situations from other staff rather than through any formal training or direction from the management team. On the day of the visit to the Home there were four members of staff on duty. One had been at the Home for three years, two had been there for approximately seven months and one was in his induction and had been there for two weeks. There were no senior staff on duty although the acting Manager had phoned the Home that morning and then came to the Home once we started our visit there. One of the residents has made two complaints with regard to medication. The outcome of the first complaint was that a member of staff would receive close supervision with regard to the administration of medication. There are no records relating to this within the member of staffs file and none could be found elsewhere so there is no evidence that this supervision took place. The residents are not woken for their medication and staff said that once a resident gets up they come over to the office in the main house to receive their medication. This can mean that residents have their morning medication quite late but staff said that they do not change the times of the lunch time medication accordingly. There is also a lack of understanding about whether it is appropriate to give some medications later than the time prescribed. The staff said that they do not allocate the responsibility of administering medication and that whichever staff is available will give the medication to the resident. Staff said that they receive training with regard to the administration of medication and that only staff who have received this training administer Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 18 medication. However, the training matrix shows that at least one member of staff who has administered medication has not received the appropriate training. Also, when we asked the member of staff responsible for the administration of medication during our visit to the Home about the policy with regard to ‘Homely Remedies’ she said that she did not know what this was, nor where it was kept. Medication is kept securely but it is kept in a small room which is very cluttered. Medication is provided from the pharmacy in a variety of formats, some are in monitored dosage packets, some in daily dosset boxes and some in original packaging. The medication trolley has many paper bags stored in it with medication belonging to different residents in these. A requirement was made at the last Inspection for the medication administration records to be well maintained as there had been gaps in the record. It was noted during our visit to the Home that there are still gaps in the administration record. The fact that there is a lack of clarity about which member of staff is administering medication, the inaccurate records and the different formats in which medication is kept means that the residents are at risk of medication errors. A medication error occurred on the day of our visit and we have been notified of another error made earlier this year. Staff told us that some of the residents look after their own medication but that recently two residents have been stopped from doing this as they had not been managing this situation well. It is not clear what systems were in place to monitor the residents ability to manage their own medication. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The residents do not all feel that their views are listened to. The poor management of complaints and lack of attention to safeguarding issues means that the residents are at risk of abuse. EVIDENCE: The Home does have a complaints procedure which is available to the residents. However, the complaints which are made are not investigated properly and accurate records are not kept about the investigation or outcome. One of the residents told us that they had told the Manager about the poor practice of one of the staff and that he didn’t know what had happened about the complaint. One of the residents said that he was confident that the staff would deal with any complaints. The lack of training for staff about mental health and communication as well as the lack of opportunities for residents to raise concerns, such as residents meetings, means that the concerns/complaints that residents have are unlikely to be raised or dealt with appropriately. We were told that one of the residents has a history of making unfounded allegations about staff but the care plan does not include any information about this, nor has there been any multi professional discussion about this. The acting Manager said that he is arranging a review to discuss this issue. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 20 We have been notified of three safeguarding allegations since the last Inspection. Two of these were appropriately notified through the Norfolk safeguarding procedures, but one had not been. During the visit to the Home we looked at the complaints record. This showed that there had been eight complaints made. The records are poor and despite the Operations Manager looking into the situations after our visit it has not been possible to clarify the actions taken, or the outcomes, for all of the complaints. All of the staff about whom the complaints have been made, apart from one, are all still working at the Home and none of the management team are clear about whether the investigations carried out exonerated staff or of what action was taken at the time to deal with the situation. The AQAA states that staff receive training with regard to Safeguarding Adults but the training matrix shows that although the majority of staff have attended training this should have been updated by now and there are some staff who still have not attended the initial training. Staff told us that they would report any concerns to the acting Manager or to one of the assistant Managers. The acting Manager has attended general Safeguarding training but has not attended any training which covers the procedure for making referrals to the Norfolk Safeguarding team. The organisation are not following their own recruitment procedures, nor their procedures for protecting residents. We looked at a selection of staff recruitment files and found that two of the staff out of the four files that we looked at had started work at the Home before they had received a satisfactory Criminal Records Bureau disclosure or PovaFirst clearance. One of the staff was on duty on the day of our visit and we made the acting Manager aware of the situation so that he could carry out a risk assessment about the action the organisation should take about this situation. One of the staff files also indicated that a member of staff had been asked to leave their last employment yet there was no record of any follow up to this having been undertaken to find out the reasons for this. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home provides basic accommodation for the residents in a range of communal and private living areas EVIDENCE: The Home provides accommodation for residents in a variety of settings. The main house provides bedrooms which are mostly single with one shared room. There are communal areas such as the dining room, lounge, smoking room and bathrooms. The bathrooms in this house have recently been upgraded and decorated but still look fairly institutionalised. The dining room has been tastefully refurbished and redecorated. There are also two houses known as ‘Mousehold’ which provides accommodation for up to four residents each with a shared kitchen/dining room, smoking room and bathroom. There are then two buildings of small flats, mainly for one person but with some for two people. We saw a two Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 22 person flat where the residents share the bedroom. The residents said that the bedroom was really too small to share but that they have got used to it. This flat has recently been redecorated with a new cooker fitted. However, the sofa is ripped and dirty. The acting Manager said that a new sofa has been ordered. We also saw a two person flat where each resident has their own bedroom. One of the residents said that he really likes living there as he can “…have my own space and staff help me if I need it”. The different living areas show lots of evidence of residents having been encouraged to personalise their home. There are smoking areas at each of the living areas as the majority of the residents smoke. The Home has a small laundry area which is not sufficient for the number of residents who live at the Home and so the laundry is sent out to an external laundry service. Once the new accommodation is used there will be a large laundry and most of the laundry will be done on site. There is currently only one domestic member of staff who works Monday to Friday. There is no domestic cover at weekends. During the walk around the site it was noted that there was soap and hand towels, as well as protective gloves, available in the bathrooms. There are lots of areas across the site which are in need of refurbishment, recarpeting or redecoration. The Operational Manager said that now that the new build has been completed the older parts of the Home will receive attention and improvements will be made. The organisation has recently completed a new build of additional accommodation for residents, a new kitchen and laundry as well as additional office space. The organisation have applied to the Commission for registration for this accommodation. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels are not adequate to meet the needs of the residents and staff do not receive the appropriate training and support to enable them to carry out their roles effectively EVIDENCE: When we arrived at the Home on the day of the visit there were four staff on duty. As previously stated in this report there were no senior staff on duty and one of the staff was shadowing staff as part of his induction and should not have been counted as part of the staffing rota. The staff told us that the assistant Managers were both on a training day and that the one senior support worker was off duty. The acting Manager had phoned the Home in the morning and arrived later that morning. A requirement was made at the last Inspection for the Home to provide adequate numbers of staff to meet the needs of the residents. This requirement has not been met. The staffing levels do not provide enough staff to ensure that residents can be supported on an individual basis. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 24 The staff on duty were helpful and co-operative during the visit to the Home. They provided information when asked and explained to the residents what we were doing at the Home. The use of hand held radios continues for staff to communicate with each other and these are intrusive and institutionalised. One of the residents said that the staff “are helpful and talk to me when I want them to”. Another resident said that the staff “are good”. Another resident told us that he had complained about one of the staff as they did not do what they were supposed to. As previously stated in this report complaints about staff have been made to the management team. During the visit to the Home one of the staff raised her voice to one of the residents who told them “don’t yell at me” Some of the staff who we spoke to were very enthusiastic about supporting the residents and clearly wish to provide a good service to the residents. They were aware of the gaps in their training and had actually undertaken their own research with regard to working with people with mental health difficulties. The member of staff who is undertaking their induction said that he had received a lot of support from the staff team and that he feels that his induction is effective and appropriate to the job he will be doing. Discussions with staff and observations of the training matrix provided to us show that the majority of staff have attended mandatory training but that some of this is in need of updating. Training that is specific to the individual needs of the residents has not been provided despite plans for this to have taken place soon after the last Inspection. The acting Manager said that he is going to meet with a new training provider to discuss NVQs. Staff meetings have started to take place again and staff said that these are useful and that they feel confident in raising any issues. Discussions with staff and inspection of records show that there have been staffing issues at the Home for some time and that these have not been addressed effectively. Action is now being taken to address these issues and to provide the training and leadership to the staff team to enable them to provide more effective support to the residents. We looked at four of the staff recruitment files and found that two of the staff have started working with the residents before they had received an appropriate Criminal Records Bureau disclosure or POVA First response. The organisation have also not received both references for one of these members of staff and the other had it recorded on a reference that their employment had been terminated with no record of any follow up prior to the staff being offered a job at the Home. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 25 Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The Home lacks leadership and direction so the service provided is not consistent or person centred. The views of the residents are not routinely sought. EVIDENCE: There has been inconsistent management of the Home for the last few months. Both the registered Manager and one of the assistant managers were appointed in 2007. The registered Manager was off sick for several months earlier this year and then returned for a few weeks before going on sick leave again. The Manager is not going to return to work and so the organisation are making plans to recruit for this position. The organisation has recognised that Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 27 the Home needs management input and one of the Managers from another Home within the organisation has been providing management support on a daily basis, either by telephone or by actually being at the Home. The Operations Manager also provides additional support to the assistant Managers. The organisation has strengthened the management team recently with the appointment of a second assistant Manager who is a trained mental health nurse and has experience within the field of mental health. The Home has an administrator who has a good understanding of the policies and procedures relating to the areas for which she is responsible. She was helpful in providing information and records during our visit to the Home. However, despite the arrangements in place the Home lacks direction and leadership as there is no permanent, effective Manager. The staff do not receive regular formal supervision although staff told us that they are able to speak to the acting Manager or to the assistant Manager whenever they need to. Residents and staff also told us that the building works that have been taking place over the last few months have been unsettling and noisy. We saw the record of accidents/incidents but there is no system in place to audit these and to see if there are any trends or whether any action needs to be taken to prevent future occurrences. Records and information provided by the Operations Manager after our visit to the Home show that complaints and staff disciplinary situations have not been dealt with effectively and accurate records have not been kept. The training matrix shows that some of the staff have received training with regard to health and safety and infection control, but not all. The radiators in the Home are covered and staff said that the hot water temperature is controlled to reduce the risk of burns/scalds. The monthly reports completed by the Operations Manager for last month state that records need to be kept of the weekly fire alarm tests but that the maintenance manual was up to date. We did not see these records during our visit. We did see the fire risk assessment document which was not completed fully. Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 1 2 1 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 1 1 2 X X 2 X Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 29 yes 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 YA7 2 YA14 16 (2)(m) Standard Regulation 15 (1) Requirement The care plans must contain detailed information about individuals care needs to ensure that residents needs are met The views of the residents must be sought about their interests so that they can be supported to take part in meaningful activities Only staff who have received appropriate training and assessment of competence to administer medication to ensure that residents receive medication in a safe way The medication administration records must be accurate to ensure that residents receive the correct medication at the correct time All complaints must be fully investigated and an accurate record kept of the details All staff must receive training with regard to Safeguarding Adults to ensure that the residents are protected from abuse The accommodation must be upgraded to ensure that the residents live in accommodation DS0000069241.V368180.R01.S.doc Timescale for action 31/08/08 30/09/08 3 YA20 13 (2) 31/07/08 4 YA20 13 (2) 09/07/08 5 6 YA22 YA23 22 (3) Schedule 4 13 (6) 09/07/08 30/09/08 7 YA24 23 (2)(b) 31/12/08 Hollybrook House Version 5.2 Page 30 which is homely and comfortable 8 YA33 18.1 (a) The staffing levels must be sufficient to meet the needs of the residents The previous date of 01/08/07 was not met Staff must receive training with regard to mental health to enable them to meet the needs of the residents A fire risk assessment must be carried out to ensure that appropriate plans are put in place to protect the residents from fire 31/07/08 9 YA32 18 (1)c 31/10/08 10 YA42 13 (4) 31/08/08 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 Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Hollybrook House DS0000069241.V368180.R01.S.doc Version 5.2 Page 32 - 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. 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