Inspection on 23/10/06 for Hollybush

This inspection was carried out on 23rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hollybush 13/11/09

Hollybush 12/05/09

Hollybush 13/05/08

Hollybush 07/03/06

Hollybush 10/08/05

Hollybush 08/03/05

Hollybush 02/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hollybush 45 Glamis Road Newquay Cornwall TR7 2RY Lead Inspector Ian Wright Key Unannounced Inspection 9:15 23rd and 26th October 2006 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 Hollybush DS0000008930.V311933.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. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hollybush Address 45 Glamis Road Newquay Cornwall TR7 2RY 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) 01637 874148 F/P 01637 874148 Mr Neil Edward Brazier Mrs Nicola Carla Brazier Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (14) of places Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 14 adults of old age (OP) Service users to include up to 4 adults with Dementia (DE(E)) Total number of service users not to exceed a maximum of 14 Date of last inspection 7th March 2006 Brief Description of the Service: Holly bush accommodates up to fourteen elderly people, up to four of who may have dementia. Holly bush is situated in a residential area on the outskirts of Newquay. The home is close to shops and in walking distance of the coast. Mr and Mrs Brazier are the registered providers. The majority of bedrooms are situated on the ground floor. Five bedrooms are situated on the first floor and are accessed via the stairs or a stair lift. All bedrooms have en suite facilities. There are assisted bathroom / shower facilities for people with mobility problems. There is a large lounge / dining room, which provides shared space for service users to relax in. The home has a conservatory and service users can use the garden. There is car parking available for service users, staff and visitors. The ground floor is wheelchair accessible. A copy of the inspection report was not on display, at the time of inspection, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £325 to £360 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. The manager said the fees for service users with dementia are decided on an individual basis based on assessed need. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place in twelve and quarter hours over two days. All of the key standards were inspected. The methodology used for this inspection was: • To case track five service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with seven staff their experiences working in the home. • Discussion with other service users and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: A trip risk was identified in one service user’s bedroom and this needs to be addressed. Some further work needs to be completed to ensure staff are fully trained. This should include fire training and formal training regarding dementia. All new staff need to have a Protection of Vulnerable Adults ‘First’ check (POVA First) check before they commence employment. This check Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 6 ensures they are not on a register which states they are not fit to work with the vulnerable. 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. Hollybush DS0000008930.V311933.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 Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Service users are issued with a copy of terms and conditions of residency or a contract, so they are aware of their rights and responsibilities. The pre admission assessment procedure is good, and enables the registered provider to ascertain they can meet the needs of service users, before admission is arranged. EVIDENCE: A copy of the home’s statement of terms and conditions of residency / contract was inspected. An individualised copy of this document was on all service user files inspected and these seemed satisfactory. The registered provider assesses service users before they are admitted. The manager said service users or their relatives could visit the home before formal admission is arranged. Some service users remembered an assessment was completed before admission was arranged. Copies of assessments were available for inspection in service user files. Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. All service users have a care plan, and there is evidence these are regularly reviewed. This helps to ensure service users’ care needs are suitably met. Healthcare support seems appropriate so service users can be assured they will receive suitable support from medical practitioners. The operation of the medication system is satisfactory so service users can be assured their medication is handled appropriately. Issues regarding the diverse backgrounds of service users appear suitably addressed. Service users have said they feel they are treated with respect and dignity. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. Care plans inspected were reviewed in the last month. Some service users the inspector spoke to were aware they had a care plan, but others were not. Service users however said care is delivered to a good standard, and staff did their best to meet their needs. Service users said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. The inspector spoke to a community nurse who said she felt health care needs were met appropriately. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 10 The registered provider has a satisfactory medication policy. Medication is administered via the monitored dosage system. The medication system was inspected and was generally satisfactory. Some prescribed medication (i.e. creams) were not on the medication sheets. The manager said these were only used on an occasional basis. However these medications should be written on the medication sheet- with a note to state if they are self-administered. Administration and other records seem satisfactory. All staff have received satisfactory training regarding the administration of medication. Service users said they felt staff worked with them in a manner, which respected their privacy and dignity. Service users were positive about their care. Service users said personal care was provided to a good standard. The registered provider has a satisfactory policy regarding anti discrimination. There are currently no service users from ethnic minorities, although the registered provider stated she would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Routines and activities are satisfactory so service users can live a lifestyle that meets their needs. Visiting arrangements are flexible. Appropriate arrangements appear to be in place regarding the management of service user monies. Meals are provided to a good standard, so service users receive an appetising, wholesome and nutritious diet. EVIDENCE: Service users said they could get up and go to bed when they wished and routines are flexible to suit their needs. The inspector observed staff working in an appropriate matter with service users. Routines appear unrushed and appear to take individual wishes and needs into consideration. Service users either spend time in the lounge or in their bedrooms. There are some organised activities, for example, there are keep fit sessions, quizzes and entertainers occasionally visit. A Methodist minister visits the home on a regular basis. Service users said they could receive visitors when they wished. The library regularly visits the home. Some service users also attend a drop in centre for the elderly once or twice a week, which seems an excellent opportunity for people to get out. The inspector spoke to the relatives of one service user who were happy with the care provided. Service users also made Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 12 many positive comments regarding their care including ‘everything is A1’, ‘couldn’t be better’ etc. Service users all said they were encouraged to make choices and did not feel there were excessive or inappropriate restrictions placed upon them. Some small amounts of cash are looked after on behalf of service users, and satisfactory records are kept regarding these. Other service user monies are either maintained via individual solicitors or by service users’ relatives via Power of Attorney arrangements. Bedroom doors are not lockable, as should be the case as outlined in the national minimum standard, but the manager said service users could have a cash box to store valuables if they wish or the providers can lock valuables away. Service users the inspector spoke to say they felt their personal belongings were safe and secure in the home. Service users have their meals in the downstairs dining room, or in their bedrooms. The inspector shared lunch with service users on the first day of the inspection. The meal was chicken pie, followed by a choice of dessert. The meal was to a good standard. All Service users said they enjoyed the food provided. A choice of a hot and cold evening tea is offered. Suitable records of menus and records of meals provided are maintained. Special diets (e.g. pureed meals) are provided if required. Hollybush DS0000008930.V311933.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered persons have suitable procedures regarding complaints and adult protection. Subsequently service users can be assured there are appropriate procedures to deal with any concerns or bad practice. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say whom they would approach if they had a complaint or were concerned about abuse. The Commission for Social Care Inspection has not received any complaints regarding this service. Some staff have received training regarding prevention of abuse and adult protection. Staff and service users all said they had not witnessed any bad or abusive practices. The majority of staff have Criminal Record Bureau check, and a Protection of Vulnerable Adults check (POVA) (where applicable). However one member of staff who had recently started did not have a POVA First check before commencement of employment. Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Holly bush provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a pleasant garden, which service users can use. There is a large lounge / dining room which is homely and comfortable. Bedrooms are individualised and comfortable. One service user had a wire crossing the bedroom floor and the registered provider needs to cover this to avoid it being a trip hazard. The manager said she would attend to this. A stair lift is provided to assist service users to go upstairs. Decorations are to a high standard, and the inside of the building is modern and fresh. Bathroom and shower facilities are to a good standard and effort is made to make these spaces homely. Suitable kitchen and laundry facilities are provided. Cleaning staff are employed, and the home was clean and hygienic at the time of inspection. Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. Staffing levels are satisfactory so service users can be assured that a suitable number of staff are available. Recruitment records are generally satisfactory. However procedures regarding obtaining Protection of Vulnerable Adults checks (POVA First) need improving. A good effort has been made to improve staff training, although some further work needs to be completed so training meets the regulations. This will ensure staff have suitable skills and knowledge to cater for their needs. The registered provider has a suitable approach to ensuring staff have a national vocational qualification in care. Equal opportunities issues regarding recruitment and work practices seem satisfactory. EVIDENCE: The inspector observed copies of staff rotas. Two carers are on duty at any one time during the waking day. The manager is also on duty during the day five days a week. The registered providers spend two days a week at the home. One waking member of staff is on duty during the night. A cook and cleaning staff are employed. Service users were positive regarding staff attitudes for example staff were described as ‘lovely,’ and ‘kind.’ The registered provider has a suitable approach to providing National Vocational Qualifications for care staff. Due to staff turnover the manager said currently 33 of staff have an NVQ 2 or 3, although four other staff are currently working towards this qualification. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 16 Staff recruitment records are generally satisfactory. The registered provider has ensured current staff complete an application form. A Criminal Records Bureau check and Protection of Vulnerable Adults check (where applicable) are obtained. However a POVA First check had not been obtained for a member of staff who had recently started, and this should be obtained before staff start work. The member of staff concerned does not work in a caring capacity. Two references for staff employed appear to be obtained. The inspector spoke to several staff regarding staff induction arrangements. Staff said they were shadowed on several initial shifts. There is suitable documented evidence of staff induction. The registered provider’s approach to equal opportunities and anti discrimination is to a good standard. Staff training records were inspected. Staff training required by regulation has developed very well since the last inspection. However there is still some further training staff require so regulatory standards are met. For example all staff need to receive regular fire training, most staff need to receive training in food hygiene and at least one member of staff manual handling training. The manager said some staff had received this training, but their certificates were either at home or they were awaiting these from various training providers. A copy of all certificates needs to be kept on file once these have been obtained. Most staff need to receive training in dementia awareness although currently the needs of people with this diagnosis do seem to be met to a good standard. Hollybush DS0000008930.V311933.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered provider is suitably experienced, skilled and qualified to manage the home. The registered provider has a satisfactory approach to quality assurance so service users can be assured the care they receive is of good quality. The registered provider has a satisfactory approach to handling service user monies so service users can be assured their monies are suitably looked after if the registered provider is involved in this area of their lives. The management of health and safety issues is satisfactory so service users can be assured they live in a safe environment. EVIDENCE: The registered provider has suitable experience, skill and knowledge to manage the home. A manager is employed to manage the home on a day-today basis, but the registered providers spend at least two days a week at the home. Staff and service users spoke positively of the registered providers and the manager. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 18 The registered provider has a quality assurance policy. The registered provider has carried out a survey among service users and their relatives. The results of this survey were positive. There were also copies of letters of thanks from relatives. There is evidence that staff and resident meetings have both occurred at least three times in the last year. The registered provider looks after some small amounts of service user monies. Suitable records of monies are kept. Otherwise service users or their representatives are responsible for their finances, and fees are paid via bank transfer. The registered provider has a health and safety policy. Records kept of checks required by regulation are satisfactory. For example there are suitable records for the testing of fire equipment, electrical equipment, gas appliances and moving and handling equipment. Health and safety risk assessments are satisfactory and there is a suitable risk assessment regarding the prevention of Legionella. The registered provider is advised to send a copy of the Legionella risk assessment to the Environmental Health Department (Health and safety) for advice whether any regular checks need to be completed. Hollybush DS0000008930.V311933.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 3 3 X X X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 20 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. Standard OP30 Regulation 18 Requirement Staff must receive training required by law, and there must be satisfactory evidence this has been received for example • Regular fire training • Moving and handling • Food hygiene (if staff handle any food) • All staff must also receive dementia awareness training. Previous timescale of 01/11/06 not met 2nd Notification. 2. OP24 OP38 13, 16, 23 The registered provider must ensure all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (For example suitable precautions need to be taken to remove the trip risk in one service user’s bedroom) 12, 13, The registered persons must 19. obtain for all staff a Protection of Vulnerable Adults check (POVA First) check before they commence employment. DS0000008930.V311933.R01.S.doc Timescale for action 01/04/07 01/12/06 3 OP29 OP18 01/12/06 Hollybush 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 OP38 Good Practice Recommendations The registered provider is advised to send a copy of the Legionella risk assessment to the Environmental Health Department (Health and safety) for advice whether any regular checks need to be completed by the provider or a qualified contractor. Hollybush DS0000008930.V311933.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hollybush DS0000008930.V311933.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. 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