CARE HOME ADULTS 18-65
Hollycroft 90 Church Street Langford Bedfordshire SG18 9QA Lead Inspector
Andrea James Announced 06 September 2005 9:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hollycroft Address 90 Church Street Langford Bedfordshire SG1 9QA 01462 701273 01462 850689 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Home Farm Trust Vacant Care Home Only 8 Category(ies) of Learning Disability (LD) 8 registration, with number of places Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21/2/05 Brief Description of the Service: Holly croft was a large detached house in the village of Langford that had been adapted to provide accommodation for eight adults with learning disabilities.The house was situated in the main street of the village and there were pubs, church and shops in close proximity. There was an infrequent bus service to the nearby town and the home had two domestic style vehicles for the use of the service users. The adaptations to the house resulted in six single rooms on the first floor with two bathrooms and a separate toilet and staff accommodation. Two further bedrooms were provided on the ground floor with a bathroom, separate toilets, two lounges, dining room and kitchen. A laundry room was provided on the ground floor but access to this was from the garden. The large rear garden was enclosed and overlooked open fields. To the front and side of the building was parking space for five or six vehicles but some manoeuvrability was required if the parking space was full. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that was carried out on the 6th of September 2005, 7 months after the last inspection. The duration of the inspection was 5 hours. The home was registered to meet the needs of 8 service users with learning disabilities. The home had a new manager that had not yet applied for her registration but was available for the duration of the inspection. 5 of the 8 service users were on holiday in Spain on the day of the inspection, as a result the 3 service users who remained in the home represents the views of the service users in this report. The inspection followed a case tracking methodology where the service users were spoken to and their records were inspected in detail. The report also consists of information received from care staff on duty and the manager. What the service does well:
The home provides good standards of care to the service users and had enabled them to maximise their independence both in the home and the wider community. Some service users were not able to verbally express their views about the service but showed non-verbal appreciation for the care staff where possible. One service user was able to say that he liked the home and had no problems. He smiled a lot and appeared to be happy and relaxed within the home environment. Another service user was able to say that he enjoyed living at the home and he spoke at length about the various activities and choices he was offered at Hollycroft. He spoke about his forthcoming holiday to Yarmouth, his weekend stays with his family and friends and the various places he attended during the course of the week. A house rota was available for the service user to enable them to develop their domestic skills within the home and service users were observed carrying out these tasks in a willing manner. The home ensured that the service users received varied amounts of activities and some were able to attend college courses to develop academically. Service
Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 6 users were also able to develop relationships within the home and in the wider community. The home offered staff training on several areas that ensured the skills and experience of the care staff were developed and as a result the needs of the service users were being met. The home ensured that more than 50 of the care staff had received their NVQ level 2 qualification in care and some carers were about to embark on their NVQ level 3. What has improved since the last inspection? What they could do better:
The home should ensure that all service users have a full and comprehensive care plan that details the care intervention to be carried out by the carer staff. This document must be related to the identified needs recorded in the assessment information and should be reviewed and updated on a regular basis. Where identified the care plans should also have satisfactory risk assessments that identifies any areas of harm that could be posed to the
Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 7 service users. This was an outstanding requirement from the last two inspection reports and remains unmet. The home should ensure the safety of the service users in all aspects of their daily living. On the last inspection 4 windows were identified as requiring replacement because they were unable to be opened. The care staff and service users explained that in the winter months the windows would swell and cause condensation and in the summer months the temperatures in the rooms were very high. This was also identified as a fire risk, and the home was given a requirement to replace the windows but this was not actioned and as a result an immediate requirement was issued to the home on this inspection. The carpets in the communal areas of the home needed to be replaced as they had become worn and dirty through continuous usage. The home did not have a fire risk assessment and some records for fire testing were not satisfactorily maintained. The quality monitoring of the service also needed further development to encompass the views of the service users, care staff and relatives of the home. The Commission would like to thank the service users, care staff and the manager for their co-operation in the inspection process. 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. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 5. Satisfactory processes were in place that enabled perspective service users the opportunity to choose if they wanted to live in the home, receive good assessment of needs and have contractual agreements that detailed the conditions of their placement. EVIDENCE: The home had developed their Statement of Purpose and made it available to the service users and perspective service users. The records of service users inspected showed that a full assessment of need was carried out using the new assessment tool. The manager also demonstrated a clear understanding of the procedures and understood the need for the new assessment tool that had recently been implemented in the home. The service users contractual agreements were developed to ensure the cost of the placement was recorded and satisfactory signatures were seen for both service user and the home. The home had no new admissions since the last inspection ad as a result this standard could not be assessed in its entirety. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 The home was good at encouraging service users to develop, make choices and take risks in order to maximise their independence through daily living skills. The home was poor at identifying the needs of the service users and implementing satisfactory care interventions where needed, as a result some service users health care needs were not addressed. EVIDENCE: The home had various activities rota and day care programmes that produced evidence that the service users were encouraged to develop their daily living skills. One service user spoke about his college placement and the relaxation and art session he had at the day centre. Another spoke about the pottery sessions and how much he enjoyed it. Service users were encouraged to take risk by becoming involved in community activities and staff encouraged and supported service users in their aspirations. On the day of the inspection 5 of the service users were on holiday in Spain and other holidays were scheduled for the remaining service
Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 11 users, which suggested service users were able to choose the holiday they wanted. Service users said they were able to make decisions in their day-to-day lives and commented that they had regular residents meetings and yearly reviews. The home failed to implement satisfactory care planning documentations that identified the needs of the service users. It was concerning that the care staff had no formal instructions as to how to meet the needs of the service users. The manager was aware of the deficiency in their recording systems and pledged to resolve these problems as soon as possible. This was an outstanding requirement for the last two inspections to the home. The care plans seen also failed to have satisfactory risk assessments and as a result some service users welfare could be put at risk. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,13,14,15, and 17 The home ensured service users were enabled to live a fulfilling lifestyle which encompassed, personal development, cultural awareness, community involvement, leisure activities, social and family contact and healthy eating. EVIDENCE: The home ensured the service users were able to develop to their full potential wherever possible. Service users were observed to prepare their own lunches and wash and put away dishes used. Service users spoken to said they also helped to clean their rooms, carry out laundry duties and helped with the preparation and shopping for food provisions. They said they had regular residents meetings and were consulted about any changes to the home. Two service users were supported to have a relationship within the house. Service users were encouraged to participate in community activities such as attending concerts, cinema’s and other leisure venues.
Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20. Service users received good personal support that enabled them to maximise their independence. The ability to maintain good health care practices were in place and as a result service users wellbeing in regards to health issues were satisfactorily met. EVIDENCE: Care staff said the service users health care needs were being met. Records showed that referrals were made to various health care professionals. The service users health was addressed by the input of various external professionals for example dieticians, physiologists, gp’s and district nurses. The home needed to ensure that the needs are identified in the care plans. The medication procedures had improved since the last inspection and were satisfactorily maintained. The manager was in the process of identifying training for the care staff and was also looking to change the present system of receipt and storage of medication to a more secure system. Service users did not self- medicate. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Satisfactory processes for complaining and reporting abuse were available in the home which resulted in service users being able to voice their views or report suspected abuse should they occur. The processes for recording service users money was poor and as a result service users could be at risk of financial abuse. EVIDENCE: Service users spoken to said they had regular residents meetings and felt confident in expressing their views. The care staff and manager were observed communicating effectively with the service users. The service users said they felt able to complain should they have concerns. The home ensured care staff were trained in abuse awareness and this was also covered in their induction process. Care staff said they knew how to report abuse should they occur. The financial records of the service users showed that inaccurate recording of service users money resulted in some transactions being unaccounted for. The manager gave an explanation of what might have transpired but there was no evidence to substantiate the findings. It was also noted that only one signature was recorded for transactions of money being passed to the service users. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28 and 30. The home had satisfactory process in place to ensure service users were comfortable and safe in their communal areas and bathroom and toilet facilities promoted their independence and privacy. All areas were free from offensive odours, which resulted in a welcoming environment for the service users. Some environmental standards were poorly maintained in service users bedrooms and as a result service users safety and welfare was compromised. EVIDENCE: The home was clean and welcoming and was decorated to a modern standard. The service users bedrooms were decorated to ensure individualisation and sufficient communal space was available for all service users. The home had some areas that required attention, namely the worn and dirty carpets in the communal areas of the home and the garden that appeared unkempt. The manager said she had plans to replace the carpet and to redesign the garden. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 16 One shower room was being used for storage and as a result less bathing facilities were available for the service users. It was recommended to the manger that this room be returned to its original use to provide sufficient facilities for the service users. The home also failed to action the requirement from the last inspection asking for the replacement of some of the service users bedroom windows, which were seen as a potential fire hazard or entrapment. The service users comfort was also being compromised. The windows failed to open and when prised open failed to remain open causing excessive heat in hot weathers and severe condensation in cold weathers. An immediate requirement was issued to the home for this to be actioned. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35 and 36. Satisfactory processes were in place for staff training, supervision, and to ensure competent and qualified staff were available to meet the needs of the service users. The home’s recruitment processes were poor and as a result service users safety could be at risk. EVIDENCE: The home had a steady core of staff that had worked in the home for a number of years. Those spoken to appeared knowledgeable about the needs of the service users. The home had 7 carers 3 of which were full time and the others had a part-time contract. The staff spoken to said, “It is a happy house”, and they felt supported to do their jobs. The care staff said they received training and the records showed that several areas of training had been explored and a schedule was seen for future training needs. More than 50 of the care staff had obtained their NVQ level 2 in care. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 18 The care staff spoken to said they received regular supervisions. Records showed that at least 6 supervisions were offered to all care staff on an annual basis. The recruitment procedures needed further development as some of the staff files viewed failed to show that satisfactory clearances were obtained for all care staff to include Criminal Record Bureau checks, references and application forms. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,42 and 43. The arrival of the new manager appeared to have created a more stable and focused staff team that enabled the service users to feel confident and reassured that their interests and needs will be met. The home’s quality monitoring systems were poor and as a result there was no evidence to suggest the home reviewed their care practices. The home had satisfactory health and safety policies and procedures but further development was needed to ensure the service users safety. EVIDENCE: The new manager had been in post for a few months and appeared knowledgeable about the needs of the service users. She had a clear vision for the staff team and explained how she would make improvements to the home. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 20 The care staff and service users spoken to said they felt supported by the manager and they liked her. The manager had 15 years of experience working with adults with learning disabilities and had obtained her NVQ level 4 qualification in management. She was due to embark on her NVQ level 4 qualification in care in January 2006. The manager had not yet applied for her registration to manage the home. The home failed to show how they were able to quality monitor the service offered to the service users. The home had designed questionnaires that were due to be sent to families and friends but no other form of quality monitoring was available in the home. The home had satisfactory health and safety policies but further development was required to be made to some of the fire procedures. The home failed to provide a fire risk assessment and some fire records seen suggested that records for weekly and monthly checks were not obtained. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 1 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hollycroft Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x 2 3 I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 22 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 6 Regulation 15 (1) Requirement All service users must have a full and detailed care plan that illustrates the care interventions to be carried out for all identified needs. Previous time scale of: 30.4.05 All care plans must be reviewed and updated on a regular basis. All identified risks must be risk assessed and satisfactory interventions implemented for all service users. Previous timescale of:30.04.05 Arrangements must be made for staff administering medication to have appropriate training. Previous timescale of : 30.9.04/30.4.05 Arrangements must be made to ensure service users money is not used to pay for staff accommodating service users on leisure actvities. Previous timescale:30.09.04 Arrangements must be made to ensure satisfactory receipts are obtained for all money from or to service users bank accounts. At least two signatures must be obtained for any money being dispensed to the service users, Timescale for action 30.11.05 2. 3. 6 6 15(2) (b) (c) 13 (4) (b) 30.11.05 30.11.05 4. 20 13 (2) 30.11.05 5. 20 13 (6) 30.10.05 6. 23 13 (6) 30.10.05 7. 23 13 (6) 30.10.05 Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 23 to ensure accountability. 8. 25 23 Arrangements must be made for an action plan detailing when the windows will be replaced, to be sent to the Commision. The windows must be replaced in the 4 service users bedrooms identified. Previous timescale:30.04.05 Arrangements must be made for the broken shower being used for storage to be repaired and used for its original purpose. previous timescale:30.4.05 Arrangements must be made to ensure all staff recruited in the home have satisfactory application forms and clearances on file and are kept at the home. Effective quality assurance systems must be in place within the home and actions taken where identified in improving quality services for the service users. Previous timescales: 30.10.04/30.04.05 Arrangements must be made to risk assess the home against potential fire hazards. This information must be kept under review. Satisfactory testing and recording of all fire equipment must be kept updated in the home. 07.09.05. Actioned 30.10.05 9. 25 23 (2) (b) 10. 27 23 (2) (j) 30.11.05 11. 34 19 (1) 30.11.05 12. 39 24 (1) 30.11.05 13. 42 23 (4) (a) 30.10.05 14. 42 23 (4) (a) 30.10.05 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.
Hollycroft Refer to Standard 35 Good Practice Recommendations All staff should be trained in meeting the changing needs
I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 24 2. 37 of the srvice users. Training should include medication,care planning,autism and dementia awareness. Arrangements should be made for the manager to submit her application for registration. Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Bedford Office Clifton House 4a Goldington Road Bedford, MK40 3NF 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 Hollycroft I51 S14915 Hollycroft V243002 060905 Stage 4.doc Version 1.40 Page 26 - 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!
