Inspection on 20/12/05 for Hollygrove

This inspection was carried out on 20th December 2005.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollygrove 16/02/09

Hollygrove 04/02/08

Hollygrove 12/10/06

Hollygrove 01/08/05

Hollygrove 29/03/05

Hollygrove 15/07/04

Hollygrove 08/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hollygrove 49 Roman Road Salisbury Wiltshire SP2 9BJ Lead Inspector Roy Gregory Unannounced Inspection 20th December 2005 10:10 Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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 Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hollygrove Address 49 Roman Road Salisbury Wiltshire SP2 9BJ 01722 415578 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) Turning Point Limited Ms Deborah Stone Care Home 9 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (2) of places Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 7 service users with a Learning Disability at any one time No more than 2 service users with a Learning Disability, over 65 years of age at any one time. 1st August 2005 Date of last inspection Brief Description of the Service: Hollygrove is a purpose-built service, initially opened in 1996, providing care and accommodation for nine people with a learning disability, the majority of whom have a range of personal and communication needs.The home is operated by the voluntary organisation, Turning Point, who also have a number of other services within Salisbury.The property is situated in a residential area of the city, a short drive or bus ride drive from the centre. Hollygrove is a two-storey building, with residents’ bedrooms on both floors. All bedrooms are single, have wash hand basins fitted and are close to toilets and bathrooms. Various aids and adaptations are provided for less mobile residents, and a stair lift has been installed. Communal space includes a large kitchen and dining area, a sitting room, and seating areas in the hallway and on the landing. There is also an attractive garden. Car parking is available on site and on the street. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10:10 a.m. and 4:00 p.m. on Tuesday 20th December 2005. The inspector met with six residents, spending some time sitting with residents in the sitting room, and as a guest at the midday meal. The registered manager, Debbie Stone, was not on duty, but the project workers on duty in the morning and afternoon respectively, made documentation available. Additionally there were conversations with care staff. The inspector looked at two care plans in detail; other records consulted included those relevant to staff supervision and training, fire precautions records and daily recording of care and residents’ activities. All communal areas of the building were visited and many individual rooms were seen. A pre-inspection questionnaire was received from Ms Stone, and the inspector has discussed inspection findings by telephone with Ms Stone, since the inspection. Additionally, comment cards were received from eight relatives of residents. What the service does well: What has improved since the last inspection? To improve provision for infection control, as required at the previous inspection, improvements had been made for hand washing in the staff toilet, Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 6 and the manager has put in motion action to procure certification that the home is free of legionella bacteria. Procedures have been implemented to minimise risks of the latter. Ms Stone has carried out a staffing review, which has not conclusively demonstrated a shortfall in staff, accordingly she has introduced systems to encourage most efficient use of staff, whilst intending to secure some increase in staffing to meet the age-specific needs developing for some residents. A link has been made with Age Concern, in readiness for accessing training for staff on issues related to ageing, a recommendation at the previous 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. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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 Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (None of these standards was assessed at this inspection) EVIDENCE: The key standard no. 2 was not considered relevant at this inspection, as there have been no new admissions since 2003, and none were in prospect at this time. National Minimum Standard no. 5 was met at the previous inspection. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 10 Care plans are working documents that direct care, to include the encouragement of decision-making. Residents are aware of and involved in the review process, such that changing needs are recognised and responded to. EVIDENCE: Each shift, including night workers, provided brief and objective records of care given and significant events, to give a picture of each resident’s wellbeing and lifestyle. It was evident that these records both maintained a high level of awareness amongst staff of resident needs, and fed directly into regular reviews of individual care plans. Handwritten additions and amendments to care plans showed that they were used as active documents. Guidance in plans included not only support to meeting physical needs, but also advice on communication needs and guidance on supporting individuals to make and express choices. Whilst there was a basic three-monthly routine of internal review, it could be seen that reviews and changes took place more frequently if circumstances changed greatly in the interim. With regard to annual reviews, there had been some excellent work involving residents directly in the process, such as by use of pictures selected by residents, using the office computer with support, as Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 10 representative of things they were doing. The care planning and review process linked well with residents’ participation in “Person centred planning”. All care interactions observed incorporated seeking resident understanding and consent, whilst staff were also responsive to residents’ indications of self determination. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 11, 12, 14, 16 & 17 Commitment to person centred planning has enhanced good practice in identifying interests and providing support to personal development. Residents engage in a variety of both purposeful and leisure pursuits, whilst also able to experience responsibilities. Provision for meals is planned to meet individual needs. EVIDENCE: The provider organisation has appointed visiting facilitators for person centred planning (PCP) in line with government “Valuing People” guidance. Staff thought this was helping open up a wider range of developmental opportunities for residents, and care records supported this view. In one instance, an external advocate had been introduced, to help establish an individual’s achievement and wellbeing at Hollygrove, and to confirm their wish to remain there. For all residents there was a good record of participation in activities and how these linked to interests identified through care planning or PCP. For example, one regularly pursued an interest in attending toy and model fairs, going to church and visiting animals. Each resident also had a care plan for domestic Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 12 responsibilities. For example, “X has limited ability but enjoys helping mop up spills. Also returns dirty cups and can put laundry in bin with support.” Aspects of this plan were seen in action, staff empowering the resident rather than taking over tasks that needed to be done. There were many observations of exercise of choice, such as where to sit, what to listen to or watch, or occupying oneself in a private rather than communal room. The right of a person not to join in a home’s Christmas party was recognised, with an extra member of staff arranged on the rota to provide that person with one-to-one attention during the time of the party. There was evidence in care records of the home sharing information with day services about successful and less successful activities and interventions, with a view to seeking the best “fit”. The dining room had a magnetic whiteboard, on which there was a pictorial display of which staff were on duty and coming on duty, and places that individual residents were due to be going during the day. A warming and nutritious home-made soup was made for the midday meal. One resident expressed a wish to have this at a later time, when it was ensured that the meal was at an appropriate temperature. Staff sat at table with residents and maintained interaction with them, including giving assistance as necessary in line with care plans seen. A record of a residents’ meeting held since previous inspection showed attempts having been made in a variety of ways to establish favourite and disliked foods for each resident, including having used the pictorial menus. Daily records showed staff observations of unusual reactions to food, e.g. greater or lesser quantities being consumed, or obvious dislikes. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 & 20 The quality of care planning means that residents’ care preferences and health needs are well understood and catered for. Medication practice is safe, and is monitored and adjusted through a continuous review process. EVIDENCE: All residents appeared well presented and content. Staff interactions with residents were sensitive and displayed competence in communication. They were underlined by guidance in care plans. Health plans contained guidance on specific medical conditions, which staff had signed to show they had read them. “OK Healthchecks” were in use. These displayed liaison with the learning disability nurse from the community team. The checks led to referrals within the past year to physiotherapists, speech and language therapists, etc. Medical appointments were well recorded and planned, and it was seen that they were brought forward in response to specific concerns arising. Routine asthma nurse contact was in place for one resident. Seizure charts were in place where requested by doctors. Care plans contained current up to date information about medications prescribed to individuals, together with a commitment to ensuring regular reviews of medications in use. Records showed such reviews were frequently undertaken. Night staff had reported difficulties experienced by a resident that Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 14 appeared related to a change of medicine, and a further review was swiftly arranged. Medications administration charts were in good order, with effective systems in place for double-checking. There was evidence of training given by the supplying pharmacist. Care plans included guidance on assisting residents with taking medicines, where necessary. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 23 The provider and home have appropriate procedures in place to offer residents protection from harm. EVIDENCE: The home had received no complaints since previous inspection, at which time the key Standard in respect of complaints procedure and practice was met. Guidance to staff on local inter-agency vulnerable adult procedures was readily available. The provider organisation has a policy on only engaging the services of contractors from a recognised list, and there were risk assessments in place for the conduct of contractors’ visits. Where behavioural issues for one resident had possible implications for the safety and wellbeing of other residents, appropriate risk assessments and management plans were in place, not only to protect others, but also to recognise and work with probable causes. Review documentation showed sharing of information and concerns with other agencies, and a balancing of individual and group needs. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 24, 25, 28, 29 & 30 The home environment balances practicality, in terms of meeting resident needs, with homeliness. The kitchen alone stood out as requiring attention. The review of care plans leads to changing environmental needs being recognised and provided for. Standards of hygiene are high. EVIDENCE: The inspector spent some time sitting with residents in the main sitting room. This was comfortable, with Christmas music playing at an unobtrusive volume. There was a mixture of personal and group Christmas cards on display in several places, giving a personal, homely feel. A wheelchair user was able to enjoy the amenity of the room alongside those using armchairs and recliners, with easy access. Several bedrooms were seen, all were personalised to reflect the personalities of their occupants. One had a new carpet, and diary entries showed staff had involved the resident in this change, before and after the event. There was evidence of consultation with an occupational therapist before procurement of a new bed for another resident, after the review process had identified such a need to aid transfers into and out of bed. Another resident was to have a new bed provided by their family, in recognition of needs associated with their Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 17 ageing. A new assisted bath was due to be fitted to replace a conventional bath during January 2006. Very good standards of cleaning were seen throughout the home, including vanity units in bedrooms. A weekly cleaning schedule was seen. There was evidence of the manager having acted on previous requirement to obtain a certificate that the home is free of legionella, and Ms Stone has since confirmed that little used water outlets are subject to a weekly flushing routine. Required enhancements to staff hand washing facilities had been made. The environment was let down by broken cupboards and drawers in the kitchen. Whilst this is not an area accessed by residents other than with supervision, this shortfall may have implications for hygiene and health and safety, and in any event contrasts with attention to maintenance and homeliness elsewhere in the home. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 & 36 Quality of work suggests staffing is generally adequate, providing it is kept under review in the light of changing levels of resident need. Appropriate recruitment, supervision and training practices are in place to ensure the competency of staff is kept up. EVIDENCE: There had been no new recruitment of staff since previous inspection. The inspector is aware from inspection of other Turning Point homes that the provider’s centralised policies and procedures for recruitment of staff are robust and safe. As at the previous inspection, staff saw allocation of staff hours as quite stretched in the light of residents’ changing needs, in relation to ageing. For example, two residents were identified as taking much longer to accomplish tasks, whilst it remained the case that residents required a lot of support for attendance at various medical appointments. On the day of inspection, two residents had medical appointments at different locations, within ten minutes of each other. It was also the perception of two relatives, via comment cards, that there were not always sufficient staff on duty. Ms Stone, however, had undertaken a staffing review as required at previous inspection, and this had shown there was only a marginal shortfall when using a recognised calculation tool. She subsequently told the inspector she has identified more efficient ways of working for staff, with more use of checklists to help them keep to task. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 19 Morning routines were said to be less pressured as some day services now had a later start to the day, but a diary entry for a resident on the day of inspection said “only had a wash as short of staff.” Rotas showed that numbers on shift were generally 3 or 4, falling to 1 or 2 at times of minimal occupancy. Seven staff were due to support the residents’ Christmas party (one specifically to support one resident’s choice not to join in). Provision could be seen in the rotas for staff involvement in supervision and for first aid course attendance. A support worker considered it was supervision that suffered at times of greatest pressure on staff time, although it would always be re-scheduled. This could be verified from supervision and appraisal records. Training records were excellent, tracking how courses were identified as needed, arranged, and attended. A link had been made with Age Concern, and it was planned to incorporate training on age-related issues in the next annual training programme. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 The home benefits from a stable staff team under competent management, and with a supportive provider organisation. Quality assurance is dependant on care planning and review processes. There are good systems in place to promote the health and safety of residents. EVIDENCE: Debbie Stone has recently gained the Registered Managers’ Award. Both she and a project worker (effectively a deputy manager) have been assisting the provider organisation by working for periods at other Turning Point homes, but never at the same time. Examples of written communication between senior team members, and between management and the support staff as a whole, showed that important information was quickly disseminated. Additionally there were minutes of three full staff meetings held in 2005, which covered a range of mainly operational matters. Staff at all levels spoke with confidence about the work of the home, and demonstrated that key worker roles were taken very seriously. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 21 Minutes of Turning Point area health & safety meetings showed that Ms Stone was a key member. Health & safety documentation within the home was well organised, with a wide range of generic and environmental risk assessments. Records of monthly health & safety monitoring showed that when faults were identified, they were swiftly rectified. There was very good recording of monitoring of fire precautions, and accident reports were informative. The home receives unannounced monthly visits from the provider company that conform to Commission expectations. These identify both good practice and shortfalls, based on observation and interaction, thereby assisting the management task. Other provision for quality assurance, based on canvassing of views of residents and their supporters to inform developmental planning, was undeveloped, although it could be seen that the care planning review and person centred planning processes generated creative practice. Hollygrove DS0000028451.V268948.R01.S.doc Version 5.0 Page 22 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 X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hollygrove Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 X X 3 X DS0000028451.V268948.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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 YA39 Regulation 24 (1&3) Requirement There must be a system for reviewing the quality of care provided, based on consultation with residents and their representatives. Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA24 YA33 Good Practice Recommendations The kitchen should be assessed for state of repair, and identified shortfalls made good. There should be a regular review of dependency levels and related staffing needs. 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