Inspection on 02/08/05 for Hollyrood

This inspection was carried out on 2nd August 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 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollyrood 22/05/08

Hollyrood 27/09/06

Hollyrood 06/01/06

Hollyrood 23/02/05

Hollyrood 04/11/04

Hollyrood 02/10/03

Hollyrood 28/07/03

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

CARE HOME ADULTS 18-65 Hollyrood Heath Road Coxheath Maidstone Kent ME17 4NP Lead Inspector Lynnette Gajjar Announced 2 August 2005 09:50 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. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hollyrood Address Heath Road Coxheath Maidstone Kent ME17 4NP 01622 743185 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) MCCH Society Ltd Miss Katherine Jane Reeves CRH Care Home 4 Category(ies) of LD Learning Disability registration, with number of places Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23 February 2005 Brief Description of the Service: Hollyrood is one of a group of small care homes managed by MCCH Society Ltd. It is a detached old police house, which has been adapted to provide 24 hour residential care for four ladies with learning disabilities. There are two private bedrooms with fully assisted en-suite bathrooms on the ground floor. The home has a large kitchen / dining area and small lounge. A further two bedrooms are situated on the first floor and these share a main bathroom with Apollo bath seat, toilet and washbasin. The staff sleepover room/ office is also based on this first floor. The home has ramps and grab rails at both the front and back garden areas and around the home. 7.7 fulltime equivalent staff work on a roster system to staff the home. The home has a minimum of two staff on duty between 9.00am and 9pm with one staff member on site sleeping over between 9pm and 9.00am. The home is situated on the main road of Coxheath at the traffic light junction with the main A249 to Maidstone and Hastings. The home has good local amenities and shops in the village of Coxheath, and is on the main bus routes into the town centre of Maidstone. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The inspection took place on 2nd August 2005 between 9:50am to 15:00pm. The home currently has three service users in residence, who have lived together for a number of years. The fourth service user was away on holiday with one to one staff support. Time was spent speaking with all service users collectively and privately, staff and the manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service user in the report. Some judgements about quality of life and choices were taken from direct conversation and physical responses with people living in the home as well as direct observation followed by discussion with staff, evidencing records and care plans held at the home. Additional information was obtained through receipt of the manager’s preinspection questionnaire, a tour of the premises and conducting a case tracking exercise, by reading the care plans of the two residents. Comment card feedback was also received from residents, their relatives, care managers, GP and other professionals working with the home. The home was clean and well presented. Documentation was on the whole in good order and the requirements and recommendations from the previous inspection had been implemented. Service users appeared relaxed and happy with staff. What the service does well: Service users feel they are involved in making decisions about their lives. They have a real sense of ownership about their home and trust that staff maintain their confidences. Service users through positive interaction with staff and managers feel genuinely liked and respected. Service users stated they felt safe and secure at the home. Service users have a happy and fulfilled lifestyle with good two-way relationships and contact with their families. Comments received from relatives included: Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 6 “I have full confidence in the staff/carers in the manner that they always looked after (name of service user)” “We visit (name of service user) regularly and are more than satisfied with the way she is looked after, she has improved so much since she has been there, and the staff are wonderful to them all” “As always (name of service user) is happy, clean and well dressed, I have no worries about her care” There are good relationships with other professionals and G.P to ensure up to date assessments, health care and equipment is assessed and made available to promote a safe and supportive lifestyle. Comments received included: “ I have always been impressed with the standard of care that I have observed.” What has improved since the last inspection? What they could do better: Service users lifestyle and personal care will be enhanced further on the installation of the en-suite walk-in shower room assessed and recommended by the occupational therapist, by not having to share a fellow service users ensuite bathroom. Staff safe working practice would be enhanced through recorded environmental risk assessments and strategies to minimise risk whilst completing their duties. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 7 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. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 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 Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 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) 1,2,3,5 Service users and their families are given all the information they need to make an informed choice about whether to live at Hollyrood. EVIDENCE: The homes statement of purpose and service user guide gives clear information about the services provided. Due to recent changes some minor updating is required. Both documents are in both written word and object reference pictorial formats. The key working and person centre planning process is developing to offer clear promotion and support in identifying personal aspirations and meeting individual care needs. The service users have lived together in the home for a number of years, two since it’s opening in 1987. The home has not had any new admissions over passed few years, although the organisation has full procedures and assessments to follow in the event of a vacancy occurring. Care plans contained a written tenancy agreement, which gives the service user’s security and rights of residency and details the tenants and landlord’s rights and responsibilities. Not all service users would be able to understood or followed this document, so would require representative’s support to understand and sign on their behalf. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 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) 6,7,8,9,10 Clear, structured and directive guidance is in place to ensure consistent and respectful style of care is provided to personal wishes and preference. EVIDENCE: Two individual care plans were inspected. Staff maintain a comprehensive care plan, guidance and supporting risk assessments to ensure consistent, safe care and support is given. Those seen are reviewed monthly with yearly reviews with Care Management from the local authority. Care Plans seen were easy to understood and follow. Records are stored securely. Interaction between service users and staff is good showing genuine respect, friendship and appropriate familiarity with each other. Service users discuss daily as well as getting together formally through service user meetings, what they would like to do, daily routines and chores, activities and issues for the home. Minutes of these meetings are kept. Service users are involved in making decisions and participate in all aspects of the home today, to the best of their abilities. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 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 standard(s) 11,12,13,14,15,16,17 Service users are given encouragement and support to make choices about aspects of their daily lives, including a range of local social and recreational interests. Menus provide wholesome and nutritious food. EVIDENCE: Continued support from staff enables individuals to access village amenities and surrounding area including shopping, walks in the park, trips to the coast, garden centres, meals out, cinema, and charitable activity centres. Service user families are in regular contact, with an open door visiting policy. Due to their maturing age, current service users do not aspire to attend education or work environments but to concentrate their time in social, leisure and recreational activities. Feedback through questionnaires indicated all were more than happy with the care provided (see summary). There is high regard from families towards the staff team and care provided. Residents are supported to visit or meet relatives outside the home also. The kitchen has been redecorated offering a cleaner environment to maintain. The kitchen is stocked with fresh produce and meals were served with ample portions. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 12 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) 18,19,20 The health, social and personal care needs of residents are well supported with regular contact with specialists and external professionals. Staff promotes safe practice in storage, handling and recording of medication. EVIDENCE: Through reading records and discussion with service users and staff there is regular contact with the GP, chiropodists, opticians, Occupational Therapists, Aroma-therapists and consultant appointments to maintain good standards of healthcare. Staff clearly evidenced good contact and understanding of service users current health care needs and was supporting service users to appointments and assessments. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Medication procedures have been improved through the installation of new medication storage cabinet, reviewed procedures and in-house protocols to promote safe medication practice. Staff undertake in-house training and assessments of competency before undertaking this task. All medication is dispensed, checked and administered with two staff present. Records seen today were well recorded with no gaps. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 13 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) 22,23 Systems are in place to enable those living and visiting the home to raise concerns or complaints with staff. Protection from abuse is promoted through staff training and understanding of actions they may need to take. EVIDENCE: Copies of the complaint procedure are available in the home. Due to the nature of the service and those living here, using this system is can be limiting. Service users indicated through eye contact and discussion, who they would talk to if they were unhappy about something. Service user meetings also focus on this, using object-referencing cues. Service users can also rely on others such as relative/ advocate to identify concerns and raise them on their behalf. Staff who were spoken with showed a good understanding of how to protect and prevent abuse, including reporting under local procedures. There are no current adult protection alerts relating to this home. Formal training is in hand for all staff in September. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 14 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) 24,25,26,27,28,29,30 Service users live in a warm, safe and clean home, which will be enhanced further with the completion of the en-suite shower facilities and redecoration of the first floor bathroom. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. Service users talked of and undertook daily chores and cleaning within their agreed activity plan. Staff were supportive giving guidance and the full physical assistance where needed at a pace the service users could manage safely. Redecoration of the kitchen and hallway has taken place since the last inspection as well as the installation of washbasins to the first floor bedrooms. Staff confirmed the un-used and broken en-suite bathroom (since July 2004) has been assessed by occupational therapist and recommendations for walk-in shower room made in past week. This has been forwarded to senior management for the allocation of funding and completion. Service users share the open plan kitchen/dining area and separate small lounge. Service users received visitors in communal areas or privacy of their rooms. Bedrooms are personalised to individual taste and personal choice. The home and garden is well maintained, with appropriate grab railing fitted, moving and Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 15 handling equipment and pathways through out. Staff have started to introduce more vibrant colour visual cues to assist a service user around the home. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 16 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) 31,32,33,34,35,36 Service users have benefited from the recent stabilizing of the staff team, resulting in good morale and enthusiasm to improve the service users whole quality of life. EVIDENCE: The home has benefited from the stabilizing of staff team through three new staff since March 2005. All have undertaken a thorough and comprehensive recruitment and induction programme including all core training. The organisation continues to encourage and support care staff to completed their NVQ 2 and 3 in care, but new staff have to achieve full probation before being put foreword for this. The home currently has one staff holding NVQ 3 in Care. Staff feel supported by the manager and senior managers of the organisation. Care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. Service users reacted fondly towards individual staff and their help. Staff were seen to support individuals respectfully but also with respectful familiarity resulting in some fun joking and banter from both parties. Staffing rosters have reflected changing care needs of individuals. Full-recorded supervision takes place at least monthly including set action points and goals. New staff have additional 3 and six monthly appraisals as part of their probation period. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 17 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) 37,38,39,30,42 Service users personal preferences in care are encouraged through the registered manager and service managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The manager has worked with this service user group for many years. She has completed the NVQ 4 in Care and just submitted the three units required for verification for the Registered Managers Award. Service users and staff expressed a high regard for their management approach to the home. Service users through the interaction observed appeared very comfortable and well supported by the manager. Monitoring health and safety in the home is to a good standard, with health and safety walking routes taking place, and equipment serviced as required to maintain a safe home and facilities. Risk assessments are completed for individual’s activities but little are formally recorded for staff activities and duties. Staff evidenced a good understanding of accident/incident recording and reporting under regulation 37 to the Commission, as well as assessment and monitoring of falls. Regulation 26 Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 18 monitoring visits are taking place monthly by other managers within the organisation as another auditing and monitoring system. Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 19 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 2 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hollyrood Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 2 x H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 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 OP29 Regulation 23(2)(n) Timescale for action The registered person shall Full written having regard to the number and repsonse of needs of the service users action planed and ensure that: appropriately timescales assessed adaptations and such equipment and facilities are to be submitted provided for service users who to the are old, inform or physically commissio disabled. n by 8th In that the ground floor en-suite September be fitted as assessed and 2005 recommended in the occupational therapist letter dated 27th July 2005. Requirement 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 OP1 Good Practice Recommendations It is recommended that the use of photographs of staff be inserted to the service user guide/ statement of purpose to assist service users with staff recognition. It is recommended that a risk assessment be undertaken H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 21 2. Hollyrood OP20 3. 4. 5. 6. 7. OP30 OP30 OP38 OP39 OP42 regarding the number lock used on key cabinet specifically to strategies when a staff member leaves. It is recommended that laundry facilities are located where food is stored, prepared or eaten. It is recommended that risk assessments are undertaken where staff are allergic to Hepatitis B immunisations to ensure safe personal safety. It is recommended that photographs be used as part of in house quality assurance reviews used through the service users meeting. It is recommended that the organisation continues to develop a Quality Assurance tool accessible and understood by service users It is recommended that formal environmental health and safety risk assessments are undertaken for staff activity and duties. It is recommended that detailed records of fire drills undertaken (who took part ,staff/service users, and those involved response) \and completed. It is recommended that temperature records for fridge and freezer also include a small column to record action taken, some recordings seen today were above the recommended 5 degrees. 8. OP42 9. OP42 Hollyrood H56-H06 S24090 Hollyrood V231584 020805 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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