Inspection on 06/01/06 for Hollyrood

This inspection was carried out on 6th January 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

Hollyrood 22/05/08

Hollyrood 27/09/06

Hollyrood 02/08/05

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 Unannounced Inspection 6th January 2006 09:25 Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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 Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hollyrood Address Heath Road Coxheath Maidstone Kent ME17 4NP 01622 743185 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) MCCH Society Limited Miss Katherine Jane Reeves Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 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 24hour 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. 7.83 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 DS0000024090.V277128.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection took place on 6th January 2006 between 9:25am to 14:25pm. The home currently has four service users in residence, who have lived together for a number of years. 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. 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 or it was evidenced active work was taking place to address them. Service users appeared relaxed and happy with staff. What the service does well: What has improved since the last inspection? Replacing of the flooring in the kitchen offers a safer surface for service users and promotes better hygiene management in this area. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 6 Service users are benefiting from having a committed core staff team who work well together to promote open and service user led service, whilst the manager continues to work in recruiting to the vacant positions. Advice and recommendations and quotes from the occupational therapist have been received regarding appropriate bathing facilities to meet the needs of the service user for the one remaining en-suite bathroom on the ground floor. Staff have undertaken training in the protection on vulnerable adults and continue to book and attend core training as required, providing confidence in working with the service users. 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. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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 Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 1,2,3, 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. Both documents are in both written word and object reference pictorial formats. No changes have occurred since the last inspection. 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. Personal wishes and goals are discussed openly and staff support service users at a realistic and individual pace to achieve these. 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. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 6,7,8,9,10 Clear, structured and directive guidance is in place to ensure consistent and respectful style of care is provided to personal wishes and preference. EVIDENCE: One care plan was inspected. Staff maintain a comprehensive care plan, guidance and supporting risk assessments to ensure consistent, safe care and support is given. This continued to be reviewed monthly with yearly reviews with Care Management from the local authority. Care Plans seen were easy to understood and follow. Service users were familiar with their care plans and enjoyed sitting with the inspector discussing their goals and achievements since the last inspection. Records are stored securely. Time spent talking to service users showed interaction between them and staff is good, with genuine two-way 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 Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 10 participate in all aspects of the home today, to the best of their abilities. Due to the aging process mobility for two service users has become slower and much harder for individuals, staff evidenced good working with physiotherapists to re assess their needs and review current walking aides to be more appropriate and maintain some independence. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 11,12,13,14,15,16,17 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 Maidstone amenities and the local area including shopping, cinema, bowling, garden clubs, fitness groups and various activity centres. All service users were out for the morning. 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. All service users have had a holiday (going away separately). Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 12 Resident’s families are in regular contact, with an open door visiting policy. With regular visits to the home, their relatives home and social activities. When discussed with residents: “I saw my brother’s and their wives over Christmas it was very nice” Another service user had received a thank you card from a friend and was continuously looking at it smiling to themselves and very happy to show and discuss this with the inspector. Staff and records also indicated regular and two way contact with relatives and residents. The kitchen was observed to be clean with refitted flooring. The kitchen was stocked with fresh produce. Adapted cutlery and crockery is available for those requiring such assistance. Service users receive full staff support at mealtimes in the purchasing, preparation and serving of meals. Service users are encouraged to assist within in their capabilities. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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 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, physiotherapists, 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. A service user has been discharged from regularly seeing local consultant due to suffering no behavioural difficulties for two years. Good staff support and guidelines have assisted them to maintain low anxiety levels and manage situations that previously would have caused great distress and leading to inappropriate behaviour. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. This is currently compromised Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 14 for one service user whose en-suite is not fit for purpose and they have to share a fellow service users en-suite bathroom. Whilst both ladies as good friends tolerate this, through discussion today the ladies it was a growing inconvenience as this short-term arrangement was dragging on. Medication procedures and in-house protocols 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. Consideration should be given to current holding of the medication key to ensure accountability of access is to shift leader. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 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. All staff have undertaken formal training since the last inspection. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 24,25,26,27,28,29,30 Service users live in a warm, safe and clean home, which will be enhanced further with the completion of the en-suite shower facilities. 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 first floor and one ground floor bathrooms have taken place since the last inspection. Flooring has been replaced in the kitchen. 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. Due to the high cost of this facility the organisation have requested if alternative cheaper facilities could be recommended. The manager is to make contact to discuss this. Whilst the commission is sympathetic to the budgetary constraints to install this facility, the organisation must seek to secure satisfactory alternative options from the Occupational therapist that do meet the needs of the service user and provide a safe and Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 17 appropriate bathing/ shower facility. To reduce the sharing of another’s ensuite facility promoting privacy and dignity to them both. Service users share the open plan kitchen/dining area and separate small lounge, which with all service user in and staff this is compact. There is no separate communal private communal area. Service users received visitors in the lounge or for privacy in their rooms. Bedrooms are personalised to individual taste and personal choice, with fitted washbasins. The home and garden is well maintained, with appropriate grab railing fitted, moving and handling equipment and pathways through out. Staff have introduce more vibrant colour visual cues to assist a service user around the home. Bath hoist seats observed today require regular cleaning to the back and underneath to promote effective infection control management. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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): 32,33,34,36 Service users have benefited from a stable core staff team, resulting in good morale and enthusiasm to improve the service users whole quality of life. EVIDENCE: The home has benefited from a core stable staff team March 2005. All have undertaken a thorough and comprehensive recruitment and induction programme including all core training. The home has currently has 5 care staff and the manager of the 7.83 allocated staff hours for the home. The manager has undertaken two sets of interviews recently that were poorly attended by candidates short-listed to the 1.83 vacancies. One staff has been offered a post pending satisfactory CRB and reference checks. Existing staff and a core of regular MCCH BANK staff currently cover the vacancies. 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 expressed feeling 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. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 19 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 and flexi shifts for activities. 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 DS0000024090.V277128.R01.S.doc Version 5.1 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 Service users personal preferences in care are encouraged through the registered manager 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 Registered Managers Award. Service users and staff continue to express 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. Staff evidenced a good understanding of accident/incident recording and reporting under Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 21 regulation 37 to the Commission, as well as assessment and monitoring of falls, which has reduced significantly over the past year. Regulation 26 monitoring visits are taking place monthly by other managers within the organisation as another auditing and monitoring system. Staff regularly undertakes health and safety core training within in good practice timescales for updating and refreshing knowledge. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 X Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 23 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard YA20 YA30 YA27YA30 Good Practice Recommendations It is recommended that consideration be given to the accountability of access to the medication cabinet should be held directly by the shift leader. It is recommended that laundry facilities are not located where food is stored, prepared or eaten. It is recommended that regular cleaning of the back and underneath sections of the bath hoist seats be built into the cleaning programme to promote effective infection control management. Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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. Extracts may not be used or reproduced without the express permission of CSCI Hollyrood DS0000024090.V277128.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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