Inspection on 13/02/09 for Hollystead

This inspection was carried out on 13th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollystead 12/02/07

Hollystead 28/01/06

Hollystead 26/11/05

Hollystead 10/02/05

Hollystead 12/08/04

Hollystead 28/07/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hollystead 14 Old Mill Lane Liverpool Merseyside L15 8LN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lorraine Farrar     Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Hollystead 14 Old Mill Lane Liverpool Merseyside L15 8LN 01517227874 01517227824 Hollystead@nugentcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nugent Care Name of registered manager (if applicable) Mrs Sylvia Youds Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD. The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Hollystead is owned and operated by the Nugent Care society. They provide a number of services in the area for people with different support and care needs. The service provides both a permanent home and two short stay (respite) beds for people who need care and support for a short time. All of the people who live at Hollystead require support as they have a learning disability. In addition they are registered to support people who also have a physical disability. The house is a spacious detached Victorian house situated in its own grounds. Parking is available both within the grounds and on the street outside. Internally the house has been adapted to meet the needs of people who also have Care Homes for Adults (18-65 years) Page 4 of 38 16 Over 65 0 care home 16 Brief description of the care home physical disabilities. This includes providing ramps, a lift and adapted bathing and shower facilities. Everyone living at Hollystead has their one bedroom. Of the sixteen bedrooms one is en-suite and the others provide washbasins. There are four bath or shower rooms around the house for people to use. Shared space includes a light and sound room, activity room, three lounge areas and a dining room. The large grounds provide plenty of space for people to sit in warmer months or go for a short walk. Staff are available at Hollystead twenty four hours a day to support the people living there Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We gathered information for this inspection in a number of different ways. Before we visited we sent comment cards to some of the people who live or have stayed at Hollystead. Three people completed these with support and returned them to us. We also sent comment cards to some of the staff who work there and received two responses. The manager completed a self assessment form that we sent to her. This provided us with various information including, the support they offer to people, staffing matters and health and safely. In addition it also provided information about where the managers feels the home are doing well and any improvements they have made or plan for the future. In February 2008 we carried out an annual service review of Hollystead. This involved Care Homes for Adults (18-65 years) Page 6 of 38 sending out and receiving information about the service and looking at any information we had received since out last inspection there in February 2007. Before our visit to the home, we reviewed all of the above information along with any other information we have received it since our last inspection and annual service review. This was all taken into consideration in planning our visit and in writing this report. We carried out an unannounced visit to Hollystead on 13 February 2009 and were there for seven and a half hours. During that time we met several of the people who live and work at Hollystead. We also spent time observing daily life in the home and the support people receive. We looked in detail at the support provided to three of the people living at Hollystead. This included the support they receive with their health and personal care, their everyday lives and interests and their environment. This helped us to form a picture of the overall support people living at the home receive. It currently costs between eight hundred and thirty seven pounds, twenty one pence and eight hundred and eighty pounds, seventy pence each week to live at Hollystead. What the care home does well: What has improved since the last inspection? The people living at Hollystead are receiving increasing support to make use of the small kitchens within the home. Staff advised that people are supported to bake and to make snacks for supper a couple of times a week. This improves their opportunities to learn and take part in everyday living tasks and also to participate more fully in the running of their everyday lives. Care Homes for Adults (18-65 years) Page 8 of 38 Plans are in place for supporting people with serious decisions using forms based on their rights under the Mental Capacity Act. Once these are fully in place they will help to ensure that peoples rights are protected and that any serious decisions made on their behalf are based on evidence that the decision is taken in their best interests. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 38 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is not always obtained about people considering moving into or staying at Hollystead. This could result in the person not getting all of the support they need to meet their needs and choices. Evidence: The people who live or have stayed at Hollystead told us in their comment cards that they received enough information about the home before they moved in to help them make a decision as to whether it was the right place for them to live or stay. Nobody new has moved permanently into Hollystead within the past year. We looked at records for one person who had stayed there for a short while. Initially they moved in due to an emergency. The manager told us that she requested a copy of the persons social services assessment to help staff at the home plan for the right care to be provided, but this did not arrive. No assessment had been carried out for the person once they arrived at Hollystead and the care plan that was written contained only brief information. Care Homes for Adults (18-65 years) Page 12 of 38 Evidence: A senior member of staff told us that if someone was considering moving in they would usually assess their needs and invite the person to visit several times, stay for a meal and overnight if they wished. Obtaining this level of information would help staff to decide if they can meet the persons needs and their choices and plan how to do so. Where someone moves in in an emergency, it is important that a social services assessment is obtained as quickly as possible and that staff from the home also carry out their own assessment. This will help to ensure that as much information as possible about the person, their support needs and their choices is available, so that staff can provide them with the right support. There are some documents available to give to people considering moving into the home. The manager identified in her self assessment form that she plans to update these within the next few months. We looked at a copy of a service users guide for Hollystead. This was written in plain English with pictures to make it easier for people to understand. However there were a large number of small pictures and this may not prove as easy for people to see and understand. For example one page contained eight lines of writing and twenty one small pictures. A video about the home is available to share with people considering moving in but staff we spoke with were unsure of how up to date this was. A member of staff from the organisation that runs the home advised us that, if needed, they can arrange for information to be provided in different languages and formats. This arrangement is one way to ensure people and their families receive the information they need in a way they can best understand. Care Homes for Adults (18-65 years) Page 13 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Hollystead are supported by a staff team who are aware of their needs and choices and work towards meeting these. However records are not always detailed enough to guide staff in how to do this. This could lead to the person not getting all of the support they require to meet their needs and choices. Evidence: There are individual care files for all of the people who live at Hollystead. We looked at three care files of people who live at the home to check what their care needs were and how these were being met. We found that people have several different care files, including an all about me file, a medical file and a care plan file. This means that information is located in different places and it was difficult to easily establish a full picture of the persons support needs and choices in all areas of their life. The quality and quantity of information in peoples files varied. For example one care file we looked at had been reviewed in May 2008 and stated that it should be reviewed Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: again in November 2008; however we could find no evidence that this had occurred. The same person had risk assessments on file dated 2005 for areas such as support with bathing and travel. However they also had up to date and reviewed risk assessments on file for supporting them to manage their agitation and behaviour. These latter assessments provided good detailed information for staff to follow. However if risk assessments and care plans are not reviewed regularly this may mean that changes to the persons support needs are not noted and acted upon as quickly as they should be. Records we looked at for another person contained recent care plans that had been updated in January 2009 and these provided clear information on supporting the person in all areas of their life including their health and personal care, meeting their spiritual needs and managing their behaviour. Up to date risk assessments were also in place for this person that gave guidance on how to support them whilst minimising any risks. In addition we noted a short term care plan had been written and was being followed by staff for supporting this person with a recent health care need. About me documents contained some clear information about the person and their likes and dislikes. For example one used photographs to illustrate the things the person liked to do. This is good practice as it may also provide a good way to discuss the persons files with them. We also noted that reviews of the persons care involved their family where possible. As some of the people who live at Hollystead cannot verbally communicate this helps to ensure as much information as possible is obtained about the person and the support they need and prefer. The guidance given in some plans did not always provide clear facts for staff to follow in supporting the person. One plan we looked at said the person was to be, encouraged to eat a healthy diet. However it did not say how this was to be achieved and we could find no evidence that it was being monitored on a regular basis to establish whether this support was being provided and whether it was effective. In discussions with staff we found that wherever possible people are supported to make everyday decisions for themselves. As the people living at Hollystead do not communicate verbally, records showed that the views of their family and others are taken into account when making decisions such as decor or meeting their spiritual needs. Staff were able to explain how people show simple choices such as whether they are tired and ready to go to bed and also how they support people to make decisions such as what to wear each day. Residents meetings are held which provide some of the people living at Hollystead with a way to put across their point of view about how the home operates. We also spoke to a member of staff from the organisation that runs the home who Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: explained that they are planning to introduce decision making forms based on peoples rights under the Mental Capacity Act. These forms will be used to support serious decision making . This is good practice as it will help to ensure that people are supported to make any decisions that they can for themselves and if they are unable to do so then decisions will be based on their best interests. Care Homes for Adults (18-65 years) Page 16 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social needs and choices of the people living at Hollystead are recognised. However they do not always receive sufficient support to ensure they are able to lead an interesting and varied life based on the principle of providing people with an ordinary lifestyle. Evidence: There are several facilities provided at Hollystead that the people living there can use to learn and engage in their hobbies. These include a well equipped light and sound room that can be used for relaxation. In addition an activity coordinator is employed and there is a dedicated activity room. This provides people with space to engage in various activities including arts and crafts. Two smaller kitchens provide facilities for people to make a drink or simple snack. Staff advised us that recently, increased support is offered to some of the people living there to bake or make a snack for Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: supper. We also noted that there are a number of books and DVDs that people can access if they wish. Staff we spoke with told us there is a minibus for the home but due to a limited number of drivers this is not used as much as it could be. However they said that they do use taxis to get out and about. One of the people living at the home told us she was going on holiday later in the year and staff confirmed that they provide support people to go on holidays. For example some people have enjoyed holidays to Lourdes with support from a local organisation. Records in the home do not provide a clear picture of the support provided to the person with their leisure and hobbies during the day. For example one person goes out three times a week supported by a group run by Nugent Care but records did not fully state where they have been supported to go. Records for other people did not show that they had been out and about very much or engaged in different activities within their home. It is therefore difficult for staff to review whether they are providing all of the support people need to become part of their community and engage in activities and hobbies of their choice. Information about peoples religious beliefs is recorded and this showed that people receive support to maintain their religion and attend services if they wish. We also noted that staff support people to maintain relationships with their families. This includes supporting them to visit their family, welcoming visits from families and engaging them in discussions about the persons care and support needs. During our visit we observed that the people living at Hollystead felt comfortable within the home and felt free to use whichever communal areas they wished. We also noted that they felt comfortable with the staff team and received a positive response whenever they wished to have conversation or seek reassurance. Staff spent time sitting with and engaging with people as well as meeting their care and support needs. Hollystead has set mealtimes and a cook to provide meals, so routines may not be as flexible as they would be in a more domestic style setting. We observed part of the evening meal at Hollystead. Food is brought from the main kitchen in a heated trolley and we saw that staff then serve this for people. The meal of salad and either fish and chips or chicken and jacket potatoes looked very appetising. Menus reflected the fact that people are offered a variety of meals and a choice is always available. We sat opposite one of the people living at Hollystead and noted that although her food had been cut up for her there were large pieces of chicken on her plate which she Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: attempted to eat, which may have caused her to choke. We also noted another person sitting at a chair with a tray in front and repeatedly banging their head on the tray, with the result that at one point their head also banged into their plate of food. After a while a member of staff sat with this person and they became less agitated. IA member of staff we spoke with advised that they had sought advice as to whether there was a medical reason for the person to behave in this way and also tried different options of chairs. Nevertheless this self harm at meal times could lead to the person causing themselves an injury. Some of the people living at Hollystead require support to eat their meal. We noted that this support was provided in a dignified way. A member of staff sat quietly with the person, chatted with them and took their time supporting them to finish their meal. However as most people were in the dining room with with several members of staff bustling about the overall atmosphere was not as relaxed or sociable an occasion as it could be. We visited the kitchen and found that there were sufficient supplies of food in the home and that this was stored correctly. As most food is delivered by a main supplier and made by a cook the people living there have limited opportunities to shop for and prepare or observe their meal being prepared. This limits peoples opportunities to become part of their local community and lead as ordinary a lifestyle as possible. Care Homes for Adults (18-65 years) Page 19 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support is provided to the people living at Hollystead with their health and personal care. However records in the home are not always completed in sufficient detail to ensure this continues. Evidence: During our visit it was evident from meeting the people who live at Hollystead that they had received support from staff to meet their personal care needs. Staff we spoke with displayed a good knowledge of the health and personal care needs of the people living there and were able to explain how they meet these. Records showed that staff support people to make and attend health care appointments. This includes regular appointments such as the chiropodist as well as more specialist hospital appointments. One person had recently had an operation and a detailed short term care plan had been written to support them over the following few days. Staff we spoke with were aware of this plan and throughout our visit we observed them providing the support needed. This was backed up with detailed records that showed staff had monitored and supported the person through the night. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: Other short term care plans had been written for people who had a short term health need such as an infection. These plans are very good practice as they provide both a way to guide staff on the support needed and a clear way to monitor the persons health and ensure they are getting the support they need. Records we saw also showed that staff are observant with regards to peoples health and take action if anything unusual is noted. For example a mole had been noted on one persons body and staff ensured that they received advice from their GP regarding this. As some of the people who live at Hollystead are not able to communicate verbally this level of staff observance helps to ensure that they remain as well as possible. As we have identified peoples care plans are not always easy to follow for unfamiliar staff. This also applies to their personal care and heath care plans. We found the contents of these varied. Some plans contained good detailed information about the person and their support needs and choices. Other plans were briefer and may not contain enough information for unfamiliar staff to support the person safely and well. For example we looked at a plan for one person who required staff to move them from their bed, to chair or chair to bed etc. Nowhere in the plan could we find it recorded as to whether aids and adaptations were used to support the person or whether staff physically lift them. In discussions with staff they explained that they physically lift this person. However the lack of clear guidance regarding this may mean that unfamiliar staff do not have all the information they need to ensure the safely of both the person and themselves. We looked at how medication is managed for some of the people who live at Hollystead. Staff who deal with peoples medication have all received training in this area which helps to lessen the risk of mistakes occurring. A locked cabinet and fridge are provided for storing medication and we found that most medication was stored correctly during our visit. Medication administration record sheets (MAR sheets) are in place for everyone and these have a photograph of the person attached. This is good practice, as some of the people who live at Hollystead cannot verbally communicate and this acts as an extra check for any staff dealing with medication, who may be unfamiliar with the person. MAR sheets had been fully signed by staff to indicate that they had given the person their medication as prescribed. However one MAR sheet we looked at recorded that the person had a 100mg of medication for epilepsy. This had been crossed out and a member of staff advised us that it had never been prescribed for the person and was an error on the sheet. Another person had medication in the cupboard to use as needed for epilepsy. However this was not recorded on their MAR sheet. Inaccurate Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: records of peoples medication may lead to them not getting all of the support they need with their medication, which could impact on their health. Care Homes for Adults (18-65 years) Page 22 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An open approach to concerns and complaints within Hollystead helps to make sure that the people living there feel safe and are confident that they will be listened to. Evidence: Information about Nugent Cares complaints procedure is clearly displayed in the hallway for people to access. The people who live at or have stayed at Hollystead told us in their comment cards that they know who to talk to if they are unhappy about something and how to make a complaint. Staff told us in their comment cards that they know what action to take if anyones raises concerns with them about the home. This was confirmed in our discussions with staff during our visit to the home. Staff had a good knowledge of how to deal with any concerns that were raised, including how to notice and deal with any potential adult protection issues that may occur. This is backed up by access to policies and procedure and training for staff in adult protection. The self assessment form completed by the manager showed that five complaints have been received about the service in the past year and that these had been investigated throughly and if needed amendments were made to the persons support. This open approach to concerns and complaints helps people to feel safe whilst living at Hollystead. Care Homes for Adults (18-65 years) Page 23 of 38 Care Homes for Adults (18-65 years) Page 24 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hollystead is well maintained so that it provides people with a safe, warm and well adapted house to live in. However the current layout of some areas means that it is difficult to support peoples right to live an ordinary lifestyle within their local community. Evidence: Hollystead is a grade two listed building set in its own grounds. Spacious, well maintained gardens surround the house and provide places to walk and sit. Ramps and slopes ensure that the gardens are accessible for people who have mobility difficulties. All of the sixteen bedrooms are single with one providing en-suite facilities. One of the people living there told us that they were able to choose the decor for their room and a member of staff was able to explain how decor had been chosen for other people who live there, based upon discussions with their family or their known preferences. The bedrooms we visited were all clean, well decorated and personalised and provided specialist equipment or adaptations for people who needed them. A lift provides access for people to areas of the home including the basement and first floor. The basement has been adapted to provide an activity room where people can Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: take part in activities such as arts and crafts. There is also a light and sound room which has plenty of equipment to provide people with a peaceful, enjoyable experience. There are two lounges on the first floor of Hollystead. Both of these are furnished with plastic wing back chairs, with one also having dining chairs to sit on. These chairs were arranged around the walls and we noted that neither room had a homely, welcoming or comfortable appearance. The furnishing and arrangements of these communal rooms do not fit in with the principle of supporting people with learning disabilities to live an ordinary lifestyle. A separate dining room is also available for people to use. This has a small kitchen to the side which staff told us the people living there can use to make drinks or snacks with staff support. As meals are served for up to sixteen people at a time the dining room has several tables, with food served from a hot trolley. Although nicely decorated this again does not promote the idea of supporting people to live ordinary lifestyles. There are a number of bathrooms around the house for people to use. These include adapted baths, accessible showers, overhead tracking and grab rails. This equipment helps to ensure people can get safe support with their personal care. All areas of the house that we visited were clean and well maintained. This includes a laundry room in the basement. Staff we spoke with were able to explain how they manage infection control and we noted that equipment, including colour coded cleaning equipment, and disposable gloves and aprons was available. This all helps to prevent or quickly deal with a possible outbreak of infection. In discussions with the manager she was aware that the size of Hollystead means that it does not lend itself easily to supporting the people living there to live an ordinary lifestyle. Different ways to use communal rooms could be explored so that people could live within smaller groups within the large house. Care Homes for Adults (18-65 years) Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at Hollystead have a good knowledge of the people living there and how to meet their needs. However a high use of agency and ancillary staff may mean that they do not get continuity of support or as much support as possible to lead an ordinary lifestyle. Evidence: The people who live or have stayed at Hollystead told us in their comment cards that staff listen to what they say and that they treat them well. However a relative commented, agency staff dont know you. We noted in our last big inspection of Hollystead in February 2007 and in the review of the service we carried out in February 2008 that a high number of agency staff are used by the home, which may impact on the continuity of the service people receive. The self assessment form showed that in the past twelve months three hundred and ninety eight shifts had been covered by agency staff. The manager stated that they do use preferred agency staff, which does provide some familiarity for the people living there. Staff we spoke with during our visit advised that there are currently three full time and one part time carer vacancies within the home. The manager again explained that they try to use preferred agency staff and that a big recruitment drive is underway with a Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: closing date for applicants of 20 February 2009. However on-going staff vacancies and use of agency staff may impact on the continuity of the support people receive and may also have an impact on planning and implementing future improvements for the service. We noted that there is a high use of staff other than care staff working at Hollystead during the day. During the day there are usually four care staff, an activity coordinator and a team leader working in the home. In addition to this there is a cook, two domestics in a morning and one in an evening, a laundry assistant, administrator and the manager. Although the people currently living at Hollystead may not be able to fully participate in everyday household tasks, the high use of ancillary staff may mean that they dont participate in everyday household tasks as much as they could. During our visit we noted that staff have built good relationships with the people who live there. Staff had a good knowledge of the support needs and choices of the people living at Hollystead and were able to explain how they work towards meeting these. We observed staff responding positively to requests for support, taking time to reassure people and provide both practical and emotional support. Over half the staff team hold a nationally recognised qualification in care, (NVQ) with others working towards obtaining this. Staff told us both in their comment cards and during our visit that they get the training they need to support the people living at Hollystead. A training record had been put together for the staff, which showed that staff receive training in basic areas of care such as safeguarding vulnerable adults, health and safety and fire. These records showed that only fifteen staff had up to date manual handling training; however a member of staff advised that this was planned for all staff in March 2009. As some of the people who live at Hollystead require support in this area it is important that staff are up up to date with current good practice in order to maintain both their own safety and that of those they support. Staff receive more specialist training in areas such as medication for people who have a prolonged seizure, the mental capacity act and person centred planning. The training provided and planned helps to ensure that staff are equipped with the skills and knowledge to support people safely and well. We looked at recruitment files of several members of staff who work at Hollystead. These confirmed that before anyone starts work a series of checks are carried out on them. These include obtaining a Criminal Records Bureau disclosure and written references. These checks help to ensure that staff are suitable to work with people who may be vulnerable. One long standing member of staff did not have references on file and the manager advised that these are probably filed at head office due to the length of time she has worked there. Care Homes for Adults (18-65 years) Page 28 of 38 Care Homes for Adults (18-65 years) Page 29 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear systems are in place at Hollystead to support the safe and efficient running of the home. However these have not always been fully implemented within the past year, which may impact on the overall quality of the service people receive. Evidence: Mrs Sylvia Youlds is the registered manager of Hollystead. She is experienced in working with people who have a learning disability and in a management role and has been the appointed manager at Hollystead since October 2008. In addition she is working towards obtaining a care management qualification and attends regular training to keep herself up to date with current good practice. In the self assessment form she completed Mrs Youlds demonstrated a good understanding of the service provided at Hollystead and of how to further improve this. In discussions during our visit we found Mrs Youlds to be motivated and enthusiastic to improve the service for the people living there and aware of the need to support people to become more independent and live a more ordinary lifestyle. Staff we spoke with said that they find her management style supportive and that she listens to their views. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: In addition to the manager, who is supernumerary, a team leader or care supervisor is available at Hollystead twenty four hours a day; at night they sleep on the premises to provide support if needed. This provides a clear management structure to support the running of the home. There are some systems in place within the home and Nugent Care for checking the quality of the service. However it appears that these were not all fully implemented during the time Hollystead was without a manager in the past year. A representative of Nugent Care visits Hollystead unannounced once a month. Whilst there they look at a variety of things, including the environment and care plans, in addition to which they talk with staff and the people living there. This helps to make sure that Nugent Care are aware of what is happening at the home. We met with the Head of Nugent Care Performance Management Unit during our visit. during our visit. She explained that the company are introducing a system of three monthly visits based on looking at the national minimum standards of care for adults. This will include recording evidence under each standard and if needed drawing up and monitoring an action plan. In addition the recording book gives clear guidance on areas for managers to monitor regularly. Once introduced this will provide a good way to plan improvements to the service and ensure they are carried out. We were advised that Nugent Care carry out surveys with the people living in their services and that this was done at Hollystead last year. However no record of this or what if any action they identified could be found. We were also advised that the company are looking at different ways to support people to complete these, including individual visits to people. This would be good practice as it may support people who do not find paperwork easy, to express their views. However the lack of a consistent quality assurance system and plan currently may lead to improvements for the service not being identified and acted upon as quickly as they should be. We looked at a sample of health and safety certificates within the home. Some of these were up to date and showed that checks are carried out regularly. This included checks on the main electric supply, water temperature and lifting equipment. However a legionella risk assessment stated that it should be reviewed in November 2008 and we did not see any evidence that this had been carried out. The fire book showed that a recent risk assessment for fire had been carried out. However the last date recorded for fire alarm and emergency lights to be testing was in December 2008. A member of Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: staff thought that these tests had been carried out more recently and may be recorded elsewhere. It is important that an accurate record of health and safety checks is readily available so that they can be audited and arrangements made if they are overdue. This will help to ensure that the building and equipment are safe for the people who live, work and visit Hollystead. Care Homes for Adults (18-65 years) Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 Before anybody moves into Hollystead as an emergency a copy of their social services assessment must be obtained. Staff from the home should carry out an assessment of the persons needs as soon as possible after they have moved into the home. This will help to ensure staff have sufficient information to plan how to support the persons needs safely and well. 03/04/2009 2 6 15 All care plans and risk assessments must be updated at least every six months and more often if their needs or choices alter. This will help to ensure that any changes to the persons needs and choices are noted and can be acted upon. 03/04/2009 3 6 15 Care plans must all be reviewed to ensure they 03/04/2009 Care Homes for Adults (18-65 years) Page 34 of 38 contain sufficient information to guide staff on how to meet the persons health and personal care needs. This will help to ensure that the person receives all of the support in these areas that they require. 4 15 15 A documented review of the support provided to the person who was observed becoming agitated at tea time must be carried out. Support must be put into place that prevents or minimises their risk of self harm. This will help to ensure they do not harm themselves and also help to provide a more pleasant mealtime experience for them. 5 20 13 A review of all medication administration sheets must be carried out to ensure they are an accurate reflection of the persons prescribed medication. This will help to lessen the risk of mistakes occurring or of people not getting all of the support with medication that they need. 6 35 18 All staff must receive regular 10/04/2009 training in the moving and handling of people. This will help to ensure staff can support people in a way 31/03/2009 27/03/2009 Care Homes for Adults (18-65 years) Page 35 of 38 that is safe for both themselves and the person concerned. 7 42 23 Regular checks on the fire system must be carried out and recorded. An up to date legionella risk assessment must be obtained. This will help to ensure that Hollystead is a safe place for people to live, work and visit. 03/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide and any other information available for people considering moving in should be reviewed and updated as soon as possible. This review should take into account research based evidence on the best way to provide easy to understand information for people. This will help to ensure people receive as much information as possible about the services provided and enable them to make a decision as to whether it is the right place for them to live. 2 6 Information that is in care files and is no longer relevant or up to date should be archived. This will help to ensure that relevant information can be located quickly, when needed. Clear records should be maintained of the support people receive with their hobbies and daily lives. This will enable an evidenced based review of the support they receive to be carried out and therefore establish if people are receiving all of the support they need and choose with their everyday lives. A review of the way in which food is bought and meals are made and served should be carried out. This should include examining different options to make mealtimes more sociable occasions. Page 36 of 38 3 14 4 17 Care Homes for Adults (18-65 years) 5 24 Consideration should be given to type of furniture and the way it is arranged in the lounges to make sure that it is more domestic in style. This will help to provide people with a more comfortable, homely house to live in. Consideration should be given to the use of communal rooms and whether these can be better used for smaller groups of people, within the larger setting. This would give people the opportunity to live a less institutional lifestyle. Consideration should be given to the high use of ancillary staff at Hollystead and whether these roles could incorporate more day to day support for the people living there. This would provide people with more opportunities to become engaged in every day life within their home. Consistent and regular quality assurance systems should be implemented within the home as soon as possible. These will provide a clear way to identity and act upon improvements for the service that will benefit the people living there. 6 24 7 33 8 39 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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