CARE HOME ADULTS 18-65
Hollywell House 63 Clevedon Road Weston Super Mare North Somerset BS23 1DD Lead Inspector
Nicola Hill Unannounced 1,2,3 & 7 June 2005 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. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hollywell House Address 63 Clevedon Road Weston Super Mare North Somerset BS23 1DD 0208 5928264 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) hollywell@aol.com Mrs Olabisi Mojibade Hill Mrs Olabisi Mojibade Hill Care Home 9 Category(ies) of 1. People with learning disabilities. (8) registration, with number 2. People with learning disabilities - over 65. (1) of places Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 8 persons aged 18 - 64 with learning disabilities and 1 person aged over 65 years with learning disabilities. Date of last inspection 12 January 2005 Brief Description of the Service: Hollywell House is a small community home for people with learning disabilities. It is near local shops and amenities. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Hollywell was prompted by concerns raised by North Somerset Council. The inspection was undertaken over a period of four days this was in order to meet with all members of staff and gather the views and opinions of all the residents at the home. The registered provider for Hollywell House, Bisi Hill, was also present on each occasion. The majority of residents were home on the first visit; due to the half term break organised by the day centres and colleges. One resident was on holiday, and another out with a relative. The overall outcome of the inspection was that the residents were very content and happy at Hollywell. The staff team, who had been at the home during the transition from the old owners to the new owner, unanimously agreed that things had changed for the better. The concerns raised were thoroughly investigated, and the issues around the monitoring of personal care were upheld. In order to improve the standard of personal care support given to the residents, Bisi Hill has undertaken a review of the work practices of the staff team in the mornings. This has enabled her to be aware of what is being done to support residents with personal grooming, and more importantly what is not being done. As a result of this the registered person has planned to increase the level of staff each morning to ensure that there are a minimum of two carers to support the residents with herself as an additional third person. Each resident will be consulted about an individual personal care support plan, which will be in his or her room and identify specifically what areas of support are needed. The registered person will be monitoring care on a daily basis, and the home will be revisited in six weeks time. The other issues that were raised relating to the welfare and happiness of the residents at Holywell House were not substantiated. There are very positive outcomes for the residents of this home; the atmosphere is very relaxed and homely. The residents have access to all areas of the home and were unanimous in their appreciation of the recent holidays they had gone on. The registered person has also recently recruited two new members of staff to the team to enhance the service she is able to offer to the residents. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
Since the last inspection the majority of the residents have been away on a holiday. For one resident this was the achievement of a long-held ambition. The owner of the home has also initiated redecoration of some of the areas. There is also new furniture in the communal areas, which replaces the oldfashioned wingback chairs. These improvements have been noted by the residents, one resident stated that it made her feel as though the owner liked them because she had spent that amount of money on new furniture. The office equipment has also been moved from the downstairs communal area,
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 7 which allows the resident to use the room more fully. The office equipment has been located upstairs in the communal lounge, which was rarely used. The new owner has recruited staff on a full-time basis, which replaces the large number of very part-time staff who were working in the home prior to her purchasing it. This allows for a better keyworking and consistency, and greater continuity of care. The staff spoken with were positive about the training courses they had been supported to undertake. This type of distance learning is new to them and different from the previous owners work practice. The staff also stated that they felt that Bisis priority was the residents, rather than making a profit. This meant that they were confident that if they asked her to purchase an item of equipment that they are deemed necessary to improve resident care, then this would be forthcoming. What they could do better:
It was discussed in depth with the registered provider that the concerns raised from outside agencies were a judgment on the perceived standard of care received by residents at Holywell House. The monitoring and implementation of personal care support needed to be improved, and Mrs Hill had already put a system in place which will be evaluated for effectiveness. It was noted that the new staff to the home did not have all the relevant checks completed before they started work. These need to be completed as a priority. Mrs Hill has also started to implement person centred planning at the home, which is accessible to the residents as they have pictures and symbols to allow residents to understand them. These as yet are incomplete; this is because of the timescale that Mrs Hill allowed herself was unrealistic. The registered provider and inspector spoke at length about prioritising the work, for example ensuring that personal care is of a very high standard, is now the main priority at the home. Until recently Mrs Hill had worked for a large organisation and had been able to rely on their network of support for provision of policies, paperwork, et cetera. Now she has to rely on herself, and has found that she is trying to do too much at once. To ensure this schedule is under control we have discussed identifying priorities such as client care and concentrating on this until the standards reached a consistent satisfactory level. When this has been completed then the next task will be identified and implemented. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 8 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. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 9 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 Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 10 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 There is information available for service to use, on which they can base a decision whether or not to move into Hollywell House. EVIDENCE: There have been no vacancies at Hollywell House since the last inspection, and none expected to arise. The statement of purpose and service user guide are both available to the residents at the home should they wish to see them. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 11 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) 6,8,9 The care planning system in place is incomplete. This needs to be completed in order to provide the information needed for staff to care for the residents satisfactorily. EVIDENCE: The residents all have a support plan in place although they may not have been reviewed since last September. The owner of the home has introduced more person-centered files, which are easy to use, and information is easily accessible. The person centered files have symbols and pictures to aid understanding for the resident who, it is planned, will have a more pivotal role in the writing of their care plan and identifying the support they need to be independent. There is a daily record maintained for each resident, some of the entries were informative, whilst others were poor and lacked any detailed information. This is an area where vigilance by the registered provider is required to bring it up to a standard where information is recorded consistently. The residents at Hollywell House are able to talk directly to the registered
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 12 person on a daily basis. This ensures that they are confident in their relationship with her, and able to be included and consulted on any changes that are happening in the home. Some of the residents are more willing than others to participate in this type of consultation. For example, some residents are quite vocal and freely express their opinions about situations as they arise. The residents enjoy their relationship with each other, and it is noted that from the last inspection, there are less grumbles and complaints made about each other. This could be taken as an indication that the group are generally harmonious and enjoy each others company. The staff working on the evening also stated that the majority of the resident join in the games and group activities that go on in the evenings. The residents are able to attend house meetings to raise issues of concern, but can find this quite intimidating and may prefer to do this on a daily basis. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 13 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) 11,13,14,15 The residents are able to self-advocate and therefore are able to make informed decisions about their chosen lifestyle. EVIDENCE: The residents at Hollywell House are assessed and treated as individuals, with individual social needs. Some of the residents attend the local Day Centre, and some attended the local college. Work placements were discussed, but generally felt by the residents not to be viable. The residents are supported to take part in the community activities, such as attending girl guides. One resident also stated that they no longer wish to attend certain clubs that took place during the weekday evenings; this was due to falling out with other people who attended. The registered person provides transport to and from the clubs, and if necessary the resident is supported by staff to attend. The families of some of the residents play a large part in their lives. They are encouraged to visit the home; one resident always spends Saturday with their family. Some families are more actively involved in the day-to-day care of
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 14 their relatives than others. As mentioned earlier in the report, the residents are very pleased with the improvement in their diet and meals at Hollywell House. The quality and variety of food was important to them, and also being able to choose what meals were planned was important. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 15 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 The implementation of individual personal support plans is needed to ensure that residents personal care needs are met. EVIDENCE: The concerns from North Somerset Council focused mainly on the personal care support that the residents did not appear to be having. It was noted from the personal observations of the inspector, that some of the resident needed additional care and attention. It was discussed in depth with residents, staff and the registered person and the action plan put forward by the registered person to rectify the situation has already been detailed earlier in this report. One resident, who needed a visit to the hairdresser, admitted that it was personal choice that she had not bothered to raise this with the registered person. However, following discussion with the inspector the resident arranged with Mrs Hill to visit the hairdresser, and an appointment was made and kept for the following Saturday. One specific area of concern related to one resident wearing soiled clothing to the day centre, and this was explained by the arrival of the transport for the day centre coinciding with the home’s morning coffee break. The resident was reluctant to give up his coffee, but also rushing to get to the transport. However, now as this has been highlighted the situation will be addressed.
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 16 The care files for the individual residents demonstrated that the physical and emotional health care needs were identified and appropriate action taken. For example, one resident had unfortunately developed epileptic seizures, these have been monitored, and the resident was attending an appointment to see the consultant neurologist on the 7th June 2005. Other aspects of health care provision, such as continence advice, had not been sought due to the registered person’s lack of knowledge about the services available in the North Somerset area. It has now been rectified and the continence adviser will be visiting the residents at Hollywell House who are in need of advice and support. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 17 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 There is a complaint system in place at the home which has not been accessed by North Somerset Council to raise concerns. The adult protection training should be renewed and include all members of staff. EVIDENCE: The concerns raised by North Somerset Council have been investigated fully and found to be partially substantiated. The concerns and complaints were not addressed directly to the home and therefore the complaint procedure at the home has not been used. With reference to adult protection, the inspector would recommend that all staff at the home have training in adult protection awareness which is available at no charge through North Somerset Council. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 18 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) 24,30 Recent investment in this home has improved the home creating a comfortable and safe environment for those living there. EVIDENCE: The registered person has invested in new furniture, and renewing the décor in areas of the home. It should be noted that Hollywell House provides a very comfortable environment; all the residents have single rooms, which are decorated to individual taste. All residents use the communal areas, and the dining room is a focal point for them to congregate during the daytime. There is limited outdoor space, however, some of the residents sit on the bench at the front of the house where there is a particularly sunny aspect. Since the last inspection the dedicated cleaner had left the home, and cleaning duties have been allocated to the care staff. Because of the concerns raised about the standard of personal care given to the resident the manager will be looking for a dedicated cleaner for the home to allow more care time to attend to residents need. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 19 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 Recruitment practices to ensure the safety and welfare of residents have not been followed. EVIDENCE: There have been additions to the staff team in the last inspection. The registered person has taken the decision to increase the hours of the part-time staff, to allow for greater continuity of care. Two full-time staff have joined the team, neither of whom have a large amount of experience working with people with learning disabilities. The staff at the home are acquiring new skills through distance learning training, and have to address new areas of work, which they are unfamiliar with. It has led some of the original staff team to leave, however, new recruitment and staff have been put in place. The staff are all willing to learn, but need reassurance as through any period of change when things are unfamiliar and people are unsure. There will be an increase in staffing levels in the mornings to ensure that residents are fully supported with their personal care. The newer staff to the home have indicated that they would be willing to undertake the NVQ 2 in care, with the additional learning disability award framework units.
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 20 The recruitment practice for the two new members of staff was not followed fully implemented and this was highlighted to Mrs Hill. A clear procedure must be in place to ensure that all the relevant checks and references are completed before people start work; this is to ensure the safety and welfare of the residents living at Hollywell House. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 21 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) 37,38,43 The manager has a clear view for a plan and vision for the home, but must effectively communicate this to be service users and staff. By providing clear leadership throughout the home staff will be able to demonstrate an awareness of their roles and responsibilities toward the residents. EVIDENCE: The registered provider also acts as the registered manager for the home. However, in this capacity all of the administration as well as the day-to-day running of the home is the responsibility of Mrs Hill. It has proved to be a large task, especially as the deputy for the home who was in place when Mrs Hill bought the home, left at Christmas time. Mrs Hill had experienced difficulty in being able to complete all the tasks herself, and have found the workload to be overwhelming. She is also keen to have residents more greatly involved in the day-to-day running of the home and in the individual planning of care. Her vision for the
Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 22 home is to manage Hollywell to implement and uphold the principles of the Valuing People paper. However, trying to implement too many things at the same time has meant that Mrs Hill had made inroads into many areas of the home, but not completed any of them. This was discussed and it was agreed that Mrs Hill should prioritise her work, and delegate tasks to which she does not have to retain responsibility for, to other members of staff. Unfortunately all the staff team at Hollywell House are relatively inexperienced in completing tasks other than caring. Additional training and support is needed to enable staff to be successful. In the short-term this will not allow her any extra time, but in the long term it will ensure that there is equal distribution of the work of the home. The primary task identified is for the improvement in the standard of personal care for the residents. The inspection took place over several days and following the first visit, Mrs Hill was able to identify strategies that she should put in place to improve the quality of personal care. Once this has been implemented and monitored for success, and then further development tasks can be identified. It was suggested that resident care plans, particularly for two individuals, be fully explored with comprehensive action plans for staff to follow. The staff and residents at home all appeared quite content and happy with the way things are. Staff, who have been there several years, stated they felt the new owner has improved the quality of life for the residents and the home. The residents had no complaints and demonstrated they had a very close relationship with Mrs Hill. She needs to act as a leader and to communicate her vision for the home fully to both staff and residents. This will allow for staff and residents to work together toward a clear identified goal. There were no health and safety concerns evident to the inspector on the tour of the building. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 23 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 x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 3 x 3 3 3 x x Standard No 31 32 33 34 35 36 Score 3 3 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hollywell House Score 2 x x x Standard No 37 38 39 40 41 42 43 Score 3 2 x x x x 3 D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 18 34 Regulation 12 13 Requirement The personal care needs for the residents are fully documented, and understood by staff. Two references and CRB checks are completed prior to staff working at the home to ensure the safety and welfare of the residents. Timescale for action 7/6/05 7/6/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 6 23 30 38 Good Practice Recommendations Daily care records should reflect the dialy life and activity of the residents. Adult protection awareness training should be attended by all staff. A dedicated cleaner should be employed for the home. The manager must communicate her vision for the home to residents and staff so that it is a shared goal. Hollywell House D53_D02 S61655 Hollywell House V223036 010605 Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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