CARE HOME ADULTS 18-65
Hollywell House 63 Clevedon Road Weston Super Mare North Somerset BS23 1DD Lead Inspector
Nicola Hill Key Unannounced Inspection 6th May 2006 10:00 Hollywell House DS0000061655.V293706.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 Hollywell House DS0000061655.V293706.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. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 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 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) Hollywellhouse@aol.com Mrs Olabisi Mojibade Hill Mrs Olabisi Mojibade Hill Care Home 9 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 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. 2nd December 2005 Date of last inspection 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 DS0000061655.V293706.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 6th May 2006, on a Saturday morning to enable the inspectors to meet with the residents of the home when they were home from the day centres. The inspectors were able to observe the daily activity of the home and observe interactions between staff and residents. The morning was very busy and the staff were coping with unforeseen incident. The home remained very positive whilst dealing with a wide variety of issues presented by its resident. The staff at the home have received training to enable them to understand and implement care plans, which were available for all the residents, in order to benefit resident’s lives. The inspection took place with the staff on duty and lasted approximately 5 hours; the inspector spoke briefly by phone with the manager who was in London. It was agreed that the inspector would return to the home to provide feedback to the manager later in the week. The fees for the home are negotiated individually based on the needs of the prospective resident. What the service does well:
The inspectors were able to see the residents being supported to make personal choices about how to spend their time. The staff were there to facilitate the daily running of the household, and worked together in the very busy household. Some of the residents chose to spend time in their rooms after others had gone out with relatives. One resident who chose to stay in bed later than usual, was able to get up mid-morning and be supported with personal care and breakfast. This resident was also very keen to attend a planned activity with the staff later in the day. He was able to discuss with the inspectors how much he enjoyed being able to go out with the support of staff that he got on extremely well with. The inspectors were able to look at the care planning format that the manager has introduced into the home. It is noted that they have pictures on them, which the residents who have limited reading and writing skills are able to recognise. One resident chatted with the inspector while they went through the care plan and she recognised and stated that she had been involved in planning the care and writing the plan that, she acknowledged was specific to her. The resident on the whole get on well but are a group of individuals. The staff were extremely adept at responding to the individual personalities and the competing needs. The comments from the resident in general are very
Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 6 positive and the residents were happy to talk with the inspectors. Comments such as “I like living here but sometimes the other residents can be bit of pain but we all have to get on with each other” were made to the inspectors. Some of the service users find other residents difficult at times and can be overly controlling, however the staff on duty demonstrated that they were able to identify and defuse difficult situations and that they would use the specific guidance in place to ensure that no untoward incidents occurred. What has improved since the last inspection? What they could do better:
On reviewing the medication it was noted that the stock control of medication was inaccurate, this applies only to the homely remedies and PRN medication as all other medication used delivered within a Nomad box. The staff on duty were reluctant to accept that creams and ointment should be thrown away after a 28 days as it was considered a waste, but this is an educational issue which the manager will be able to address. It was noted for one resident that there had been deterioration over the past week or so, but this was not reflected in the care plan. This was brought to Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 7 the attention of the staff at the time, and on a return visit to provide feedback to the manager, it was noted that the care plan had been updated. 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 DS0000061655.V293706.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Quality in this outcome group was good. There is sufficient information available to prospective service users. EVIDENCE: There had been no new admissions to the home as there have been no vacancies at the home. The manager has updated the statement purpose to ensure that current details about herself, as manager and owner of the home have been included. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome group was good. Residents are supported as individuals. EVIDENCE: The inspectors reviewed the care planning systems at the home and were able to discuss this directly with the residents. The manager has introduced a new format of care planning, which has pictures, which allows for greater accessibility by residents with limited reading and writing skills. The care plans also include photographs of the residents and indicate that they are directly involved with the drawing up of care plans and the identification of individual needs. To test this hypothesis, the inspectors sat with the residents and looked at the care plans together. One resident in particular was able to read all of her care plan and was able to state that she had been involved and recognised the care plan and identified needs and plan for the future. The review of the care plan with the resident was a very positive event for the resident, and increased their knowledge about what was happening in the
Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 11 home and the day-to-day function of the home. The resident also enjoyed the one-to-one interaction with the inspectors and was able to ask many questioned about the role of the CSCI, and the outcomes of the inspections. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 12 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): 12, 13, 15, 16 & 17. Quality in this outcome group was good. The home supports residents have preferred lifestyle choices. EVIDENCE: All the residents have an individual file, which identified their individual needs and choices. Within the files there are daily activities planned and these are linked to the day centres where residents are supported with individual activities. The inspectors discussed the prospect of working with some of the residents; however, this had been a poor experience from some, whilst others were involved with voluntary work. One resident stated she felt that their needs were listened to and that they could actually discuss anything directly with the manager and she would be responsive. Many of the residents also are still involved with families and have family visits or go to visit families over the weekend. One resident was due to have a birthday, and was planning his party to be held at the home rather than at the home of his relative (mother).
Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 13 The menu choices available are based on resident preferences and these are discussed at house meetings. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 14 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. Quality in this outcome group was good. Personal and healthcare support is individualised. Stock control of medication not in the unit dosage system remains a challenge. EVIDENCE: The individual care files indicated that each person had a contract for their room and the resident and the manager signed this. There is evidence of care assessment and reviews carried out by North Somerset Council Social Services, the meetings identified any action to be taken. Case tracking through the daily record and health care notes confirmed that the action had been taken. There were risk assessments in place for one resident that required early updating and this was brought the attention of the manager. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 15 The local community learning disability team are supporting the home to introduce individual health action plans. The this is a fairly new initiative from the health team, and will need time to enable all staff to understand the significance of health action plans as they are in addition to the health care recording already in place at the home. The residents confirmed that they attended various appointments with dentists and the local doctors. The staff are available to support the resident to attend the doctor or hospital appointments. The manager also ensured that there are links to specialist services through the community learning disability team and that where possible the specialist service has come to the home to see people in their own environment. In particular this has worked with a resident who is involved with the challenging behaviour team. This resident has autism and can be very demanding of staff time and aggressive toward other resident. The staff team, manager, resident and health staff are all working together to modify behaviour so that it is acceptable to the other residents. The medication of the home is supplied by the local pharmacist in a Nomad tray. The check on the medication indicated that the “when required” medication not included in the Nomad boxes was not being accurately recorded. This had been a problem at the last inspection and will be made a requirement so that the manager introduces a system whereby there is more accuracy in recording stock levels. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 16 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. Quality in this outcome group was good. The complaints process is open and accessible to residents. EVIDENCE: The inspector reviewed the complaint book and noted that there had been no complaints received by the home since last inspection. The residents were aware that they were able to make complaints but all felt that they could raise them directly with the manager and that they would be listened to and action taken. They were also aware that sometimes the complaints they made, particularly about other residents, would not always be able to be resolved fully to their satisfaction, and it was case of everybody just trying to get on. All staff have received training in abuse awareness, and there have been no incidents in this home. Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 17 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 & 30. Quality in this outcome group was good. Hollywell House is a pleasant, homely environment. EVIDENCE: The inspector did not undertake a tour the premises as four of the residents were still in bed, or were using their rooms and a tour of the premises would have been too intrusive. However, the areas of the home visited by the inspectors were clean and well maintained, and there were no obvious health and safety hazards. The manager has also undertaken a home audit of the bedrooms and has identified certain areas for redecoration or repair. Hollywell House DS0000061655.V293706.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, 35 & 36. Quality in this outcome group was good. Staff are supported through training and supervision to meet the individual residents needs. EVIDENCE: The manager at Hollywell House has managed to retain her staff team and to provide stability to the residents. The staff rota indicated sufficient staff on duty. During the week at the busiest times there can be three staff on duty to ensure that residents are supported with personal care to allow them to go to their daily activity. The inspectors were able to read the staff files held at the home. It was noted that the recruitment process is very good and provides a safeguard when recruiting staff. The staff files also indicate that there is quite a lot of training available to staff and that they receive regular supervision. It is suggested to the manager that both supervisor and the supervisee sign notes to indicate agreement of their content.
Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 19 The manager has now made links with several training centres and informational resources so that there is some on-site training available for staff, which enables them to care more effectively for specific residents need e.g. autism. Two of the full-time staff are from Poland and are currently undertaking NVQ qualifications at the local college, and also working alongside the manager to improve their skills and understanding of the different culture of the UK. Hollywell House DS0000061655.V293706.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, 39 & 42. Quality in this outcome group was good. The management systems promote the safety and welfare of the residents. EVIDENCE: The manager continues to lead the staff team to support the residents to achieve a good quality of life. She is available 24 hours to either in person or by telephone, and this is to both residents and staff. The staff team at a Hollywell House have been supported to attend training courses, and also to develop themselves in the their knowledge and skills so that they are able to progress in the care industry. The manager has also been able to carry out quality audits on the home in order to identify areas of development. Linked to the development are the
Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 21 business planning, and the investment in the home to provide a good standard of fixtures and furnishings for the residents to enjoy. The inspectors looked at the following health and safety records to ensure compliance with the Health and Safety at Work Act. The home has had checks on the water system for Legionella in 2006. All the alarms were recently checked by H and H Alarms to ensure that the fire system is working effectively. It was noted that the fire extinguishers had been subject to the annual check in November 2005. Fire drills and alarm tests had been taken place out as per the recommendation by the Avon Fire Brigade, however the emergency lighting required a check, as this had not been done for several months. Hollywell House DS0000061655.V293706.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 X 3 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 12, 13 Requirement The system for when required medication must be reviewed by the manager so that a foolproof system is introduced which provides an auditable record. Timescale for action 12/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hollywell House DS0000061655.V293706.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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