Inspection on 05/02/09 for Hollywood Rest Home

This inspection was carried out on 5th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollywood Rest Home 03/12/07

Hollywood Rest Home 24/01/07

Hollywood Rest Home 15/06/06

Hollywood Rest Home 17/11/05

Hollywood Rest Home 09/06/05

Hollywood Rest Home 21/01/05

Hollywood Rest Home 28/06/04

Hollywood Rest Home 27/02/04

Hollywood Rest Home 14/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollywood Rest Home 34 Cresthill Avenue Grays Essex RM17 5UJ     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: Michelle Love     Date: 0 5 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 Older People 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 Older People Page 2 of 31 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Hollywood Rest Home 34 Cresthill Avenue Grays Essex RM17 5UJ 01375382200 01375381611 hrh@hollywoodresthome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gurmit Singh Dhillon,Mr Rajpaul Singh Dhillon Name of registered manager (if applicable) Mr Rajpaul Singh Dhillon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hollywood Rest Home is situated in a quiet residential area on the outskirts of Grays. It is registered to provide care and accommodation for up to 27 older people who may have a formal diagnosis of dementia. Accommodation is provided on two floors with a passenger lift to the first floor. There is a choice of two large communal lounges and one dining room. Hollywood Rest Home has an attractive garden to the rear of the property, which is well maintained and accessible to residents. Limited parking is available to the front of the property. The monthly fees range from 1,713.37 to 3,720.31. Additional charges/costs are 0 0 Over 65 15 27 care home 27 Care Homes for Older People Page 4 of 31 Brief description of the care home incurred by residents relating to hairdressing, purchase of personal toiletries, newspapers/magazines and sweets etc. Care Homes for Older People Page 5 of 31 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 7.5 hours, with all but one key standard inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered provider/manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the Care Homes for Older People Page 6 of 31 general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The registered provider, deputy manager and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings, were given as a summary to both the registered provider and deputy manager. The opportunity for discussion and/or clarification was given. As a result of concerns relating to poor medication practices and procedures, an Immediate Requirement Notice was issued. What the care home does well: What has improved since the last inspection? What they could do better: Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that residents are protected. This is a second repeat requirement and should this remain outstanding at the next inspection to the home, further enforcement action may be taken. A better system needs to be implemented to ensure that all staff working within the care home receive regular formal supervision, as currently this is not undertaken regularly for some people. Care Homes for Older People Page 8 of 31 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. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current and prospective people are provided with sufficient information so they can make an informed decision as to whether or not Hollywood Rest Home is the right choice for them. The care needs of individual people are assessed before they are offered a placement. Evidence: There is a Statement of Purpose and Service Users Guide in place for Hollywood Rest Home. This provides specific information about the service so that prospective residents have the information they need so as to make an informed choice as to whether or not this is the right care home for them. Surveys returned to us confirmed that people felt they had sufficient information about the home. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective residents needs. In Care Homes for Older People Page 11 of 31 Evidence: addition to the formal assessment procedure, supplementary information is sought from the individual residents placing authority and/or hospital. The AQAA details that respite care is provided to people on an occasional basis as and when required/requested. As part of the inspection process the care files for 2 people newly admitted to the care home were examined. Records showed that both people were assessed prior to admission by the deputy manager and that both people and their next of kin/representatives were given the opportunity to visit the home. Documentation was seen to be detailed and informative, identifying the persons care needs and providing specific information relating to their personal details. Written confirmation that the management team and staff team of the home can meet the persons care needs were readily available within each file examined. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People can be assured that their care needs, wishes, preferences and risks to their well being will be clearly recorded within a plan of care. Shortfalls were identified in relation to some aspects of medication practices and procedures. Evidence: As part of this inspection, a random sample of 3 care files were examined. Records show there is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these needs are to be met by care staff. In addition to the above, formal assessments are also completed pertaining to manual handling, nutrition, behaviour and pressure area care. Evidence showed that since the last key inspection the deputy manager has strived hard to develop the homes care planning system further so as to ensure that individuals care needs are clearly recorded and there is sufficient information for care staff to deliver appropriate care in line with the persons care needs. Care Homes for Older People Page 13 of 31 Evidence: Information recorded was seen to be detailed and informative, identifying all aspects of peoples physical, emotional and social care needs. Additionally risk assessments were devised for all areas of assessed risk, identifying the specific nature of risk and the steps to be taken to minimise the risk. From discussion with some members of care staff and the deputy manager, it was evident they have a good understanding of individuals care needs and how these are to be met on a day to day basis. Although in general terms there was evidence to show that the care plan for each person had been regularly reviewed and updated to reflect changes to individuals care needs, of those care files examined, not all elements of the care file were up to date. This was discussed with the deputy manager at the time of the inspection and we expect this to be managed by the home rather than make a requirement on this occasion. On examination of daily care records for the above 3 people case tracked, these were seen to be much improved in content and written on a daily basis. Records provided good evidence of staff interventions and how people living in the care home spend their day. Staff surveys returned to us provided mixed comments relating to staff being given up to date/sufficient information about the individual needs of the people living in the care home. Whilst some recorded they were provided with sufficient information, one survey recorded, some things that happen during the day are not written down i.e. if someone isnt feeling well and has been sick. Surveys from relatives and other professionals recorded that people felt that the care needs of people living within the care home were met. One healthcare professional survey recorded, this home accepts some extremely difficult to manage residents, that other homes have refused to take. They manage extremely well under difficult circumstances and I have always found the staff to be open to new ideas and willing to accept helpadvice and to act upon this. Another survey recorded, staff demonstrate good insight into mental health issues, are prompt at reporting any changes/concerns, enabling us to respond promptly hence preventing deterioration. Records continue to show that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services, Community Psychiatric Nurse etc as and when required. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. We were advised that medication systems within the home continue to be primarily overseen by the registered manager. Medication in the main is managed through the use of a monitored dosage system (blister pack). Medication is stored securely, however the temperature of the storage facility is not monitored and/or recorded. The deputy manager was advised that this Care Homes for Older People Page 14 of 31 Evidence: must be undertaken on a daily basis so as to ensure medication does not deteriorate and/or lose its effectiveness. On inspection of Medication Administration Records (MAR) these showed there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR record had been left blank and not signed or initialed by staff. Records also showed that one person did not receive their prescribed medication, yet the MAR record recorded this as being administered. This refers specifically to their once weekly medication (Alendronic Acid). Records showed 4 signatures, however on inspection of the medication trolley, the packet of Alendronic Acid contained 1 tablet. The MAR records for 2 people showed there were anomalies between the quantity of medication to be administered and the number of signatures. For example one persons MAR record showed they were to have Quinine Sulphate tablets administered 3 times weekly. MAR records showed that week commencing 12/1/09, 7 signatures were recorded and week commencing 19/1/09 4 signatures. For the same person their MAR record showed they were prescribed Alfacalcidol Capsules, one 3 times weekly. Records showed for week commencing 19/1/09 5 signatures were recorded. Additionally, where a variable dose e.g. 1 or 2 tablets to be administered was recorded, the MAR record did not always identify the actual amount of medication administered. On inspection of the medication trolley, medication (eye drops), which should be discarded after 4 weeks, remained in the medication trolley and had not been dispensed with. The MAR records were not always accurate, identifying medication carried over and where medication had been stopped. As a result of the above areas of concern and continued breaches of regulation relating to poor medication practices and procedures, an Immediate Requirement Notice was issued. The training matrix showed that the majority of staff who administer medication have up to date training, however formal training is scheduled every 3 years. Consideration should be undertaken to provide more regular training for staff so as to ensure their continued competence, especially in light of the above findings and areas of concern. Care Homes for Older People Page 15 of 31 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People living at the care home can be assured that they will have their social care needs met and will receive a satisfactory diet according to their individual needs. Evidence: A social assessment form is completed for all people residing at the care home, depicting their personal preferences, likes and dislikes, hobbies and past interests. An activities co-ordinator is employed at Hollywood Rest Home, Monday to Thursday 09.00 a.m. to 12.00 p.m. and 13.00 p.m. to 14.00 p.m. and on Fridays 13.00 p.m. to 17.00 p.m. A weekly activities programme is displayed and following the last key inspection, a pictorial format has been devised. On inspection of the record of social activities for people living at the care home, these included, table tennis, bingo, flower making, puzzles, cards, arts and crafts, indoor bowling, sing-a-long and board games. Further development is required in relation to providing social stimulation for those people with poor cognitive ability e.g. enabling individuals to assist/get involved with day to day tasks within the care home (laying the table, folding napkins, making a bed etc) so that individuals may gain a level of satisfaction, achievement and self worth.`Also as suggested at the previous key inspection, consideration could be made Care Homes for Older People Page 16 of 31 Evidence: for the devising of memory boxes and/or life story books for individual residents, which may help with drawing out memories. People spoken with confirmed that activities are provided on a daily basis and they have the option whether to participate or not. Visiting arrangements at the home remain open, whereby visitors can see their member of family and/or friend at any reasonable time. On inspection of menus at the home, these showed that people are provided with two main choices of meal at lunchtime and teatime. It was positive to note that since the last key inspection, a pictorial menu has been devised so as to enable people within the home to make an informed choice. On the day of inspection, the lunchtime meal was observed to look plentiful and appetising and people spoken with during the inspection made positive comments about the food e.g. the food is really good and I have no complaints. Where people required assistance to eat their meal, this was undertaken with sensitivity and respect. During the morning of the inspection, several staff members were observed to enter the main lounge and to pour cold drinks for people. Limited verbal interaction was noted to take place between staff with residents, and people were not given a choice of drinks and/or offered a hot drink (tea/coffee). Staff spoken with confirmed that people are provided with a hot drink at set times during the day, however people can request to have a hot drink should they choose. Consideration must be afforded to those people who are unable to request a hot drink as a result of their poor communication/cognitive ability. Care Homes for Older People Page 17 of 31 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People can be confident that their complaints will be listened to and they will be protected from abuse, neglect and self harm. Evidence: There is an appropriate complaints policy and procedure in place at Hollywood Rest Home. Since the last key inspection records showed there has been 1 complaint relating to a night staff member sleeping whilst on duty. Records showed that the specific nature of the complaint, investigation undertaken, action and outcome was recorded. Relative surveys returned to us, advised that people know how to make a complaint should the need arise. One survey recorded, Information on arrival was very comprehensive and where we have been unhappy, we have been encouraged to voice concerns and have always had a response. One healthcare professional survey recorded, on the few occasions I have raised concerns, they have always been quickly acted upon. Several records of compliments were available and included, To all the staff just to say a big thank you for all youve done for [name of resident]. All the best to you, To Mr Dhillon and all staff, thank you very much for the care you gave our [name of resident] in their short stay at Hollywood Rest Home and for the floral tribute you sent. We feel sure they would have been happy to have lived at Hollywood. Thank you all and To Teresa and everyone at Hollywood. Thank you so much for everything youve Care Homes for Older People Page 18 of 31 Evidence: done, we really appreciate it. One safeguarding issue has been raised since the last key inspection pertaining to financial issues for one person. Records showed appropriate agencies were contacted by the management team of the home for further investigation. A copy of the Safeguarding Adults Guidelines (Southend, Essex and Thurrock) were readily available. Staff spoken with demonstrated an understanding and knowledge of safeguarding procedures. The training matrix provided, recorded that this training is undertaken every 3 years and the majority of staff have up to date training. Care Homes for Older People Page 19 of 31 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, 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. 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. People live in a home that is comfortable, safe and homely which meets their needs. Evidence: As part of this inspection a tour of the premises was undertaken with the deputy manager. A random sample of service users bedrooms were inspected and all were observed to be personalised and individualised. People spoken with confirmed that they like the premises/their own private space. All areas of the home were observed to be clean. tidy and odour free. The AQAA details that within the past 12 months the laundry facilities within the home have been upgraded. Although no health and safety issues were highlighted at this inspection, infection control measures need to be tightened up. This refers specifically to bars of soap within a communal toilet and bathroom. The deputy manager was advised at the time and the issue dealt with. One staff survey returned to us recorded the first aid box is empty, bandages are washed in the washing machine and then reused on all residents and sometimes there is no cleaning products i.e. disinfectant. If the above is true, the management team of the home must address this as a matter of priority so as to ensure appropriate infection control measures are in place which safeguards peoples wellbeing. Care Homes for Older People Page 20 of 31 Evidence: Maintenance at the home is undertaken by Mr G Dhillon, who visits the home most days. A random sample of maintenance records/certificates were examined and these showed that fire drills are undertaken regularly, fire alarms, emergency lighting and fire extinguishers are tested once weekly/monthly. Other certificates were examined in relation to the passenger lift, gas and electrical safety installation, hoists and employers liability and all were noted to be in date. Care Homes for Older People Page 21 of 31 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. People living at the care home have appropriate support to meet their care needs. People can be confident that staff have the skills and training to care for them. Evidence: We were advised that staffing levels at the care home remain at 4 members of staff (including the person in charge) between 07.00 a.m. and 22.00 p.m., 2 waking night staff between 22.00 p.m. and 07.00 a.m. and 1 sleep in person each day. In addition to the above, ancillary staff are employed (laundry person, cook and cleaner). The registered managers hours are supernumerary to the above and as highlighted at the previous key inspection, the deputy manager is not afforded any supernumerary shifts. The deputy manager is responsible for care planning processes and other systems within the care home and consideration should be made by the management team of the home to review the above, so as to enable her to complete documentation and supervisions etc within her normal working hours. On inspection of 4 weeks staff rosters, staffing levels as detailed above are being maintained. On the day of inspection the staff roster was inaccurate as it detailed that the registered manager was on duty from 10.00 a.m. to 18.00 p.m., however they were not on duty throughout the time of the inspection. During the inspection we became aware that since November 2008, Thurrock Council has been providing Care Homes for Older People Page 22 of 31 Evidence: additional funding for one person (2 hours per day for 7 days per week-additional care and 3 hours per day for 7 days per week-additional housekeeping). On inspection of 4 weeks rosters there was no evidence to show that the above additional staffing was being provided. Following discussions with the cleaner we were advised that they were asked by Mr Dhillon to undertake one extra hour per day and not 3 as agreed and invoiced by Thurrock Council. As a result of the above Thurrock Council have been advised of the above. Staff surveys returned to us recorded mixed comments relating to appropriate staffing levels being in place. These ranged from there are always enough staff on duty to meet the individual needs of all the people who use the service to sometimes there is only two members of staff to look after all the residents and employ more staff as theres usually not enough. A random sample of 4 staff files were examined for those staff newly appointed since the key inspection. All records as required by regulation were readily available and files were well maintained. A record of induction was completed for all 4 people, however the induction file for one person was not on the premises and the administrator visited the registered providers house to obtain the documentation. The training matrix provided to us evidenced that the majority of staff have up to date training relating to core subject areas (food hygiene, health and safety, fire awareness training, first aid, manual handling, safeguarding, infection control). Additionally the matrix also provides details of training courses undertaken by staff for those conditions associated with the needs of older people e.g. dementia awareness, dealing with challenging behaviour, epilepsy awareness, parkinsons disease, diabetes, continence awareness, sensory impairment etc. Where there are training deficits for individual members of staff, the training plan has identified this and in some cases dates for training have been arranged. Further training has been applied pertaining to palliative care, personal care, stoma care, catheter care and person centred care. The training matrix identifies 11 people as having attained NVQ Level 2, with one person currently undertaking NVQ 2 training and 1 person as having achieved NVQ Level 3 and another staff member undertaking this course at present. Care Homes for Older People Page 23 of 31 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. In general terms the home is well run and provides positive outcomes for people. Evidence: It remains evident and positive at this inspection that the management team of the home are continuing to strive to achieve and maintain progress with meeting regulatory requirements and previous identified deficits. The deputy manager has continued to address previous identified shortfalls in relation to care planning and risk assessing and this has resulted in a good standard of care plans now being in place identifying individual peoples care needs and how these are to be met by care staff. We also recognise that the registered manager has ensured that robust recruitment procedures are now in place for newly appointed staff so as to protect the people who live at the care home. Shortfalls identified relate to continued poor medication practices and procedures and not all staff receiving regular formal supervision. However, we recognise with the latter that informal supervision is undertaken as and when required. Care Homes for Older People Page 24 of 31 Evidence: Evidence showed that on a day-to-day basis the home is well run and provides positive outcomes for the people who live at Hollywood Rest Home. People spoken with during the inspection, were complimentary regarding the care provided and care received. One relative survey returned to us recorded, Teresa the assistant home manager is an absolute star-she gives 150 to the job and endeavours to keep staff on their toes. I am pleased we found Hollywood Rest Home. It also recorded under the heading of what do you feel the care home or agency does well, valuing and caring for my relative as an individual. Kindness and humility are paramount in their support-even when some people are highly ungrateful or rude, staff always manage to smile and carry on caring. Relatives commented that communication with the staff team is very good and there is a clear partnership approach. Another relative survey returned to us recorded, the care and assistance we have received to date has been very good. One healthcare professional survey recorded, I have always found staff to treat residents with respect and promote privacy and dignity. A healthcare professional survey recorded, the home has a good mix of skills, Teresa (assistant manager) is extremely experienced and excellent at her job. A random sample of 9 peoples supervision records were inspected and these showed that regular formal supervision is not being undertaken in line with regulatory requirements and National Minimum Standards recommendations. For example the staff file for one person who commenced employment in September 2008 showed that at the time of the inspection they had not received supervision. Another staff file showed that they had received only 2 supervisions in 2008. Since the last inspection the deputy manager has received regular supervision from the registered manager. The AQAA details under the heading of our evidence to show that we do it well, staff are supervised regularly. This does not concur with the inspectors findings. Since the last inspection the registered manager/provider has had a quality assurance self assessment undertaken in October 2008 by an external agency so as to monitor the service provided at the care home. The results of the quality assurance show that nine people participated in interviews and were questioned as to how life in the care home meets their requirements and desires. Overall people were happy with the care provided by staff at the home and many felt the staff were caring and treated them with respect. In addition to the above there was evidence to show that both staff and resident meetings are held at the care home. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and the document returned to us when requested. Information recorded was seen to be generally informative and detailed. Care Homes for Older People Page 25 of 31 Evidence: The AQAA provides a list of policies and procedures currently available within the home. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) Ensure that safe and 13/03/2009 appropriate procedures are adopted by staff at all times in relation to administering medication to residents so as to ensure their wellbeing. Previous timescale of 3.12.07 not met. 2 36 18(2) Ensure that all staff working 13/03/2009 at the care home are appropriately supervised. This refers specifically to the deputy manager. Previous timescale of 1.8.07 and 1.2.08 not fully met. Care Homes for Older People Page 27 of 31 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 1 9 13 Ensure medication practices and procedures within the care home are appropriate and in line with regulatory requirements. So as to ensure residents safety and wellbeing. 13/03/2009 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 9 13 Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. This is to ensure a clear audit trail and to ensure peoples health and welfare. 13/03/2009 2 9 13 Where medication has a specific expiry date, medication is to be discarded and not used. This will ensure residents safety and wellbeing. 13/03/2009 Care Homes for Older People Page 28 of 31 3 9 13 Where a variable dose of medication is administered, the specific dose given is recorded. This is to ensure that people do not inadvertently exceed the specified dose of medication. 13/03/2009 4 9 13 Residents must be protected 13/03/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure residents safety and wellbeing. 5 9 13 Medication must be stored under suitable environmental conditions and records of the temperatures of the storage areas must be kept to show this. This will ensure that residents receive medicines that are effective. 13/03/2009 6 27 18 Ensure there are sufficient staff, on duty at all times. So as to ensure the needs of individual residents are met according to their specific needs, dependency and additional funding arrangements. 13/03/2009 7 27 17 Ensure that the duty roster is accurate and up to date, detailing all people working at the care home on any given shift. 13/03/2009 Care Homes for Older People Page 29 of 31 So that anyone can determine who is on duty on any given shift. 8 36 18 Ensure that staff receive regular supervision. So that staff feel supported and residents know that staff are appropriately managed. 31/03/2009 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 25 Appropriate systems are in place to control the spread of infection. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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). 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!