Inspection on 22/05/07 for Holt The

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holt The 30/04/09

Holt The 23/05/06

Holt The 04/10/05

Holt The 04/05/05

Holt The 15/02/05

Holt The 14/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holt The The Holt Main Street Hutton Buscel Scarborough North Yorkshire YO13 9LN Lead Inspector Karen Ritson Key Unannounced Inspection 22nd May 2007 09:30 X10015.doc Version 1.40 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 DS0000050401.V335116.R01.S.doc Version 5.2 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 Older People. 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. DS0000050401.V335116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holt The Address The Holt Main Street Hutton Buscel Scarborough North Yorkshire YO13 9LN 01723 862045 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) mch.care.limited@talk21.com Miss Victoria Louise Towse Mr Herbert Towse, Mrs Carol Ann Towse Ms Susan Rowley Care Home 22 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (22) of places DS0000050401.V335116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The category DE refers to one named service user under 65 years of age named in application V33321. 23rd May 2006 Date of last inspection Brief Description of the Service: The Holt is a large house set in its own secure, secluded and well-kept grounds. A former vicarage, it was converted some years ago into a care home. The home is registered to care for 22 service users with dementia. The fees begin at £390.00 per week depending on level of care required. (This information was provided on 05th April 2007). Additional charges are made in respect of hairdressing, chiropody and any personal toiletries. The building is conveniently placed for access to local facilities and a bus service runs from the village. The home is on three floors. A passenger lift gives access to all floors used by service users. The communal areas and some bedrooms are on the ground floor and there are further bedrooms on the first floor. The top floor is for staff use only. There are 16 single and 3 double rooms. Ten of the single bedrooms have an en-suite facility. There are sufficient communal facilities in lounge, conservatory and dining areas. The staff provide personal care, catering, laundry and cleaning services. Service users are offered a limited range of appropriate activities. All service users are registered with local medical practitioners. Copies of CSCI reports are available to read in the home on request. The home makes information available to service users, their families and advocates through the statement of purpose and service user guide. DS0000050401.V335116.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection for this service took 15 hours. This includes time spent gathering information and examining documentation before and after an unannounced site visit and in writing the report. The site visit took place on 22/05/07 between 10:00am and 4pm. Information for this inspection was gathered from the following: • • • • • • • • • A tour of the premises Speaking with service users. Speaking with the manager and proprietor. Case tracking service users on the day of the site visit. Looking at information provided by the home in a pre inspection questionnaire. Notifications sent to the commission from the home since the last inspection. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CSCI. Considering comments made by relatives, health care and social services staff. Although observations of care were made throughout the day of the site visit, the inspector spent a period of time sitting in the lounge specifically observing the care offered. All key standards were looked at during this inspection. The manager was present throughout the day. The proprietor visited whilst the visit was taking place. What the service does well: This home provides a very good level of care for service users in a comfortable and homely setting. All service users receive the care they need, most have some level of dementia. One service user said: ‘I think they are so dedicated and kind.’ The home writes down the care needed in a plan and involves the relative or service user if possible when it is updated. This makes sure that service users receive the care that is right for them. Relatives said that they felt well informed and were made to feel welcome when they visited the home. DS0000050401.V335116.R01.S.doc Version 5.2 Page 6 Complaints are listened to and wherever possible put right. Service users said they were encouraged to say if anything was not to their satisfaction and if there were a problem it would be sorted out. Enough staff are on duty and the inspector observed staff taking the time to chat and offer care in a unhurried way. Staff are well recruited and trained. This makes sure that service users receive good appropriate care. The home is well managed by Susan Rowley. All staff said she was a supportive colleague and service users felt the care offered just what they needed. Health and safety is a priority within the home and all policies are checks are in place. This makes sure that service users live in a safe and comfortable home. What has improved since the last inspection? The daily notes made about the care are clearer and more detailed than before. This helps staff understand what has been happening at the home whilst they are not at work. The abuse policy has been improved. It has been updated to include more detail of what must be done if there is a suspicion of harm or abuse of any kind towards service users. The accident form used by the home has also been improved to make the information more detailed. Some redecoration work has been done since the last inspection and the home looks better as a result. The outside of the home is tidier, and radiators are now all guarded. The staff rotas have changed to allow staff to remain at the home for a while when a new shift comes on duty. This is so that information can be shared about what is needed for each service user in an unhurried way. Sue Rowley has completed her NVQ level 4 training and is now working to complete her Registered Manager’s Award. This means she is better qualified and has developed her management skills to meet the needs of people living at the home. DS0000050401.V335116.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000050401.V335116.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000050401.V335116.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The home does not provide intermediate care. People who use the service experience good quality outcomes in this area. Prospective service users and their representatives have the information needed to choose a home, which will meet their needs. They are at the centre of the needs assessment and they are made aware of the service they can expect to receive. This judgement has been made using a range of evidence including a visit to the service. EVIDENCE: Assessments are detailed and include all required areas. DS0000050401.V335116.R01.S.doc Version 5.2 Page 10 A service user said: ‘They know what I need doing and they know me so well I don’t often have to ask.’ A social history is compiled for each service user with help from relatives. This gives details of past work, family relationships, interests, hobbies, likes, dislikes, food preferences and any religious or other beliefs which the service user would wish to continue observing. All relevant areas of risk are assessed and details are regularly reviewed. All assessments are carried out with the involvement of a relative where possible and most care plans are signed and dated. The detailed documentation and the person centred approach of the home ensure that each service user is appropriately placed and that each individual needs are met. DS0000050401.V335116.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good quality outcomes in this area. Individuals and their representatives are consulted about decisions regarding their lives and their health care needs are met following consultation with health care professionals. Service users are treated with dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas of care are covered in the care plan, with risk assessments where needed. These are kept under regular review. Easy read monthly updates of the care plan along with district nursing notes are also kept for each person. Clearly written daily notes add detail about day-to-day changes in care needs. This makes sure that the care offered is appropriate for the current care needs of each service user. DS0000050401.V335116.R01.S.doc Version 5.2 Page 12 The plan focuses upon what can be done to help each individual retain existing skills and covers areas of specialist involvement where needed. For example service users are weighed regularly, have their continence needs assessed and care is taken over potential pressure areas. Mental health needs are considered and CPN consulted when needed. A service user said: ‘I don’t know if they write it all down, but they know what is needed. The nurse looks at notes and the staff are very helpful.’ The willingness of the manager to consult the relevant specialists ensures the care is focused on individual needs. A period of time was spent sitting in the lounge, observing the interactions between service users and staff. All service users were spoken to kindly and respectfully by staff and many were happy to chat with the inspector. Staff interventions were always paced so that the service user had time to respond and there was an atmosphere of calm and cheerfulness. Medication is suitably kept in a blister pack made up by the surgery. Records were examined and no discrepancies were found. Senior staff who are authorised to administer medication have received training. This ensures service users medical needs are met and that the risk of medication error is minimised. All medical consultations take place in the service users own rooms and personal care is offered in private. This ensures privacy and dignity are maintained. DS0000050401.V335116.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. The quality of service users daily lives is enhanced through appropriate activities, tailored to individual needs. They have a balanced diet they enjoy. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The manager said that activities were available most often in the afternoons. There is no dedicated member of staff to offer activities, however, most staff on duty become involved in singing, dancing and individual games such as dominoes, cards or sewing. Service users were observed singing along to music with staff during the morning. One service user said: ‘It’s very important to me that they take the time to talk and just have a look at a magazine or something like that.’ DS0000050401.V335116.R01.S.doc Version 5.2 Page 14 Staff said they would also play skittles, bean bag throwing or play reminiscence games. In the warmer months, service users have the opportunity to go out on short walks, trips or to spend time in the sheltered garden. This ensures that service users are offered the opportunity for social stimulation and interesting pastimes. One service user said: ‘The food is always good, and we get plenty of it.’ A midday meal was sampled and was of a high quality. Care plans showed that service users preferences and dietary needs were taken into consideration. A lunch was observed. The dining room was set out attractively. Service users were helped without being rushed and food was brought to the table promptly. The cook said she offered a choice of menu with main meals based on traditional favourites. She added that she had attended a food safety update training the week before. All fruit, vegetables and meat are purchased locally and all baking is carried out on the premises. Service users ate well and there was very little waste. There was no evidence however that service users or their representatives were consulted over menu choices. Staff were observed asking service users if they were enjoying their meal and chatted to them whilst they were eating. Most agreed the food was good. This approach ensures that service users are offered suitable meals they enjoy. DS0000050401.V335116.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): .16,18. People who use the service experience good quality outcomes in this area. They are enabled to express their concerns and have access to an effective complaints procedure. They are protected from abuse, and have their rights protected. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. Service users said they felt confident their complaints would be listened to and acted upon. One said: ‘I only have to say and any of them would do what they could to put it right.’ Staff have had abuse awareness training recently and the policy has been updated and improved following an allegation of abuse from the manager regarding a member of staff. This member of staff no longer works at the home. The investigation followed the adult protection procedure and the manager and staff all agreed they had learnt a great deal with regard to whistle blowing and the level and accuracy of recording required at all times following this. Daily notes were examined and were detailed. This showed that DS0000050401.V335116.R01.S.doc Version 5.2 Page 16 service users were closely monitored and that their welfare was protected. The service user about whom the allegation of abuse was made, remained in the care of the home. Her notes suggested that she was well settled and had little or no recollection of the incident. The family of the service user had agreed that the Holt continued to provide the most appropriate care for their relative, and were content for her to remain there. A recommendation was made about the accident form, to include details of referral to RIDDOR where necessary or whether a Regulation 37 had been completed. The manager and staff have responded well to the challenge of the vulnerable adults investigation procedure, and they are to be commended for their openness and commitment to taking corrective action. This ensures that as far as possible, service users are protected from harm. DS0000050401.V335116.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. They live in a safe, well-maintained and comfortable environment. This judgement has been made using a range of evidence including a visit to the service. EVIDENCE: The home is well decorated and maintained and ongoing decoration is planned for the near future. The handyman said that although he worked within a budget he did not feel unduly restricted in what he could achieve, he found the manager and proprietor very supportive and listened to his comments. The home complies with the requirements of the fire department and environmental health authority. There is an attractive sheltered garden area where service users may walk or sit in the warmer months. At present, the roof is being repaired which is temporarily restricting access for service users to the outdoor areas. This is due to be completed very soon however. DS0000050401.V335116.R01.S.doc Version 5.2 Page 18 One service user said. ‘Isn’t the garden beautiful! The house is very comfortable with nice high ceilings and nice colours on the walls.’ Other service users were sitting in the conservatory area of the lounge and several positive comments were overheard about the garden. The proprietor has plans for building work, which would increase the number of rooms available at The Holt. This plan has yet to be put in place and an application for a variation in the numbers of service users accommodated has yet to be made. The laundry facilities meet the needs of the service users at present, however, this is due to be demolished in the near future as part of the extension plans and a new one will be incorporated into the main building. DS0000050401.V335116.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. Staff in the home are trained and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The manager explained that the rotas had changed since the last inspection. There is more overlap between shifts so that staff are able to have a longer hand over period. This ensures that staff have a greater opportunity to share any relevant information about individuals in their care. Staff said they felt there were sufficient on duty to carry out their duties without feeling rushed. During the period of observation, staff came into the lounge area on a frequent basis, spoke with service users and generally spent time with them. Throughout the day there was a relaxed and positive atmosphere. Service users agreed there were enough staff. One said: ‘There’s always someone you can ask for help.’ DS0000050401.V335116.R01.S.doc Version 5.2 Page 20 Almost 50 of staff have achieved NVQ at level 2. Staff are appropriately recruited according to policy. Staff files were seen and contained all required information. The files are well indexed and easy to navigate. Each member of staff has an individual training plan and this is discussed in supervision. Staff confirmed they received regular training and were encouraged to attend training which interested them in addition to foundation subjects. This approach to staffing levels, recruitment and a commitment to staff being adequately trained ensures that service users needs and wishes are met. DS0000050401.V335116.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness and respect. Service users views and preferences influence practice and they are protected by the health and safety procedures of the home. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The manager has completed NVQ at level 4 and is part way through the Registered Managers Award. She is committed to finishing this in the near future. All staff spoken to said they received very good support from her as DS0000050401.V335116.R01.S.doc Version 5.2 Page 22 manager and they felt they worked well alongside her. She was observed during the morning of the inspection and she frequently came into the lounge to talk with service users and staff. She was friendly and both service users and staff clearly got along with her. The home has a basic quality assurance system. Service users are surveyed regarding their opinions of the care they receive on an annual basis, there are also survey for relatives and heath care professionals. The manager said she was disappointed that more people had not returned completed questionnaires. The results of the surveys are fed back to staff, service users and families informally who are kept updated if there are planned improvements. One service user said she could voice her opinion at any time and felt the home would respond to suggestions she made. The home does not handle any service user finances. Evidence was submitted on the pre inspection questionnaire that all relevant safety checks had been carried out. Several certificates of maintenance were seen and were up to date and in order. The home was due an Environmental Health visit and training was due for the Control of Substances Hazardous to Health. The home has comprehensive health and safety policies and procedures and a first aid trained member of staff is on duty at all times. This ensures service users are kept safe. DS0000050401.V335116.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 DS0000050401.V335116.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations The registered providers are reminded of the need for any registered manager to have obtained a National Vocational Qualification in management. The quality assurance system should be further developed to take account of service users with dementia. 50 of staff should have NVQ at level 2 in care. 2. OP33 3 OP28 DS0000050401.V335116.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 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 © 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 DS0000050401.V335116.R01.S.doc Version 5.2 Page 26 - 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. 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