Inspection on 23/05/06 for Holt The

This inspection was carried out on 23rd May 2006.

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 22/05/07

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 23rd May 2006 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 Holt The DS0000050401.V295851.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. Holt The DS0000050401.V295851.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 Miss Victoria Louise Towse Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 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 range of fees is between £349.00 and £390.00 per week depending on level of care required. (This information was provided on 28th April 2006). 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. Holt The DS0000050401.V295851.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 12.5 hours. This includes time spent gathering information and examining documentation before and after a site visit and in writing the report. The site visit took place on 23rd May between 9.30am and 3pm. A tour of the premises was made both inside and outside the building. Four service users, a visitor and all staff on duty were spoken to. A care manager was spoken to after the site visit. Three service users were case tracked and their files with all related documentation were examined. Health and safety documentation and other relevant policies and procedures were also looked at. All key standards were assessed at this inspection. The acting manager was present throughout the site visit and the registered provider visited the home and spoke to the inspector for a short period. Sue Rowley has submitted an application to CSCI for registration as manager of the home. This is in progress at present. What the service does well: This home provides a relaxed and homely atmosphere for service users. The staff are friendly, kind and offer care in a respectful way. One service user said of a member of staff: ‘You are so kind to everyone.’ Service users needs are assessed and a detailed written plan of care is produced for staff to follow. This is a working document, is regularly consulted and kept under review. A care manager said with regard to care of one service user: ‘This person has difficult needs and they manage them well.’ Medication is stored and administered suitably and staff have received medication training. Service users are offered activities suitable to their needs and the food is good. Complaints and protection issues are well handled. The staff are well recruited and supported in their role by the manager, and all receive thorough training. A member of staff said of the manager: ‘We can go to her with anything and she always sorts it out.’ Most health and safety systems are in place. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 7 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 Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a thorough assessment of care so that their care needs may be met. EVIDENCE: The manager completes an assessment prior to or on admission. This is thorough and covers all main areas of care. Particular care had gone into a social history for each service user, compiled 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. The questions are clear and encourage reminiscence, for example service users are asked. ‘What did you enjoy most about family life?’ and ‘Is religion something that really matters in your life?’ 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 were signed and dated. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 9 Staff said that finding out about the lives service users had lived before they came to the home allowed them insight into the way they may wish to be treated now and gave them things to talk about together. A direct result of this had been to arrange for regular communion for a service user within the home. One service user said: ‘They know what to do.’ Although it was difficult to gain any further helpful direct comments due to service users’ dementia, staff and service users interaction was observed throughout the day, and it was clear that service users needs were well understood and often anticipated. The home does not offer intermediate care. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation and practice ensure that service users health care needs are met, with due regard for their privacy and dignity. EVIDENCE: The home keeps a detailed care plan for each service user kept under regular review. The plan focuses upon what can be done to help each individual retain existing skills. Health care professionals are consulted where necessary and guidance is included in the plan. A relative said that the care her father received was ‘good’ and that the staff were responsive to his particular needs. All service users were spoken to kindly and respectfully by staff and many were happy to chat freely 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 friendliness. Medication is suitably kept. Records were examined and no discrepancies were found. Staff have received medication training. All medical consultations take place in the service users own rooms and personal care is offered in private. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of service users daily lives is enhanced through appropriate activities, tailored to individual needs and the provision of a varied appealing diet. EVIDENCE: The activities on offer to service users are appropriate. The manager and staff said that they usually spend time facilitating activities during the afternoons. Service users were observed during the afternoon singing along to music with staff. One service user said: ‘They know I can sing and sometimes they ask me to sing for them.’ She was very pleased that the staff recognised her talent. 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 trips or to spend time in the sheltered garden. All service users said they enjoyed the meals. A visitor said the food was always good. Care plans showed that service users preferences and dietary needs were taken into consideration. Two diabetics are catered for at present and one person is receiving a softened diet. A lunch was observed. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 12 The dining room was set out attractively, with good lighting. Service users were helped without being rushed and food was brought to the table promptly. One service user was unwell and not able to eat with the others. A member of staff was observed helping this person eat with great sensitivity. The cook said that although she worked to a budget, she did not feel restricted over what she could order. She is in the process of completing a nutrition and health course to update her skills. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust complaints and abuse policies and procedures. Service users are listened to and any concerns are acted upon. EVIDENCE: There have been no complaints since the last inspection. The home has a complaints policy and procedure and these are now located in the Service User Guide. The home has an abuse policy and procedure and staff have had abuse awareness training. This training is to be updated following an alleged incident at the home. A member of staff has been suspended pending the conclusion of an adult protection enquiry and this member of staff has now handed in her notice. The acting manager and responsible person have both followed the correct procedure regarding this issue and the enquiry has yet to be concluded. A member of staff said: ‘I would go straight to Sue (the manager) if I was worried about anything to do with service users care.’ The manager is to begin a trainer’s course in abuse awareness shortly. Service users said they were treated well by staff, one service user said: ‘These lasses are gold, all of them, they’re lovely.’ Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in pleasant surroundings and in the main are kept safe, however some service users are at risk from uncovered radiators. EVIDENCE: On the day of the site visit the ground floor was being redecorated. All areas, which may have caused a potential hazard, were barred to service users as a temporary measure. The home has an extension to the main building, which is modern and well decorated The main house is mainly well decorated, however the manager was aware that there is still work to do to achieve a consistent standard of décor throughout the whole home. A downstairs bathroom is being refurbished. Outside were some old chairs and other domestic rubbish which was awaiting skip removal. The gardens however were well kept, sheltered and very attractive. Service users were overheard commenting on how lovely the flowers were as they sat in the conservatory area of the lounge. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 15 Three radiators in service users rooms had no guards. These were to be made safe as a matter of urgency. The laundry facilities were away from the main building and satisfactory. The staff said there was not a problem with service users receiving the wrong laundry, as it was all labelled and the system of organising laundry worked well. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ well-being is protected by staff who are employed in sufficient numbers, who are well recruited and trained. EVIDENCE: The staff rota was examined. There was sufficient staff on duty at all times to meet service users needs. Staff said they felt they were not rushed and could offer care at a suitable pace. They said they had time to chat to service users and to do activities with them. A great deal of friendly interaction was observed throughout the day, between staff members, between staff and service users and between service users themselves. Those on day shift said they would have a quiet time before night shift workers came on duty when they would sit and watch a film with the service users or chat all together. All staff said they were very well supported by the acting manager. and that they had regular supervision. Supervision records bore this out. Staff recruitment records were complete and all said they had been interviewed using set questions. The home has an equal opportunities policy and procedure. Staff said they were encouraged to take part in any training available. All staff had received induction and foundation training to TOPSS specifications. Training records were clear, well indexed and easy to follow. A visitor said she felt confident that staff were competent and that they had time to carry out their duties without rushing. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33,35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to feedback informally and their views are acted upon whilst a formal quality assurance system is under development. The home is well managed and service users on the whole benefit from robust health and safety systems. EVIDENCE: The acting manager has an application for registration with the CSCI in progress. She has almost finished NVQ level 4 in care and the Registered Manager award. She has many years experience working in a care home setting, has updated her training in dementia care and is to embark upon a trainers course for abuse awareness shortly. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 18 Without exception, the staff reported that the acting manager offered a clear lead and that she was open and approachable. She holds regular meetings at which all staff said they were encouraged to express their views. Any concerns or issues were always addressed quickly and all received feedback. All staff said they received regular supervision. Supervision records bore this out. The quality assurance system is to be developed to gain the views of stakeholders, health care professionals and others. At present the questionnaires for service users are not suitable for those with dementia, however the manager is aware of this and plans to address this as part of her plan for the coming year. Service users finances are not dealt with by staff at the home. A third party is always involved. All health and safety documentation is in place and clearly indexed for ease of checking. The home must provide radiator covers for the three uncovered radiators as a matter of urgency. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 19 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 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 X 3 Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 20 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. OP19 2. OP19 23 The rubbish in the yard must be disposed of. Standard Regulation 12 Requirement The three uncovered radiators in service users rooms must be made safe. Timescale for action 24/05/06 04/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP33 OP31 Good Practice Recommendations The quality assurance system should be further developed to take account of service users with dementia. The registered providers are reminded of the need for any registered manager to have obtained a National Vocational Qualification in care and management to level 4 by 31st December 2005. Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 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 Holt The DS0000050401.V295851.R01.S.doc Version 5.2 Page 22 - 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. 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