Inspection on 30/04/09 for Holt The

This inspection was carried out on 30th April 2009.

CQC found this care home to be providing an Good service.

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 22/05/07

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 20/07/2009.

Key inspection report 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 10:00 30th April 2009 DS0000050401.V375622.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Holt The DS0000050401.V375622.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) theholt@btconnect.com Miss Victoria Louise Towse Mr Herbert Towse, Mrs Carol Ann Towse Manager post vacant Care Home 22 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (22) of places Holt The DS0000050401.V375622.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. 22nd May 2007 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. 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 CQC reports are available to read in the home on request. The home makes information available to people, their families and advocates through the statement of purpose and service user guide. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection for this service took twelve hours. This includes time spent gathering information, examining documentation before and after a site visit. It also includes the time taken to write the report. The site visit took place on 30th April 2009 between 9:30 and 15:30. Information for this inspection was gathered from the following: 1. A visit to the home. 2. Speaking with people living at the home. 3. Speaking with staff. 4. Case tracking three people on the day of the site visit. 5. Reading survey forms from people living at the home and staff. 6. Looking at information provided by the manager prior to the site visit. 7. Notifications sent to the commission from the home since the last inspection. 8. Examining policies, procedures and records kept at the home. 9. Examining information regarding the home on the file kept by CQC. All key standards were looked at during this inspection. The manager was available throughout the day of the site visit. The proprietor also attended for part of the day and was present for feedback. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations -but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: The service provides a good level of care for people who may have a dementia. People receive a good assessment of their needs and the manager writes down what is required in a plan of care for staff to follow. This plan is kept up to date and is reviewed with advice from health care professionals. Medication is handled safely. People are well treated and their privacy and dignity is Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 6 respected. People also have their social needs assessed and the staff offer activities in the afternoons and early evenings which are based on the interests of people living at the home. Visitors are welcome. People have a good, varied and nourishing diet. Staff have training in abuse awareness and people are kept as safe as possible from risks to their wellbeing. Complaints are listened to and acted on. The home is well maintained and decorated and there are plans to extend the property to accommodate more people. There are enough staff on duty to meet the needs for people living at the home. Staff are well trained and recruited. Jane Wade, the manager, has been recently recruited. She has worked at the home previously, and has worked well to improve the quality of care in the time she has been in post. People are protected by the health and safety procedure in the home. What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 7 order line – 0870 240 7535. Holt The DS0000050401.V375622.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 Holt The DS0000050401.V375622.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the 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 have their needs well assessed so that their needs may be met. EVIDENCE: The manager ensures a full assessment is carried out for each person prior to admission. This includes a life history so that staff can begin to understand the person and their interests. A photograph of each person is kept on file and there is an admission sheet, which lists information such as GP and next of kin. The assessment includes all areas of physical, social and recreational needs. This includes people’s preferred way of dressing, a mental health assessment, nutritional assessment, pressure area risk, continence and moving and Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 10 handling as routine. The way in which dementia may affect care needs is also considered. All risks for each individual are assessed. The emphasis for each assessment is upon retaining as much independence as possible. This ensures people’s needs are well assessed and that there is detailed information for developing a care plan. Holt The DS0000050401.V375622.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the 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 have their care needs met. Medication is well handled and people are treated with regard to their privacy and dignity. EVIDENCE: A care plan is drawn up, which gives detailed instructions on how to offer the correct care for each person. The emphasis in each case is upon capacity. Staff have received deprivation of liberty training to ensure that they understand the ways in which people may be prevented from exercising free choice and helps staff understand how people can be enabled to live in a way which maximizes their autonomy. Some care plans have been transferred to computer for ease of updating and the manager has plans to transfer all care plans as soon as Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 12 possible. Each person has a provisional care plan which is used for the first 72 hours following admission, this is then updated and expanded as the manager and staff carry out observations and further assessments while the person is living at the home. Daily notes give useful and relevant information about each person and this information is passed across at each new shift. This means that staff are aware of the changing needs of each person. Each care plan includes advice from health care professionals where necessary. Psychological and other necessary assessment are included on file. Community Psychiatric Nurses visit the home when necessary and the care plans are regularly reviewed to show changes in care which have come about through discussion with professionals in review meetings. Medication is well handled. The home uses the Boots Monitored Dosage System. All loose medication is audited to ensure the manager knows how many tablets have been used and how many should remain. Medication which should be kept in the fridge is stored correctly, and eye drops and other medication is dated when opened to ensure that out of date medication is noticed and disposed of. All controlled medication is kept and administered according to the guidelines of the Royal Pharmaceutical Society. This means people are protected by good medicine management. Throughout the day of the site visit, the staff were observed treating people with care and courtesy. The home has a policy and procedure on privacy and dignity which staff cover in their induction. People said they liked the staff and it was clear from observing interactions between staff and people living at the home that there was a culture of kindness and friendly affection. One said of a member of staff: ’I think she is doing all the good things. She is kind and I love her.’ Holt The DS0000050401.V375622.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person has their social and recreational needs assessed. Activities take place on most afternoons, and can include skittles, bean bag games, reminiscence, short walks, sitting in the sheltered garden, dominoes and looking at magazines. A barbeque is planned for June. Each person has a record of what activities they enjoy and what they have taken part in. This helps staff to choose what they offer. Staff also said they had time in the early evenings to sit and chat with people when they could get to know them better. Visitors are welcome at any reasonable time. The home has a policy on visiting and some people go out with their friends or relatives. All people have a nutritional assessment and are offered meals based on their nutritional needs. The home offers a set meal at lunch time with alternatives Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 14 for preference and dietary needs, for example, a vegetarian is catered for and two diabetic diets at the moment. Menus change every three months and are drawn up after speaking with people about what they enjoy and observing what people enjoy when they find it difficult to express an opinion. People said they enjoyed the food. One person commented: ‘The food is always good and you get plenty of it.’ Holt The DS0000050401.V375622.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 have their complaints dealt with and they are protected from abuse. EVIDENCE: The home has a complaint policy and procedure and the manager is creating ways in which feedback can be obtained from those people who have a dementia and who have difficulty in expressing their dissatisfaction. All staff have received safeguarding of adults training in January 2009 and dementia awareness training earlier this year. Staff have also received deprivation of liberty training recently. This ensures staff understand the vulnerability of people who cannot always express their needs and ensures that they are protected from risk of abuse. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the 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 well maintained and decorated home. EVIDENCE: Building work is due to take place to produce an extension to the home to accommodate more residents. The laundry is due to be demolished and a new one incorporated into the new plans. Some communal areas, corridors, landings and some personal rooms have been redecorated since the last inspection. New carpets are planned for upstairs. The home complies with the environmental health and fire authority. The gardens are very attractive, with well tended flower borders in a sheltered secure setting. Bird tables and set up Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 17 near the dining room and conservatory so that people can watch the birds feeding from inside the home. People said the liked looking at the garden. Overall the environment was well decorated and maintained however; the downstairs lounge and hallway had an unpleasant odour. The manager stated the carpet had recently been cleaned and this seemed to have made matters worse. Carpets should be cleaned where possible or replaced if it is not possible to clean them adequately to keep the home smelling fresh. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the 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 receive care from well recruited and trained staff, in sufficient numbers to support the smooth running of the service. EVIDENCE: The home has sufficient staff on duty to ensure people receive the care they need at all times of the day. Extra staff are on duty at peak times. Staff have been well recruited according to policy and procedure, with two references and Criminal Records Bureau checks in place. This ensures people are cared for by staff suitable to work with vulnerable adults. 50 of staff have achieved NVQ in care at level 2 or higher. All staff have received an induction to the skills for care guidelines and all have or are working towards achieving foundation training in all required areas. They have also carried out training in specialist areas such as dementia care, to ensure they have an understanding of the particular needs of individuals who have a dementia. This ensures people receive care from well trained staff. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 19 Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and people are kept safe. EVIDENCE: The manager has recently taken up post although she has a history of working at the home in a deputy capacity and has returned. She has almost completed NVQ in care at Level 4 and is about to commence the management course of study. She will submit her application for registration with CQC soon. Staff said Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 21 they were pleased to have her with them and that she was a supportive and effective manager. One member of staff said: ‘It’s lovely to have her back.’ Another said: ‘I think she’s brilliant. She wants things done properly but she can have a laugh and joke with us and she is easy to go and talk to if you need to.’ The quality assurance system is partially organised. The manager has begun to implement quality audits across a number of health and safety areas in the home. She has been devising surveys for different group of people who may have an interest in the home and has begun staff meetings to gain their opinions about improving the service on offer. A number of health and safety documents were examined and these were up to date and maintained in such a way as to protect the people living at the home. Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 22 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 2 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 X 2 X 3 X X 3 Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 and care at level 4. 2. OP33 The quality assurance system should be further developed to survey more widely and take account of service users with dementia. 3. OP19 Holt The The home should be free of unpleasant odour to ensure people live in a pleasant home. DS0000050401.V375622.R01.S.doc Version 5.2 Page 24 Holt The DS0000050401.V375622.R01.S.doc Version 5.2 Page 25 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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