Inspection on 22/01/09 for Holyrood House

This inspection was carried out on 22nd January 2009.

CSCI 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

Holyrood House 22/11/07

Holyrood House 21/06/07

Holyrood House 06/07/06

Holyrood House 20/12/05

Holyrood House 17/08/05

Holyrood House 10/03/05

Holyrood House 13/01/05

Holyrood House 20/02/04

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: Holyrood House 46 Green Lane Ostend Burnham On Crouch, Maldon Essex CM0 8PU     The quality rating for this care home is:   two star good 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: Tina Burns     Date: 2 2 0 1 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 26 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 26 Information about the care home Name of care home: Address: Holyrood House 46 Green Lane Ostend Burnham On Crouch, Maldon Essex CM0 8PU 01621784759 01621784856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Peter Walters,Mrs Melanie Walters Name of registered manager (if applicable) Mrs Melanie Walters Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Holyrood House is a detached property that was first registered as a private care home for three older people in 1994. The owners are Peter and Melanie Walters, who is also the registered manager. This home is situated on the outskirts of Burnham on Crouch but is not within walking distance of the towns facilities. Holyrood House caters for up to three older people in a homely environment, which they share with the owners. As a family home, residents are able to receive consistent day-to-day care and involvement with the owners and a small team of care staff. Residents private accommodation is in single bedrooms on the ground floor. There is access to the front garden via patio doors and adequate car parking facilities are available at the side of the property. Care Homes for Older People Page 4 of 26 0 Over 65 3 care home 3 Brief description of the care home At the time of inspection the manager advised that the fees for accommodation ranged from £430 to £450 per week. Items considered to be extra to the fees include private chiropody, hairdressing, toiletries and newspapers. Care Homes for Older People Page 5 of 26 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: two star good 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, which focused on the core standards relating to care homes for older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a range of documents and records including the care plans of the two people who are currently resident at the home. The inspector also spoke to both residents; a visiting relative, a care worker, an independent advocate and a health associated professional. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQQA) submitted to the commission in 2008, and survey forms Care Homes for Older People Page 6 of 26 completed by one care worker and two residents with assistance from their relative or advocate. The homes owners Mr Peter Walters and Mrs Melanie Walters, who is also the registered manager, were present during our visit and fully contributed to the inspection process. What the care home does well: 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 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 8 of 26 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 9 of 26 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. Prospective residents can expect to be provided with the information they need to make an informed choice about where they live. They can also expect to have their needs assessed prior to moving into the home. The home does not provide an intermediate care service. Evidence: The Service User Guide / Statement of Purpose had been updated since the last inspection. It was very detailed and included information about the services provided and the terms and conditions of the home. There had been no new admissions since the previous inspection but information provided told us that the home has appropriate pre admission procedures in place. The Statement of Purpose told us that prospective residents or their representatives are encouraged to visit the home and if they are interested the manager then undertakes Care Homes for Older People Page 10 of 26 Evidence: an assessment of their needs. The assessment covers areas such as; personal care and well being, diet weight and nutrition, sight, hearing and communication, oral health, foot care, mobility and dexterity, history of falls, continence, medication, mental health, social interests, religious and cultural needs, personal safety and risks and carer and family involvement. If the home is able to offer a place a four week trial is offered which is followed by a formal review. If everybody agrees the home is suitable a written contract, or statement of terms and conditions is then signed and agreed. The home does not provide intermediate care. Care Homes for Older People Page 11 of 26 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 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 they will receive a good standard of care by people that know them well and respect their dignity and privacy. Evidence: Feedback from surveys and people we spoke with during the course of the inspection told us that residents have their personal and health care needs met. Comments we received included; They are so good. If only every other home was like Holyrood, then people wouldnt worry about their parents going into residential care, They always keep me informed if anythings wrong, They all get undivided attention, theyre not lacking for anything and Nothings left (health care). Always nipped in the bud, nothings left to chance. Residents care plans were examined, they were highly individual and reflected the needs identified in their assessments, giving specific details about the tasks that needed to be carried out to meet their needs.There was also good evidence that care plans are reviewed regularly and updated as required. Further more, formal annual Care Homes for Older People Page 12 of 26 Evidence: reviews took place to ensure that the home remained suitable and these reviews included local authority care managers and residents relatives or advocates. People we spoke with told us that care was provided with sensitivity and privacy and dignity was respected. Observations during our visit was that staff knew and understood residents needs, interaction was very positive and they were polite and respectful to residents at all times. Personal care was provided in private and behind closed doors. Records seen during the inspection confirmed that the home works in partnership with a wide range of health care providers so that residents health care needs are met, for example GPs, district nurses, occupational therapists, continence adviser, chiropodist and dietician. Records of appointments with health professionals and details of the outcome were maintained. Residents records included medication profiles. Medication was stored safely and administered appropriately by staff. Staff responsible for administering medication had undertaken appropriate training and been assessed as competent to handle and administer medication. Medication Administration Sheets (MAR Charts) were in place and fully completed. All staff had a clear understanding of the homes medication procedures. The written policy and procedure reflected good practice but could have been more detailed in some areas and should have covered matters such as invasive medication and what to do in the event of a medication error. The manager agreed to develop the existing procedures in line with CSCI guidance. Care Homes for Older People Page 13 of 26 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. Residents benefit from living in a small home with a family atmosphere. They are able to maintain good contact with family and friends and enjoy healthy well balanced meals. Evidence: Observations made and people we spoke with confirmed that visitors are made welcome at the home and residents are supported to maintain contact with their friends and family. One visitor told us that they visited very regularly and they were most impressed at the welcome they and their extended family (twelve people) had been given on christmas day. Feedback from residents surveys told us that there is sometimes or always activities arranged by the home to participate in. Care plans included details about preferred activities and daily routines. Due to the size of the home, the high staff to resident ratio and the needs of the current residents activities were not usually planned in advance and were generally spontaneous. This appeared to work well for the two people currently resident who seemed to most enjoy the interaction and close attention that they had from the owners and their family and the additional permanent Care Homes for Older People Page 14 of 26 Evidence: staff member. The evening before our visit everyone had celebrated a birthday together. On the day of our visit one resident occupied themselves in the privacy of their own room, the other spent their time in the lounge where they enjoyed the company of different people throughout the day. We asked people about daily life at Holyrood House. Comments we received included; Perfect, I think I was very lucky to find the place, Its not like a care home. Its like living with a family, The TVs always on and quite often theres music...., I think its good because they treat them as members of the family rather than a number, If they ask for something they get it, they never go with out and Melanie listens and talks to them....she has infinite patience. One resident was supported to have external representation in their personal matters through a solicitor and an independent advocate. We spoke with the advocate who told us that in addition to their routine visits three or four times a year they are invited to reviews and contacted if the person concerned wishes to talk to them. Residents bedrooms were personalised and included items of their own furniture and various personal belongings. It was also positive to see that further items of furniture belonging to one resident had also been given pride of place in the communal lounge where they were enjoyed by everyone. On the day of inspection one resident took their meals in their own room and the other was given full assistance in the lounge. Due to their complex needs they required feeding and this was carried out at a pace suitable to them and in a manner that respected their dignity. They seemed to enjoy their meals and the interaction that they shared during meal time. The manager advised that they didnt have a formal menu but they consulted people about their meals on a daily basis, further more they had a very good understanding of residents likes and dislikes. People we spoke with told us that food was home cooked and of a good standard. Records of meals provided and taken were maintained and confirmed that meals were varied, healthy and well balanced. Care Homes for Older People Page 15 of 26 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 feel confident that their complaints will be listened to, taken seriously and acted upon and residents are safeguarded from abuse. Evidence: The homes complaints procedure says; Your comments, either positive or negative are important to us. They help us improve our services so please do not be afraid to tell us what you think... It then gives details about how to make a complaint and the stages of the complaints procedure. Feedback from surveys and people we spoke with confirmed that people know how to raise complaints or concerns. One visitor told us Without a doubt. They also confirmed that they had confidence that any complaints would be dealt with appropriately. There had been no complaints made since the last inspection. Records seen and information provided in the AQAA tells us that staff have received safeguarding adults training. The care worker we spoke with confirmed that they had sufficient knowledge to handle any concerns and understood the procedures for reporting abuse. The manager advised that they had adopted the local authority safeguarding procedures and a copy of this was in place. They agreed to ensure that the details they had were current and up to date. Information provided in the homes Statement of Purpose included details about their Care Homes for Older People Page 16 of 26 Evidence: policy for managing Challenging behaviour. It said; Both we and our staff endeavour to correct extreme behaviour gently with patience and tact while avoiding scolding or conflict or direct contradiction. We emphasise we need to use diversionary tactics to channel behaviour which is putting people at risk or causing distress to other residents. Further information provided in the Statement of purpose also tells us that the risks associated with bed rails are understood and managed. People currently living at the home are assisted with their financial affairs by their relatives or representatives. The home is able to store valuables for safekeeping if requested. Care Homes for Older People Page 17 of 26 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. Residents can expect to live in a safe, clean, comfortable and well-maintained environment. Evidence: At the time of inspection all areas seen were safe, clean and comfortable and with the exception of one bedroom that was in the process of being cleaned the home smelled fresh and pleasant. People we spoke with and surveys returned told us that the home was always clean. There was a Fire Risk Assessment and suitable fire equipment in place. Extinguishers had been serviced in July 2008, fire bells were tested monthly, smoke alarms were appropriately maintained and regular fire drills took place. The furniture, decor and facilities provided were pleasant and comfortable and created a homely and relaxing environment. Observations made, information provided in the AQAA and discussion with the manager confirmed that the home has an ongoing redecoration and maintenance plan in place. Since the last inspection one bedroom, the lobby and the residents lounge had been redecorated. We were also advised that there are plans to repave the area outside the small lounge/diner in time for the summer as the residents enjoy sitting outside when the weather is warmer. Care Homes for Older People Page 18 of 26 Evidence: Communal space available consisted of a main lounge in the centre of the house and an adjacent lounge/diner. The kitchen was shared with the owners and their family who lived in a separate part of the house. Bedrooms were very individual and personalised with residents own furnishings, belongings and trinkets. All bedrooms had en-suite WCs and hand wash basins and there was a communal bathroom. The home has a separate utility area for dealing with laundry. The laundry area was clean and adequately equipped. Clinical waste from the home is bagged and disposed of with the household rubbish and collected through agreement with the local council. The manager agreed to ensure that the procedures they followed reflected the most up to date guidance for managing clinical waste. The homes process for managing soiled linen was discussed and the current system of soaking soiled garments in a bucket and emptying the contents down the sink in the utility area does not comply with the Department of Health Guidance (DOH) for Infection Control. The manager agreed to take immediate action to comply with DOH guidance. The use of dispersible bags in a washing machine with a sluice facility is recommended. Care Homes for Older People Page 19 of 26 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. Residents can expect to have their needs met by a small team of dedicated staff who know them well and understand their needs but some gaps in recruitment records do not fully safeguard people who live at the home. Evidence: Information provided tells us that there is a small staff team that consists of the owners, Mr and Mrs Walters, a family member and an additional care worker. If the owners are away, the care worker lives in and an agency worker is used. The manager advised that they use the same agency worker and have checked their credentials to ensure that they are suitable. Under normal circumstances all personal care is provided by the manager and care worker with the co owner and other family member assisting with meals. The co owner, Mr Walters is also responsible for the maintenance of the property and gardens. Discussion with people during our visit indicated that everyone working at the home had a high sense of commitment to the job and people who live at the home. We were told Its just a brilliant team, we work very well together. Observations we made and feedback we received tells us that staff are always available when they are needed and residents receive the care and support they need. Care Homes for Older People Page 20 of 26 Evidence: Comments included; They are so good. If only every other home was like Holyrood, then people wouldnt worry about their parents going into residential care, They all get undivided attention, theyre not lacking for anything and I think its good because they treat them as members of the family rather than a number. We talked to the manager and care worker about training they had done and looked at some of their certificates. The manager had completed the Registered Managers Award and NVQ level 4 and the care worker was in the process of completing NVQ level 3. They told us that they work with other care providers to access training and share costs and there was evidence of training in areas such as medication, POVA and manual handling. The manager had also started to do an audit of training needs to ensure that everyone had appropriate and up to date training and to devise a training plan for 2009 for everyone who works at the home. Since the last inspection there had been no new staff employed, however it was noted that the established care workers records did not include a photograph or full employment history and not all documents required had been maintained on file for the family member who sometimes assists with meals. A full discussion took place about the records required to be maintained and the manager was referred to Schedule 2 of the Care Homes Regulations 2001. Consequently the manager agreed to take immediate action to have all records required in place including an Enhanced Criminal Records Bureau Check for the additional family member despite the fact that they are only assisting with meals. Care Homes for Older People Page 21 of 26 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. Residents can expect the home to promote and protect their health, safety and welfare. Evidence: The home is owned by Mr Peter Walters and Mrs Melanie Walters who live on site in a separate part of the premises with their adult children. Mrs Walters is also the registered manager and main carer. She has worked in the care industry for many years and has obtained the Registered Managers Award and NVQ level 4 in management of care. Mr and Mrs Walters were both present on the day of the inspection. They were fully co-operative and receptive to the inspection process and welcomed discussions about how the home could improve. Feedback received throughout the course of the inspection confirmed that staff, residents and visitors found the management team extremely approachable and helpful. The manager completed the homes AQAA when we asked for it. It was reasonably Care Homes for Older People Page 22 of 26 Evidence: detailed and evidenced that they consider what they do well and where they need to improve. The home has quality assurance processes in place that include asking for the views of residents and relatives using questionnaires but the manager advised that due to the size and nature of the home they tended to receive feedback more informally and spontaneously. Some discussion took place about Quality Assurance processes generally and the manager was very keen to develop systems in this area, so that they were confident that they would identify areas of weakness and better evidence what they do well. People we spoke with and records seen told us that the care worker employed has regular supervision sessions and appraisals and in addition they had a lot of direct contact with the manager who they worked closely with on a day to day basis. The manager confirmed that she did not act as agent or appointee for any of the residents. Residents managed their money with assistance from their relatives or representatives. The manager advised that if they needed her to purchase anything on their behalf, for example clothes or toiletries, she would buy it and invoice them. Discussion with the manager, observations made during a tour of the premises and records seen confirmed that routine maintenance and health and safety tests are carried out, for example fire alarm and fire equipment tests, water temperature checks, manual handling equipment checks and portable appliance tests. Staff undertake appropriate health and safety training, procedures for reporting accidents and incidents are in place and notifications required by the Commission have been made. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 26 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 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 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 Care Homes for Older People Page 25 of 26 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 26 of 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. 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!