Inspection on 14/07/05 for Holywell Park Residential Home

This inspection was carried out on 14th July 2005.

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

Holywell Park Residential Home 10/01/07

Holywell Park Residential Home 25/11/05

Holywell Park Residential Home 18/02/05

Holywell Park Residential Home 06/07/04

Holywell Park Residential Home 24/02/04

Holywell Park Residential Home 01/10/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Holywell Park Residential Home Hodsoll Street Ash-cum-ridley Wrotham Kent TN15 7LE Lead Inspector Wendy Jones Announced 14 July 2005 09:30 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 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. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holywell Park Residential Home Address Hodsoll Street Ash-cum-ridley Wrotham Kent TN15 7LE 01732 822215 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Holywell Park Limited Mrs Sharon Michelle Apps Care Home 58 Category(ies) of Old Age (58) registration, with number of places Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 February 2005 Brief Description of the Service: Holywell Park is a family owned and run residential care home that accommodates up to fifty-eight older people. It has forty-eight bedrooms and two apartments accessed by three lifts. Some of the bedrooms have en-suite facilities. It is a large spacious house set in extensive, very well-maintained grounds and is a listed building. There is ample car parking to the front of the home. There is a shop/post office approximately two miles away. A bus runs from Hodsoll Street to nearby towns and there are train stations in nearby Meopham and Borough Green. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by Wendy Jones, Regulatory Inspector. Judgements are based on conversations with residents, management and staff; reading of care plans and records; comments received prior to the inspection from residents, their relatives/visitors and general practitioners; and a tour of the home and grounds. What the service does well: What has improved since the last inspection? Service users have all the furniture and fittings they need and want in their rooms. Medication administration records are now recorded accurately and appropriately and the controlled drugs cupboard is bolted to the wall in the medication room. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 6 Improvements have been made to the way that residents’ money is recorded and audited to ensure that records are accurate at all times. All other records are now kept in the home at all times to ensure confidentially. 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. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 standard(s) 2, 3 and 5 Service users and their representatives know that their needs can be met and are clear about the terms and conditions of the home. EVIDENCE: Residents and/or their representatives can visit the home, have a meal or stay for a trial period before deciding whether the home is for them. They are given a contract, which gives them all the information they need about the terms and conditions of the home. During the inspection a prospective resident and their relative visited to look around the home. Before a new resident moves in the manager carries out an assessment of their needs and obtains a summary of their care manager’s assessment. She continues this assessment through their trial period. The manager explained how, through this process, it had been found that the home is not right for one new resident and so they will be moving to a more appropriate home. This decision has been made with the interests of both the new resident and existing residents in mind. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9, 10 Residents’ health, personal and social care needs are fully met and they are treated with respect. Medication procedures and storage arrangements protect the residents. However, the current system of recording controlled medication could compromise the safe and secure storage of these drugs. EVIDENCE: A new Standex care planning system is being introduced into the home. Five care plans were seen that contained detailed information about residents’ personal and health care needs and evidenced that doctors and district nurses are asked to visit when needed. Daily recording has begun, but the old system of keeping a daily record about each resident in a separate file is running alongside this until the new system is fully implemented. These records were also seen. Basic risk assessments that ensure the safety of residents have been put in the new system, but more detailed assessments are to be carried out and added. The manager advised that risk assessments carried out and stored in the old care planning system are still being used at present and evidence of that this system is being used was seen. Staff said that they have a handover at the beginning of their shifts so that they are aware of any changes to the residents needs. They also said they were beginning to get used to the new care planning system and thought it would make it easier for Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 10 them to update themselves and be sure they know about any change in residents’ needs. Medication is stored securely and records accurately reflected what residents had taken and confirmed that medication is being administered safely. Staff have made sure that a resident with diabetes who has recently had to change to insulin injections, has all the help and support they need to do this themselves safely. Residents said that all their needs are being met and they are very happy with the help and support they get. They said they “want for nothing” and that staff are always very polite. Staff were clearly knowledgeable about what help and support the residents need, got on well with them and treated them with respect. Residents clearly trusted and had a good relationship with them. Some residents take controlled drugs and these are now stored securely in a cabinet which is bolted to the wall and complies with the Misuse of Drugs Regulations. Although this medication is accurately recorded and all the information required is kept, records are in a loose-leaf folder. This could compromise the safe and secure storage of this medication and it is, therefore, recommended that the recommendations in the pharmaceutical guidelines are followed and a bound book is used instead. Some residents have chosen to have a lock on their doors, and the manager makes a record of any resident that prefers not to. A new three monthly audit form was seen in residents’ rooms. This asks their views about all aspects of the facilities and support they receive and is one way for residents to ask for a lock to be fitted if they change their mind. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, 15 Residents enjoy a wide range of cultural, social and religious activities and have regular contact with their family and friends. Residents have a wide choice of wholesome and appealing meals, which are taken in very pleasant surroundings. EVIDENCE: A programme of events for July was seen showing activities and outings that residents can get involved. These included church services, bingo, card games, art classes and minibus outings. Residents said they had particularly enjoyed a motivation class the previous week. Other residents spoke of trips to Bluewater, the Hop Farm and Gravesend promenade that they had enjoyed. They also spoke of visits by their family and friends and service user plans seen contained details of these. Residents are able to use all communal areas in the home and have favourite areas where they like to sit. Some were seen sitting in the lounges in the home and one resident said they particularly liked to sit in their chair and “look out at the lovely grounds”. Others were sitting under the shade of trees and umbrellas in the gardens. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 12 Menus are prepared three weeks in advance and at lunchtime residents have a wide choice of meat and fish dishes with vegetarian/pasta options available and a range of desserts. A number of different choices are also available for tea. There are two water coolers in the home for residents to have cold water whenever they wish and hot and cold drinks are also available throughout the day. A member of staff was seen offering cold drinks to residents after lunch. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 standard(s) 16,18 Residents are protected from abuse and are confident that any complaints are taken seriously and acted upon. EVIDENCE: Two verbal complaints have been received since the last inspection. Records were seen of the investigations carried out and of verbal feedback given. Staff said that they had received adult protection training both from the home and as part of NVQ training. They were clear about what constitutes abuse and what they would do if they suspected it. The home’s training officer said that adult protection training was part of the home’s statutory training and detailed records were seen of who had attended this training and when. Comment cards received from 23 residents all stated that they felt safe living in the home. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Residents live in a clean, pleasant, safe, comfortable and well-maintained environment. EVIDENCE: The home is situated in a rural area with extensive views of the countryside around. It has a large and airy entrance hall with a staircase leading to bedrooms on the first and second floors. Residents’ rooms can also be accessed by two lifts. Residents can use grab rails and other aids that have been provided around the home. There are further bedrooms in a two-story annexe to the side of the main house, which has a lift to the bedrooms on the first floor. There are also two apartments in this annexe that have a living room and separate bedroom. Both have en suite bathrooms. Although there are a number of rooms that can be shared, all were being used as singles or were vacant at this time. The Manager said that the only time the rooms would be used as doubles would be if a married couple or two people e.g. sisters, move to the home. Most rooms have en suite facilities but there are communal toilets very close to those rooms that do not. There are four Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 15 bathrooms with Parker baths and a shower room. A sixth bathroom is due to be completed in the near future. Bathrooms have also been fitted with ceiling hoists where it has been identified that residents need them. There are a number of comfortably furnished and attractively decorated living rooms and a main dining room. A smaller dining room can be used for the dignity and comfort of residents who need more support than others when eating their meals. There is a large car parking area to the front of the house and an extremely well landscaped and attractive garden area to the side. This large area has garden tables and chairs with umbrellas, benches and an aviary. Residents said they thought they were extremely lucky to live there and all commented on how beautiful the gardens were. One resident said they enjoyed sitting by the aviary watching the birds and listening to them sing. Residents’ rooms were comfortably furnished and contained the residents’ own furniture and effects. Locked drawers had been provided for residents to lock away personal items and money. Residents said they had all they need and were very happy with their rooms. Despite it being a very hot day the home was well ventilated and residents said they were comfortable. Everywhere was extremely clean and there were no offensive odours. The laundry has two driers and three washing machines with sluice facilities to control the spread of infection. Clean and dirty laundry are kept completely separate and all laundry is turned around in a day. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 A robust recruitment process ensures that residents are protected and there are an appropriate number of skilled and competent staff on duty at all times. EVIDENCE: There were five carers, a senior carer and two heads of care on duty to look after 43 residents. Staff were able to carry out their duties unhurriedly and efficiently and had time to speak with residents. A cook, three kitchen staff, two laundry staff, four cleaners and two maintenance people were also working at this time. In addition the manager, her brother (a partner in the home) and the training officer were also on duty. A staff list and duty rosters seen showed that there were enough trained and competent staff to ensure that an appropriate number of staff are on duty and residents needs are met at all times. Although there are no vacancies at present the manager is planning ahead and advertising for more care staff to make sure there are enough staff to cover annual leave, maternity leave and any other unforeseen absences. Fifty per cent of the staff have achieved at least NVQ 2 in care with two more due to complete soon. A further two members of staff will start the course in September 2005. A training officer is employed who is responsible for planning and providing inhouse training and organising other essential training from outside agencies. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 17 She is involved in recruiting new staff and plans and carries out their induction. The training officer said that she has a training budget and has no problem funding any training identified. She is a trained trainer, manual handling assessor and trainer and an NVQ assessor. She is very aware of the need to keep her own skills up to date and is currently planning refresher training in a range of subjects. The induction and core training provided is assessed and reviewed by the training officer and updates and further training are provided when needed. The owners and training officer must be commended for their commitment to the development and support of the staff. Two members of staff spoken with explained how the managers had been “very supportive and encouraged” them to develop their skills so that they could provide the care residents needed. Both had now progressed from kitchen assistants to carers and were undertaking their NVQs in care. A head of care said that they had been supported to progress from carer to head of care. Staff said that the training they get is very good and the training officer is always pleased to help and advise them. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 Residents benefit from living in a home which is well managed, safeguards their best interests and promotes and protects their health, safety and welfare. EVIDENCE: The registered manager is very experienced and runs the home competently and in the best interests of the residents. She has achieved the Registered Managers Award and is currently completing the NVQ4 in Care. There is a calm and pleasant atmosphere in the home and residents spoken with were happy and contented. A large number of comment cards were received prior to the inspection from residents, their relatives or visitors and general practitioners who visit the home. The majority of comments were complimentary. Residents stated that they like living there, feel well cared for are treated well and feel safe. Relatives or visitors said they can visit in Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 19 private, are kept informed of important matters, are consulted and all were satisfied with the overall care provided. Although financial records and accounts were not seen on this occasion there was evidence that the home was financially viable. Ample resources were available for staff to meet the needs of the residents and the structure and contents of the home were in good condition. Appropriate insurance cover is provided for the home and a current insurance certificate is displayed. Small amounts of cash are kept for residents in separate envelopes in a safe in the manager’s office. Only the manager and her brother (a partner in the home) have access to the safe. Records kept clearly show the money that relatives have put in the safe for each resident, what has been spent and what this leaves. Relatives are asked to sign the records to say that they agree the accuracy of them. In addition the manager now carries out regular audits and also signs the records. Although supervision records were not seen on this occasion, heads of care said they were responsible for supervising staff and this was done on every shift. This averaged out to each member of staff receiving supervision at least fortnightly. Staff spoken with confirmed this and talked of the training officer ‘walking the floor’ and assessing how they were doing. All staff were clearly competent and aware of the help and support that residents needed. They spoke very highly of the training and support they received and felt well equipped to do their jobs. All records seen were stored securely and confidentially in locked cabinets in offices. Training records showed that staff received regular updates on manual handling to avoid injury to residents or themselves. The training officer said she also continually assesses staff by watching them at work. Regular fire training is provided and regular fire drills involving the full evacuation of residents are carried out. Records are kept to show that all staff have taken part and staff spoken with were very clear about their role if the fire alarm sounds. A new OTEX system has been installed in the laundry, which is linked to the washing machines. The manager was very satisfied with the system. She said that not only does it control the risk of legionella, but “kills everything” and clothes are definitely washed more thoroughly. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 20 The kitchen and dry store were clean and hygienic. However, the manager advised that the kitchen is to be completely refurbished in August and everything will be replaced. Pre-inspection information received and records sampled showed that all maintenance contracts and checks had been carried out and residents live in a safe and well maintained home. Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 x 3 3 3 3 3 Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 22 No 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. 1. 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 9.8 Good Practice Recommendations It is recommended that the controlled drugs register is a bound book to further increase the safe keeping of controlled drugs Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent, ME16 9NT 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 Holywell Park Residential Home H56-H06 S23960 Holywell Park V227240 140705 Stage 4.doc Version 1.30 Page 24 - 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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