Inspection on 02/10/08 for The Hollies

This inspection was carried out on 2nd October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies 07/09/09

The Hollies 03/05/07

The Hollies 17/01/07

The Hollies 29/11/05

The Hollies 03/06/05

The Hollies 15/12/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hollies Florida Street Castle Cary Somerset BA7 7AE     The quality rating for this care home is:   one star adequate 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: Jane Poole     Date: 0 2 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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: The Hollies Florida Street Castle Cary Somerset BA7 7AE 01963350709 01963351396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Judith Marion Adams Type of registration: Number of places registered: M & J Care Homes Ltd care home 13 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 The Hollies is a residential care home providing care and support for up to 13 older people. The home is in Castle Cary, in a quiet residential road, close to the centre. Local amenities including shops, cafes, a small museum and the post office are close by. The accommodation is arranged on two floors. There is a stair lift, but no shaft lift. There are two dining rooms and a lounge/conservatory which overlooks an enclosed and sheltered garden. The home has limited parking space for visitors at the front of the property. The current fee range is #390 to #550 per week. 0 Over 65 13 Care Homes for Older People Page 4 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: one star adequate 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: The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This inspection was carried out over a one day period, during this time the inspector was able to meet with people living and working at the home, was able to tour the building, observe care practices and view records requested. The inspector was given unrestricted access to all area of the home and all records requested were made available. Care Homes for Older People Page 5 of 26 The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. 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 Care Homes for Older People Page 7 of 26 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. Anyone wishing to move into The Hollies has their needs assessed and is able to spend time in the home before making a decision to move in. Intermediate care is not provided. Evidence: To ensure the home is able to meet the needs of new people, the manager sees and assesses anyone wishing to move in. Copies of assessments carried out by the manager and other professionals were seen in individual files. Staff spoken with said that people were able to visit before moving in. Some people living at the home said that they, or a relative, had visited and spent time at The Hollies before deciding to make it their home. One person said that they had originally had a respite stay to enable them to see if it was the right place for them. Care Homes for Older People Page 10 of 26 Evidence: 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans would benefit from further development to ensure that staff are aware of how to appropriately assist people to meet their healthcare needs. People living at the home are able to spend time in communal areas or their rooms and privacy is respected. Evidence: Everyone living at the home has a care plan. 4 care plans were viewed in detail, these were all very personal to the individual and gave information about peoples likes and dislikes as well as their needs. There was evidence that the care plans were being regularly reviewed. The care plans were very basic and two of those seen did not give clear guidance for staff in how to meet health care needs. For example one person had insulin dependent diabetes and there were no details about how this was administered or the amount of assistance required from staff. Another person had a poor appetite and had been prescribed food supplements. There was no care plan in place to say how food intake would be monitored or when supplements should be given. In addition Care Homes for Older People Page 12 of 26 Evidence: to the care plan daily records are kept, these contain large amounts of detail but the information is not easy to read, or find, and therefore specific needs and actions required should be detailed on the care plan. All appointments with health and social care professionals are recorded. Records show that people have access to professionals including GPs, district nursing staff, opticians and chiropodists. Risk assessments in respect of moving and handling, tissue viability and mobility outside the home were seen in individual files. The home uses a Monitored Dosage System (MDS) for medication. There is appropriate storage for medication including anything that requires refrigeration. The Medication Administration Records (MARs) were viewed, all medication is checked and signed in when it arrives at the home and is signed for when administered to an individual. This gives a clear audit trail. To further ensure the safety of the administration system it is recommended that MARs have photographs of the individual. Prior to this inspection concerns were raised with the Commission for Social care Inspection that medication was being administered by staff who had not received training in this area. On the morning of the inspection three new members of staff attended a training course on the safe administration of medication. The manager explained that all staff initially receive in house training and do not give out medication until they are competent to do so. Staff spoken with felt that they had received adequate in house training before going on to complete training with external providers. It was noted that anyone moving to the home is asked on their first day if they wish to self administer their medication. People are able to spend time in their personal rooms or in the communal areas. People spoken with said that they felt their privacy was respected by the staff. It was observed that staff were friendly and polite when talking with the people living at the home. Staff knocked on doors before entering bedrooms. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited activities and social stimulation available for people who are unable to occupy themselves. Visitors are welcome at anytime. Evidence: The majority of people asked said that they were able to get up and go to bed at whatever time they wished. One person said that they had to get up at a set time but were able to choose when they went to bed. People said that breakfast was at 8 o clock and that they were able to choose whether to have this in their rooms or in the dining room. There are some organised activities and the manager stated that this is an area they are hoping to improve. They are in the process of recruiting an activities co-ordinator to organise and lead activities for people living in the home. One person living at the home said that they are able to go to the local shops and please themselves how they spend their time. Another person said it can seem like a long day as staff are very busy. Holy communion is held on a monthly basis and a hairdresser visits the home Care Homes for Older People Page 14 of 26 Evidence: regularly. Staff said that they take people to local shops and are planning to take people to the carnival at the weekend. The care staff in the home are also responsible for all cleaning and laundry. It was noted that during the morning of the inspection there was limited social stimulation available for people who where unable to occupy themselves. Two members of staff spoken with said that they would like to be able to spend more time with the people who lived at the home. Everyone asked said that they were able to have visitors at anytime. One visitor was spoken with and they said that they were always made welcome. People were happy with the food served in the home and said that the cook was always happy to make them an alternative if they did not like what was on the menu. People are able to choose where they eat their meal. There is a written 4 week menu covering lunch on four days of the week, there is no written menu for the weekend but people are told each day what the main meal is and it is written on the notice-board. People are able to choose what they would like for breakfast and tea. Records seen showed that some people have a cooked breakfast. Care staff are responsible for preparing the evening meal which is usually sandwiches or a light hot snack. The kitchen was well stocked with good quality products including fresh fruit and vegetables. 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. The home has taken reasonable steps to minimise the risk of abuse to people living at the home. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The complaints policy is available in the service user guide, which is available in the main hall and every bedroom. No complaints have been made to the home since the last inspection. People living at the home said that they would be comfortable to talk with a member of staff if they had any worries or concerns. All staff asked were aware of the ability to take serious concerns outside the home. Some staff have completed training in the protection of vulnerable adults as part of their National Vocational Qualification (NVQ) training. Care Homes for Older People Page 16 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. The Hollies provides a comfortable environment for the people who live there. Evidence: The home is located in the small town of Castle Cary. It is within walking distance of local amenities such as post office, library and shops. All areas are fitted with a fire detection and call bell system. The environment is homely and pleasantly furnished and decorated. There is a communal lounge and 2 dining rooms on the ground floor that are accessible to people with all levels of mobility. A new communal lounge area is being created on the first floor and it is hoped that people who choose not to use the main lounge will use this new facility to socialise. To the back of the house there is a very pleasant garden, which is slightly elevated and not easily accessible to people with poor mobility. Risk assessments have been completed to enable people to safely access this area. There are bird tables in the garden and many people said that they enjoyed feeding and watching the birds. There is a laundry, which is appropriate to the needs of the people who currently live Care Homes for Older People Page 17 of 26 Evidence: at the home. All areas of the home seen were clean and fresh and hand washing facilities are available throughout the building. Care Homes for Older People Page 18 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. Staffing levels need to be reviewed to ensure that they are sufficient to meet the needs of the people living at the home. Recruitment procedures are not consistently robust and therefore may place people at risk. Evidence: The home employs 11 care staff, 6 (55 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. A further 2 members of staff are currently working towards this award and one senior carer is undertaking the level 3 award. Between 8am and 8pm there are two members of staff on duty. Overnight there is one member of staff with a senior member of staff on call. The manager works in the home during the day Monday to Friday. Their hours are usually in addition to care hours but they cover care shifts when required. On the morning of the inspection the manager, one carer and the cook were on duty. As previously stated care staff are responsible for cleaning and laundry in addition to care, meaning that there can, at times, be limited support and stimulation available for people living at the home. Four recruitment files were viewed. All contained evidence that the person had been Care Homes for Older People Page 19 of 26 Evidence: checked against the Protection Of Vulnerable Adults (POVA) register before they began work in the home. Three files showed that written references had not been received until after the person began work. There was no recorded evidence that telephone references had been received prior to the person starting work. The application form contains details of the last employer but does not ask for a full employment history. Currently the home do not use the ‘Skills for Care’ induction programme. The home has its own induction checklist, which covers a wide variety of areas. Staff spoken to were happy with the induction that they received. All said that they had been able to shadow other staff during the first week of employment and were happy with the induction that they received. No staff felt that they had ever been asked to do anything that they did not feel comfortable to do. Staff at the home undertake training in health and safety issues such as moving and handling, first aid and fire safety. Staff working in the home have not had refresher training in these areas for over a year and training courses have now been booked. Care Homes for Older People Page 20 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. The home is being effectively managed. To ensure the health and safety of people living and working at the home, all lifting equipment should be serviced on a six monthly basis and fire alarms should be tested at the frequency identified in the fire risk assessment. Evidence: The registered manager of the home is Mrs Judith Adams. She is currently working at another home owned by the same company. In her absence a manager has been appointed to manage The Hollies. The manager in post has experience of working with older people and has an NVQ in care at level 4. The manager completed an Annual Quality Assurance Assessment earlier in the year as requested by CSCI. The document was comprehensive and gave evidence of a commitment to ongoing improvement. Two senior carers support the manager. The senior carers, and manager, work Care Homes for Older People Page 21 of 26 Evidence: alongside less experienced staff to offer supervision and support. People living and working at the home described the manager as very approachable and always ready to listen to their suggestions or concerns. The manager was available throughout the inspection and demonstrated a good knowledge of the home and the people who lived there. There are some systems in place to monitor the quality of service offered including questionnaires and a suggestion book. There are regular meetings for staff to share information and opinions. The home does not act as a financial appointee or power of attorney for anyone. There is a facility for people to deposit small amounts of money for safekeeping to ensure that people have access to money when they require it. A sample of monies held was checked and found to correlate with records held. An up to date fire risk assessment is in place. A fire log is maintained, this shows that alarms and emergency lighting are tested on a monthly basis. The fire risk assessment recommends that alarms are tested on a weekly basis. This was discussed with the manager who agreed to change the frequency of tests in line with the risk assessment. Staff spoken with were aware of what to do in the event of a fire. As previously stated staff training in health and safety issues requires up dating and courses have been booked to ensure everyone has up to date training before the end of the year. The home has some equipment to assist staff and people living at the home. The stair lift was serviced in June this year, other lifting equipment such as bath hoists and portable hoists have not been serviced within the last 6 months but this has been booked for next week. Portable electrical appliances were tested in November 2007. Up to date certificates of insurance and registration are displayed in the home. Care Homes for Older People Page 22 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 23 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 1 7 12 Care plans must be further developed to ensure that there is clear guidance for staff. 28/11/2008 To ensure clear guidance for staff 2 12 16 The home must ensure that 28/11/2008 activities and social stimulation are provided for everyone living at the home. To ensure that everyone receives adequate social stimulation 3 27 18 The home must review the 19/12/2008 staffing levels in the home to ensure that they are appropriate to meet the needs of the people who live there. To ensure that there are adequate numbers of staff to meet individual needs Care Homes for Older People Page 24 of 26 4 29 19 No staff must begin work in the home until references have been received. To ensure that people living at the home are protected. 10/10/2008 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 1 2 3 9 15 18 Records should be maintained of all in-house training in the administration of medication It is recommended that the home draws up a full menu in consultation with people living at the home. All staff should receive training in the protection of vulnerable adults and familiarise themselves with the local guidelines for recognising and reporting abuse. The application form should be up dated to request a full employment history. 4 29 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 © (2008) 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!