Inspection on 21/12/05 for The Hollies

This inspection was carried out on 21st December 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

The Hollies 08/07/08

The Hollies 28/11/06

The Hollies 23/02/06

The Hollies 17/02/05

The Hollies 14/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Hollies 81 High Street Yatton North Somerset BS49 4DW Lead Inspector The Hollies Paul Grey Unannounced Inspection 1.00 21 December 2005 st The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Hollies Address 81 High Street Yatton North Somerset BS49 4DW 01934 876773 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Brandon Trust Ms Janet Wheeler Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 5 Patients with Learning Difficulties excluding those detained under the Mental Health Act 1983 Staffing Notice dated 10/03/2000 applies Manager must be a RN on parts 5 or 14 of the NMC register Date of last inspection 17th February 2005 Brief Description of the Service: The Hollies is a small home for service users with learning disabilities based just off the High Street in Yatton. The home offers homely accommodation within easy access to the village centre and local bus routes. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Hollies is an established service offering long term care to service users whilst encouraging independent living. At the time of inspection only 2 service users were present, the rest of the service user group were out on their day care activities. Of the 2 service users, only one was able to give the inspector an interview to discuss life at the Hollies. The 2nd service user was unable to talk with the inspector at any length. As a consequence the inspector was able to use very little service user based information compiling this report. The inspector will attempt to redress this during the next announced inspection. The manager was present during inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 The Hollies has a statement of purpose, which can provide potential service users, or their representatives with sufficient information to make an informed choice about where to live. The staff team assesses service users aspirations and needs. Potential service users know that the home will meet their needs and aspirations. EVIDENCE: The statement of purpose reflects the current Philosophy of care and overall approach of the home. The home has not admitted a new service user for some time. The home currently has one bed available. The manager informed the inspector that a potential new service user would be invited to come for a meal and to meet the service user group. The home offers a probationary period for service users. This allows the home to ensure they can meet the service users needs and allows the service user an informed insight into life in the home. The inspector noted a range of in-depth assessments for two service user files sampled. Service user assessments were in the form of the Brandon trusts Person centered planning documents. The service users needs and preferences were reflected in the service users care plans. The inspector noted The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 8 that these were written from the service users perspective and with positive regard to the service users needs and aspirations. This was good practice. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The home assesses service users changing needs. Staff at the home support service users in making decisions about their lives. Staff support service users to take risks as part all independent living. EVIDENCE: The inspector noted evidence from the two care files sampled that regular assessment occurs. The inspector noted from talking with the manager, and documentary evidence from care plans, that service user assessments are used to generate appropriate care plans. The inspector noted care plans outline any potential restrictions on service users choice. The inspector noted two occasions where the use of a quiet room was documented. This was to allow service users opportunity to take time out if distressed or angry. The inspector observed that service users all have a key worker. The inspector noted no unreasonable restrictions on service users freedoms or human rights. The inspector noted that any potential restriction was care planned risk assessed and in the best interests of the service user. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 10 The inspector noted extensive and well documented risk assessments. The inspector noted that the staff have attempted to identify both individual and immunity risk. The inspector noted documentary evidence to demonstrate that staff at the home had taken action to reduce all reasonable risks and had drawn up appropriate strategies to manage risk. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14,15,16 The Hollies supports service users to maintain and develop a range of abilities. Staff at the home support service users with appropriate leisure activities. Service users are supported to maintain appropriate personal relationships both inside and outside of the home. The home respects service users rights in their daily lives. EVIDENCE: The inspector noted documentary and staff statement evidence regarding support for service users in developing their personal skills. The home supports service users engage in a range of educational and occupational activities both inside and outside of the home. This can manifest its self in activities at college including assertiveness training and arts or supported day care activities. The inspector noted documentary evidence of a range of day care and leisure activities supported by the home and accessed via external agencies. The service user speaking with the inspector told the inspector she enjoyed watching TV downstairs and going to college to do art. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 12 The manager informed the inspector that the staff team supported service users to maintain family relationships, via letters or phone calls. The inspector noted this is increasingly difficult for the service as parents and service users age. The inspector noted from conversation with the manager that service users are encouraged and supported with a range of small chores within the community environment. These did not appear unduly onerous and would be reviewed if the service did not wish to do them. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 The service supports its service users to meet their healthcare and emotional needs. Service users are protected by the homes policies and procedures when dealing with medication. EVIDENCE: The home registers all service users with a local GP, and offers education and support over health issues such as smoking and general health issues such as diet etc. The service user is supported by the home to access NHS facilities and to attend any subsequent appointments. The manager and staff administer service user medication based on risk assessed service users needs. The inspector noted clear and up to date records of the administration of medication; all were signed with no crossings out or omissions. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 One service user spoken with felt her views were listened to. The home protects service users from abuse. EVIDENCE: The inspector noted the home has a clear and easily understood complaints procedure. The inspector noted the home had no recent complaints documented. The manager informed the inspector that service users have been shown the complaints procedure but would generally talk with staff informally if they were unhappy. The inspector noted appropriate policies and procedures in place for the protection of service users. The home was part of the Brandon Trust and had access to a robust training schedule, which contained training on abuse and protection of vulnerable adults. The service user spoken with told the inspector she would feel able to complain if she felt unhappy at the home. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,30 The home is pleasant, comfortable and safe. The service users bedrooms are appropriate to their needs and chosen lifestyle. Service users bedrooms promote their independence. The premises are clean and hygienic throughout. EVIDENCE: The inspector noted the home was adequately maintained, comfortable and warm. The building was in keeping with the local community and had a domestic style and ambiance. Service users bedrooms were of sufficient size and layout to meet the National Minimum Standards. The home has no double bedrooms. Service users bedrooms contained appropriate furniture, fixtures and fittings and were personalised to reflect the personal taste of the service user. Service users can bring or choose their own furniture subject to fire and health and safety considerations. All rooms were lockable. The home was clean and hygienic throughout. The inspector noted the home had appropriate policies and procedure for the prevention of cross infection and appropriate laundry facilities. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X The inspector did not assess these standards on this inspection. These will be addressed on the announced inspection. EVIDENCE: The inspector did not assess these standards on this inspection. These will be addressed on the announced inspection. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,40,41, Service users benefit from an experienced manager. The homes policies and procedures help safeguard service users rights and best interests. Records required for the protection of the service users are maintained at the home. EVIDENCE: The manager is a qualified nurse with in excess of the required 2 years management experience and appropriate qualifications. The inspector noted documentary evidence indicating that the written objectives of the home are being met. The inspector was unable to assess this from a service user perspective during this inspection. The inspector sampled 3 of the homes policies. All were present, up to date and in good order. The manager informed the inspector that staff were consulted about new policies and their input was sought if they were local policies. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 18 The home maintained clear records of all aspects of care and service users lives at the home. If they wish, service users can have access to their records. Confidential records are secured in a locked office. The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 X X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Hollies Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 x x 3 3 x x DS0000020231.V272279.R01.S.doc Version 5.0 Page 20 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. 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. Refer to Standard Good Practice Recommendations The Hollies DS0000020231.V272279.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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