Inspection on 28/11/06 for The Hollies

This inspection was carried out on 28th November 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies 08/07/08

The Hollies 23/02/06

The Hollies 21/12/05

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 Nicola Hill Unannounced Inspection 28th November 2006 11:00 The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 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.V319474.R01.S.doc Version 5.2 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.V319474.R01.S.doc Version 5.2 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) www.brandontrust.org The Brandon Trust Ms Janet Wheeler Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 May accommodate one named service user who is over 65 years of age. Date of last inspection Brief Description of the Service: The Hollies is owned by the Brandon Trust and is registered to provide nursing care for up to five people with learning difficulties excluding those detained under the Mental Health Act. The fee level for the home is £1450 per week. All residents have complex needs and exhibit challenging behaviour. The home is set in attractive gardens, close to shops and other local amenities. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook the site visit for the unannounced key inspection for the Hollies with the assistant manager on duty. The inspection consisted of gathering documentary evidence from the files and records, discussing the service with the staff who were on duty, and observing the one resident who was at home at the time. Further evidence has been obtained from service questionnaires completed by residents, it was noted that none of the residents requested to speak to the inspector. The home has failed to meet all the requirements made at the last inspection; the environmental issues raised are dependent on the Trust investing in property and this is not directly under the control of the manager. The service level rating for the home reflects the lack of response to requirements, although the care and support of residents is unchanged. The home has been assessed as providing a good level of service. What the service does well: What has improved since the last inspection? The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 6 The access to the electricity cupboard in the back garden has been secured and does not present a danger to the residents. The home is undergoing redecoration to repair areas identified in the last report that were damaged or damp. 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 summary of this inspection report can be made available in other formats on request. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 7 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.V319474.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The preadmission procedures ensures a smooth transition for prospective service users. EVIDENCE: The home currently has one vacancy, however no one has been identified as a prospective resident. There have been no admissions to the home for several years. The systems in place support the preadmission assessment and give potential residents the opportunity to test-drive the service prior to moving in. The Brandon Trust has included this home in their overall strategy to move toward independent living with residents in provided supported living accommodation. There are three female and one male resident at the home, who have lived together for several years. All of the residents have their individual needs identified through person centred planning, and care plans support any personal religious beliefs. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a sustained record of delivering a quality service based on the belief that residents should be able to take control of their lives. EVIDENCE: The inspector reviewed the documentation with the assistant manager. All of the residents have a full assessment of need, and from this the service user plan has been drawn. It was evident that the care file for each individual resident had a personal plan, daily records, health care records, referrals for specialist services i.e. work placement referral, daytime activities. The service plans from the social services department were reviewed on a regular basis. As well as this the home has a service user plan which has identifies any support needed for residents to be as independent as possible. The daily records were very informative and used in conjunction with the communication books provided a good source of information about the day-to-day running of the home. Staff confirmed that using daily record and the communication book enabled them to update themselves about events in the home. The records The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 10 also reflected the choices offered to residents and the inspector of observed staff taking time with the resident who was at home to explain choices available and to support decision-making about a meal i.e. what to have and when to have it. For some of the residents who are more vulnerable due to their disability, the manager has carried out risk assessments and jointly agreed with residents a safe plan of action. The inspector was able to link the action in the risk assessments with the daily records. The home, through their documentation, were able to demonstrate that risk assessments were linked closely to care plans and regularly evaluated for success. This was discussed in depth with staff that stated that there was a need for all staff to follow agreed action plans so that residents understood the boundaries. All the residents at The Hollies, able to self advocate to some extent, and speak up and express their wishes. The resident at home during a visit engaged in conversation with the inspector, but was unable to express clear views about the home. The residents are very active in the day-to-day running of the home, there are involved in the majority of decisions about how the home is developed, and to discuss things of importance to them. This was confirmed by the responses in the questionnaires received from service users. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The promotion of the individual is central to the homes’ aims and objectives, and ensures that residents have an ordinary but meaningful life in the home and are part of the local community. EVIDENCE: During the inspection there was one resident home, the others were attending the local day centres. The inspector was able to see evidence of person centred planning, which identified preferred lifestyles. The resident who was at home had been offered choices of activity for that day; the choices could be linked to their plan. The inspector was also able to see that for one resident who enjoys drinking tea, concerns had been expressed about the excessive intake of caffeine. To resolve this problem, the home purchase decaffeinated tea, and therefore support the resident s preferences, in a way that also supports good health and well-being. The day-to-day running of the home is dependent on the needs of the residents. The routines of the home are very The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 12 flexible and residents can make major choices in their life. The home demonstrated this by ensuring that the staffing rota supports individual resident activity, for example, key workers are on duty when residents have their at home day. The staff team also make sure that the day-to-day life of the resident is supported in such a way so as to maximise their contact with the community, for example, some of the service users like to attend regular events such as football matches, residents are also supported maintain contact with their families either by relatives visiting the home, or by staff escorting residents to relatives homes. The day of the inspection was also shopping day and the staff purchase food for the planned menu, which reflects the likes and dislikes of the residents. The meal times are relaxed, and all the residents eat together in the kitchen of the home, which has a large dining table. For those who have issues with diet and weight loss, this is supported by the staff team. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have flexible personal support which is responsive to change in needs and service users particular preferences. EVIDENCE: The underpinning ethos at The Hollies is that support is offered to enable residents to meet their optimum personal appearance and promote confidence and self-esteem. The majority of the residents at The Hollies need minimal support with their personal care. For those who do require support, there is male and female staff available. The inspector was able to see held on the case files records of any healthcare interventions, also a yearly plan for health care intervention e.g. optician. Some of the residents require more intervention than others, because of prevailing medical conditions. The manager is pro-active in seeking any support or training needed in order to support the resident more fully The assistant manager was able to demonstrate the efficiency of the medication procedures in place at the home. There was ample information available for members of staff who have responsibilities to administer The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 14 medication about the type of medication prescribed, its purpose, and any potential side effects. Use of “when required” medication was examined and found only to be used minimally. The medication records appeared to be up-todate and accurate, and the inspector was able to see that all medication was stored effectively and safely. The home primarily uses a unit dosage system for those residents on regular medication; there was evidence of regular reviews of medication taking place with the GP or the consultant psychiatrist. The residents of the home have lived together several years, and as they are getting older are developing illnesses associated with old age. The manager has ensured that care plans reflect this, and that staff have training to support the change in need. This is evidenced on the care documentation and the staff training files. The inspector observed during the visit that the additional care needs which had arisen were incorporated as part of the day-to-day routine in the home. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Trust has a very clear complaints procedure, and has access to independent advocates to support residents. The adult protection procedures in place at the home ensure that referrals are managed effectively and with sensitivity. EVIDENCE: The trust has an accessible complaints procedure which is given to all residents with an explanation of how it can be used. The residents confirmed this by their responses to the service questionnaire. At the time the visit no complaints had been recorded. The staff at the home receive training in adult abuse awareness as part of their induction, this ensures that all the staff understand what constitutes abuse and how to report incidents of abuse. The recruitment procedures at the home protect residents from potential abuse by requiring references to be provided and undertaking enhanced CRB checks. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at The Hollies is appropriate for its residents. The furniture and fittings at the home are domestic in variety, and the overall impression is of a large family house. However, requirements made at the last inspection relating to the environmental standards at the home have not been met. EVIDENCE: The Inspector looked a round the building with the assistant manager to ensure that the requirements made at the last inspection had been met. It was noted that because the age of the building, damp continued to be a problem. The trust had undertaken some repair and redecoration but mould was evident through the plasterwork in the empty bedroom. The manager confirmed that the requirement made for Brandon trust to have a comprehensive professional assessment of damp on the premises had not been undertaken. The empty room at the home cannot be used until the Trust have The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 17 demonstrated that reasonable remedial measures have been taken to resolve the problem, and that an overall plan of action for treating the damp problem at the property has been produced and implemented. The external electricity cupboard has now been padlocked shut and is safe, although the rotten wooden doors had not been replaced. The Trust has failed to provide a radiator cover for the small ground floor lounge, which is often used as a “chill out” area. This was a requirement at the last inspection. The residents are encouraged to see The Hollies as their own home and are consulted in matters such as redecoration; one resident’s response in the service questionnaire was that they liked living there. The home layout is such that it provides small group living where residents, all of the residents have single rooms, which are furnished to their own personal taste. There are communal areas on the ground floor of the home and a garden for the residents to use. The residents are also supported to use the laundry facilities at the home, which are easily accessed on the ground floor. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recruitment process is clearly defined and meets the required standards. Regular supervision and training support the staff working at the home. EVIDENCE: The staff rota indicated that the home provide 24-hour nursing care support, and have a minimum of three staff on duty during the daytime, and two at night. The weekend staffing for the home is flexible, and may be reduced if residents go home. The staffing levels reflect the needs of the residents and rotas are flexible to fit around the lifestyles of individuals, for example there is an additional allocation of workers where there is an activity outside the home e.g. swimming. Currently there is one vacancy at the home for an assistant manager. There is minimal use of any agency staff, and currently the same bank assistant manager is being used to cover the vacant hours at the home. The home has recruited new members of staff since the last inspection. The inspector was able to confirm the recruitment process and induction training with the new staff. The inspector also discussed LADF qualifications with the new members of staff, who confirmed they were on the course. Some staff felt The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 19 that more support and guidance with the paperwork for the qualification would be beneficial. Staff meetings are held regularly at the home and the manager has daily contact with the majority of the team. The staff stated that they felt confident to raise issues of concern at the staff meeting or directly with the manager. The inspector was able to confirm that recorded supervision had occurred with all staff. Training for the staff group had been arranged for statutory training updates, and fire training. The staff training records were not up-to-date, however the majority of staff have an NVQ in care, or equivalent qualification. The inspector discussed with the staff team the training they receive specific to service user needs, they were able to confirm that for new techniques or equipment, training was always provided. The staff also confirmed that additional training to meet specific service users needs was also available. E.g. dementia care. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager works to improve the services and quality of life for the residents at the home. EVIDENCE: The manager has the required qualifications and experience to run the home, and the home appears to them smoothly providing a good service to its residents. She has worked at the home front number of years and has developed good relations with residents and their families. The manager is very person centered in her approach and support staff to have a resident focused attitude. The policies at the home undergo regular review by the trust, and policies and procedures are changed to meet current legislation or good practice guidance. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 21 The quality assurance systems in place at the home are: • Regulation 26 visits, which include a rolling, programme which audits all the systems in the home. • Team meetings/house meetings • Health and safety monthly audit of the premises • Quality assurance standards set by the organisation and assessed internally. • Business planning and yearly goal setting for the home and staff team. The evidence of the degree of service user involvement in these processes is unclear. The implementation of health and safety at the home is good with regular monitoring of systems to ensure that they are not a hazard to either staff or residents. The main environmental hazard for the home is the damp in the structure of the building. North Somerset Environmental Health visited the home in October 2005; they recommended that a record of cooked food temperatures be maintained. There were no outstanding jobs listed on the maintenance report file. No serious defects or areas for immediate action were identified. The fire safety risk assessment was available to the inspector as were the records indicating the checks on the fire safety system. There were a number of accidents/incidents at the home including falls, medication error and incidents of challenging behaviour. Serious accidents/ incidents and any use of restraint are reported to the Commission. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA24 Regulation 23 (2) (b) Requirement Timescale for action 31/03/07 2 YA24 23 (2) (b) Fitness of premises. The registered person shall having regard to the number and needs of the service users shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair internally and externally. The Inspector requires the mould and damp be addressed in the currently vacant room. The Inspector requires this is addressed prior to the room being used. Fitness of premises. 31/03/07 The registered person shall having regard to the number and needs of the service users shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair internally and externally. The Inspector requires the Brandon trust have a comprehensive professional assessment of damp on the premises. A copy of this report along with Brandon trusts plan DS0000020231.V319474.R01.S.doc Version 5.2 The Hollies Page 24 of action must be forwarded to the commission by the date shown. 3 YA24 13 (4) (a) 23 (2)(b) Further requirements as to health and welfare. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The Inspector requires a radiator cover be installed in the small communal lounge. 31/03/07 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 YA41 Good Practice Recommendations The manager should ensure that training records are kept up-to-date and reflect the skills of the staff team. The Hollies DS0000020231.V319474.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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