Inspection on 07/09/09 for The Hollies

This inspection was carried out on 7th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies 02/10/08

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 26/11/2009.

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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Smith     Date: 0 7 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 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): 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 provides care and support for up to 13 older people. The home is located in the small town of Castle Cary; it is in a quiet residential road, close to local amenities including shops, cafes, the park, a small museum and the post office. There are limited parking space for visitors at the front of the property. The home is not purpose built and has accommodation arranged over two floors; there are two stair lifts, but no shaft lift. On the ground floor there are two lounge areas, a kitchen, staff room, a small office, laundry rooms, bedrooms, a bathroom, staff toilet and two dining rooms, one in the conservatory which overlooks an enclosed and sheltered garden. The remaining bedrooms are on the first floor together with a bathroom and one small dining area where one couple choose to eat their meals together. There are currently two members of care staff on duty in the morning and again in the Care Homes for Older People Page 4 of 33 Over 65 13 0 0 2 1 0 2 0 0 8 Brief description of the care home afternoon. Overnight, one member of staff works in the home with a senior member of staff on call. The current fees for this home is between 450 and 550 pounds per week. Care Homes for Older People Page 5 of 33 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 last Key Inspection of this service was completed on 02/10/08. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent approximately eight hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgements within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in October 2008. We looked at latest Annual Quality Assurance Assessment (AQAA) that was sent to us by the home; this is a self-assessment that focuses on how well outcomes are being met for people living at The Hollies. It also gave us some numerical information about the service. We also looked at the service history, which Care Homes for Older People Page 6 of 33 details all other contact with, or about, the home. We sent surveys to the people who live in the home, to staff members and health care professionals who support the home as part of this Key Inspection; 15 were completed and returned. The views of each person who wrote to us have been included in this report. We spent time speaking with people who are living in the home and we informally observed staff supporting people in communal areas of the home; we sat in on part of an activities session held in the afternoon of our visit. We gathered additional information for this report by speaking with the Manager and the members of staff who were working on the day of our visit. We looked at a number of records within the home such as individuals care records, risk assessments, finance records, medication administration, staff records, complaints and compliments and some health and safety procedures. Some information we required was not available during our visit; we asked the Manager to clarify areas such as staff training, recruitment and supervision and fire safety so that we could report on these accurately. The Manager provided further information to us on 11/09/09. We viewed all communal areas of the home, the newly completed annexe and some of the bedrooms used by the people who live here. It is important to note that this inspection was carried out during a time of significant change for The Hollies. These include three recent changes in the management of the home, the reduction in the number of people who live here (currently seven) and the building of an extension. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The Registered Person should continue to review the staffing levels in the home to ensure that they are appropriate to meet the needs of the people who live here. The Registered Person must complete the development and improvement of each persons care plan and their risk assessments. This would ensure staff have clear and accurate information relating to each persons care needs. The Registered Person must ensure every member of staff completes their training programme. This would ensure staff have the knowledge and skills to support people properly. The current Manager must start the registration process with us as soon as possible. This would ensure each person who lives in the home is provided with a safe and accountable service. The Registered Person must ensure each member of staff is supervised regularly. This would ensure staff are being given support to provide good quality care to people who live in the home. The Registered Person must ensure that regular fire drills are carried out. This would ensure people would know what to do in the event of a fire and help to keep them safe. Care Homes for Older People Page 8 of 33 The Registered Person should update our contact details in the homes complaints procedure when next this is next reviewed. This would ensure that people are provided with up to date information should they wish to complain or raise any concerns. The Registered Person should ensure the homes application form is updated to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 10 of 33 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. People are given the information they need about the home to enable them to make an informed choice about whether they wish to live here. People are confident the home can support them as their needs are thoroughly assessed before they are given the opportunity to move in. Evidence: The people living in the home we spoke with, and those who wrote to us, said they did have enough information to decide if it was the right place for them to live. To ensure the home is able to meet the needs of new people, the manager visits and assesses anyone wishing to move in; there have been no new admissions to the home since our last visit. People are encouraged to visit the home before they decide to move in; this allows Care Homes for Older People Page 11 of 33 Evidence: them to have a look around the home, to meet people who already live here and to speak with the Manager and care staff. During our last visit people said that they, or a relative, had visited and spent time at The Hollies before deciding to make it their home. Care Homes for Older People Page 12 of 33 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. Peoples health, personal and social care needs are usually met. People do not have detailed plan of care that they, and people close to them, has been involved in making. Peoples right to privacy is respected and they are supported with their medicines in a safe way. Evidence: Each person who lives in the home has a care plan; we looked at three of these in detail. Following our last visit we said that care plans were very basic and did not give enough information about health care needs to ensure that staff are able to support people appropriately. The care plans currently in use have not been significantly improved since we last visited. They contain limited information in many areas and some are clearly out of date; for example one persons plan describes them being supported by a particular health professional, although the Manager told us this professional is no longer involved in Care Homes for Older People Page 13 of 33 Evidence: this persons care. They also have their food intake monitored and take food supplements; staff record their food intake in a number of ways so these records are not clear, there is no mention of the amounts of supplements they should take or whether this varies. One persons care plan explains that they may get up during the night and wander; there are no instructions for staff on how they should offer support. In another plan the way the person communicates is described as normal and in another their communication is mother tongue. The Manager told us staff speak English with both people and they are able to make their needs know in this way; this is therefore how communication should be described in their care plans. Each person has signed their care plan; there is no evidence however that people are involved in writing their own plan or reviewing it. The Manager told us that most people who currently live at the home would be able to contribute to their own care planning. The Manager has already started to re-write each persons care plan; we were shown some examples which are currently stored on computer. The ones we saw are an improvement, however they still require greater detail in some areas, they could be set out in a clearer format and each person should be offered the opportunity to help write their own plan. The Manager agreed with our comments; we spent time with them discussing care planning during our visit, offering advice and sharing good practice, to support the improvements being made. Risks to people are identified using assessments; the assessments we looked at covered areas such as how to move and handle people safely and how to keep a person safe while they are out of the home. Another we looked at described the risks involved with one person using the SRC Unit garden; it was not clear what this is and the Manager did not know. We surmised this assessment document may have been used in another home and the template then used here without changing the wording. The Manager is currently reviewing each persons risk assessments and has introduced a much clearer template. People who live in the home we spoke with, and those who wrote to us, said they do receive the care and support they need and staff are generally available when they need them. Staff listen to them and act on what they say; each person felt their privacy is respected. We saw that people were able to choose to spend time in their own rooms or in Care Homes for Older People Page 14 of 33 Evidence: communal areas; staff were friendly and polite, knew people well and always addressed them using their names. One person said we are well looked after, there is always some one to help and another person told us its very good here, they go over the top to help you. The health care professionals who wrote to us said peoples health care needs are only usually or sometimes monitored and met by the home. One professional said they must be more attentive to residents and take more of an interest in each individual and another said I have not recently had contact with The Hollies but I have not been impressed with previous interactions. The care has not seemed very consistent. 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. The home uses a monitored dosage system of medication administration and this is well managed. All medicines are stored securely in one room of the home; a medicine fridge is available and the temperature is checked each day. We looked at the Medication Administration Records (MARs); 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, photographs of each person have now been added to these records. Staff who dispense medication should be trained to do so; the training records sent to us by the Manager shows some staff have had training however six staff require training or a refresher. The Manager also told us they were arranging for a pharmacist to visit the home to provide additional training and information for the staff team. Care Homes for Older People Page 15 of 33 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. Each person is treated as an individual and they make choices about their lives. People have limited opportunities to follow personal interests or take part in activities: they are supported to keep in touch with family and friends. People have healthy meals. Evidence: The people living at the home we spoke with, and those who wrote to us, said they are generally happy living at The Hollies. They are able to choose how to spend their time and staff respect their wishes. Holy communion is held on a monthly basis and a hairdresser visits the home regularly. The Manager has restarted an activities programme for the people who live in the home; there are now activities taking place on three afternoons a week, which staff organise, and there has been a recent day trip to Weymouth. We sat in on part of a Memory Lane bingo session taking place on the afternoon of our visit; the two people who chose to take part appeared to enjoy it and the staff member running this session was confident and organised. Care Homes for Older People Page 16 of 33 Evidence: It is clear from speaking with people who live in the home, staff members and the Manager, and from looking at daily records and the homes AQAA, that organised activities or outings have not taken place in the home for some time. One person who lives in the home said not very much happens here, sometimes we go into town but most of the time we are at home; another person told us nothing much has been going on for so long it is difficult to get people interested in things. When we last visited, the home were in the process of recruiting an activities coordinator to organise and lead activities; this post has not been filled so the Manager and care staff remain responsible for this. One member of staff said there have never been any activities since I have been working here; it has only changed since the new Manager arrived and another staff member told us since the home had a new Manager the activities with the residents has improved. We are encouraged to spend time with residents now. The Manager told us and also wrote in the homes AQAA they wish to develop the activities offered much further and would like to use the services of an alternative therapist to provide massage and aromatherapy, possibly introduce pets into the home to enhance the residents wellbeing and re-assess the financial budget to employ an activity coordinator. The care staff remain responsible for all of the cleaning and laundry. The staff we spoke with, and those who wrote to us, said they wish to spend more time with the people who live in the home rather than carrying out these tasks. One staff member said we would like to do a lot more for the residents such as one to one and another said they felt the care staff should spend more time caring for those who we are employed to care for. At present only seven people live at the home; there are two care staff on duty in the morning and again in the afternoon. Staffing levels and the employment of extra staff such as domestics will be reviewed as the number of people who live at the home increases. We did note that as the numbers have fallen, staffing has not been reduced. The health care professionals who wrote to us, said the home sometimes supported each person to live the life they choose. One professional said they need to provide a much more stimulating environment for residents. Each person is supported to maintain contact with their families and friends. Visitors Care Homes for Older People Page 17 of 33 Evidence: to the home are welcome and relatives are kept up to date about important issues. The Manager told us they wish for more family involvement and they hope to be able to invite family members to the house meetings once these have started. The people we spoke with said they were happy with the meals provided in the home. Two cooks are employed; one works in the home four days per week and the other three. One cook told us they do not see their colleague as they always work on different days; they communicate by leaving each other messages or notes if necessary. There is a four weekly menu, now including weekends, which shows that a wide range of nutritious meals are freshly cooked in the home; the main meal of the day is written on a notice board in one of the lounges. One person told us they do good meals here. The main meal is at lunchtime; only one main meal is noted on the menu although people said the cook was always happy to make them an alternative if they did not like what was on the menu. We spoke with the cook who confirmed this, although people need to let them know in the morning so they have enough time to prepare an alternative. This may not always work in practice as we asked two people what they were having for lunch and neither knew. One person said I dont know what we are having and another said I dont know what is for lunch, nobody has told me. We spoke with the Manager who said people can look at the notice board to see what is for lunch; they may also introduce a written weekly menu which can be placed on tables in the dining room as this may help to remind people and encourage them to discuss their ideas for meals they would like. The Manager would also like to improve communication and team work between the two cooks and a meeting with them has now been arranged. Care Homes for Older People Page 18 of 33 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. If people have concerns with their care, they or people close to them know how to complain. Any concern would be looked into and action taken to put things right. People are safeguarded from abuse and neglect and action would be taken to follow up any allegations. Evidence: The home has policies and procedures on how to recognise and report abuse, making a complaint and whistle blowing, which staff can use in confidence to raise any issue or concern they have regarding poor practice. Our contact details should be updated when these documents are next reviewed as they are out of date. The people who live in the home we spoke with, and those who wrote to us, said they know they are able to complain if they are unhappy about any aspect of the home. The staff we spoke with, and those who wrote to us, know what to do if an individual, family member or a friend is concerned about any aspect of the care and support they provide. There is a complaints, concerns and suggestions book kept in the hall; there have been no complaints made to the home since our last visit. One person has complimented the home on their food. Care Homes for Older People Page 19 of 33 Evidence: Staff are subject to enhanced Criminal Record Bureau disclosures (known as CRBs), before they start work in the home. Some staff have completed training in how to recognise and report abuse (currently known as safeguarding vulnerable adults) as part of their National Vocational Qualification (NVQ); no other training has been provided to staff in this area. The home maintains a record of each accident, incident or other significant event which occurs in the home. We are notified of significant events together with any other concerns regarding individuals who live in the home. Care Homes for Older People Page 20 of 33 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 homely, clean and comfortable environment for people to live in. Evidence: The Hollies is located in the small town of Castle Cary; it is in a quiet residential road, close to local amenities including shops, cafes, the park, a small museum and the post office. The home has limited parking space for visitors at the front of the property. The home is not purpose built and has accommodation arranged over two floors; there are two stair lifts, but no shaft lift. On the ground floor there are two lounge areas, a kitchen, staff room, a small office, laundry rooms, some bedrooms, a bathroom, staff toilet and two dining rooms, one in the conservatory which overlooks an enclosed and sheltered garden. The remaining bedrooms are on the first floor together with a bathroom and one small dining area where one couple choose to eat their meals together. The people who live in the home we spoke with, and those who wrote to us said the home is generally kept fresh and clean; they are encouraged to bring in personal items, pictures and photographs to help make their rooms personal to them and more homely. Care Homes for Older People Page 21 of 33 Evidence: We did view all of the communal areas of the home; these were generally clean and tidy. The environment is homely and pleasantly furnished and decorated. We also viewed the bedrooms used by people who live at the home; these were homely and suitably furnished. One bedroom had a strong malodour; this was discussed with the Manager who told us they would clean the carpet in this room, and if this does not resolve this issue, the carpet will be replaced. An extension at the rear of the home has recently been completed; this has added a further four ground floor bedrooms. Each has their own toilet and wash hand basin and a door which opens out onto the garden. These rooms are not in use at present; an application to have these rooms included in the homes registration is in the process of being made to us. At the rear of the home there is a garden, which is slightly elevated and not easily accessible to people with poor mobility. There are bird tables in the garden and many people said that they enjoyed feeding and watching the birds; one person fed the birds whilst we were there. The garden is not currently well tended and is a little overgrown; the maintenance of the garden has been affected by the building work which has just been completed. They employ a local gardener and the AQAA states they plan to landscape the garden and give each person who lives in the home the opportunity to participate in horticultural activities within the next 12 months. Staff have access to personal protective clothing such as gloves and aprons and there are hand wash facilities available around the home; we did note that none of the staff who work in the home have had infection control training; this is being addressed. Care Homes for Older People Page 22 of 33 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. People have appropriate support; the staff who support them must be provided with regular training and support to ensure peoples needs continue to be met. Checks are carried out on new staff to ensure they are suitable to work in the home. Evidence: The home currently employs 13 members of staff; there are 11 members of the team who are classed as permanent care staff and two members of Bank Staff who cover when permanent staff are not working, due to sickness or when they are holiday. Twelve staff members have attained a National Vocational Qualification (NVQ); this is commended. Between 8am and 8pm there are two members of staff on duty; overnight there is one member of staff who lone works, with a senior member of staff on call. On the day we visited there were two members of care staff on duty together with the cook; the Manager was also working in the office and fully supported the inspection process. The staffing levels appear to be sufficient to meet the needs of the people who currently live at the home; as stated earlier in this report, staffing levels have remained unchanged even though the number of people who reside here has reduced. The Manager told us that staffing levels would be kept under review to ensure that Care Homes for Older People Page 23 of 33 Evidence: peoples needs would continue to be met when new people choose to move into the home. The people who live in the home we spoke with, and those who wrote to us, said they are treated well by staff; they are usually available when they need them and they listen to them and act on what they say. Those staff we observed supporting and interacting with people who live in the home had a good understanding of peoples needs and how to communicate effectively with them. Staff had a good rapport with individuals; there was a relaxed, homely atmosphere. One person who lives in the home said the staff are very friendly; I cant fault any of them. The staff we spoke with, and those who wrote to us, said they are generally happy working at The Hollies. They said there are usually enough staff to meet peoples needs and the way information is shared, between care staff and the manager, works reasonably well. There are some issues within the staff team; it is clear that being without a consistent Manager has been very difficult, although staff do remain positive they feel some changes would benefit the home. When asked what the home does well comments include: its a small friendly home with good staff and we support each other well. When asked what could be improved there were various comments including: have regular meetings with the owner, listen to staffs cares and concerns, policies need updating this has not been done, we need transport to be able to take people out to socialise and we need a cleaner and an owner that would listen to us. It is noticeable that staff feel things are improving since the new Manager started working in the home; there are many positive comments about them in the next section of this report. The Manager told us they are aware of the concerns of the staff team and they try to resolve issues wherever possible; an issue regarding restructuring weekend pay is currently being handled in an effective way allowing staff to share their feelings about these changes. Staff are provided with training courses to enable them to provide care and support to the people who live in the home. The records provided by the Manager show that staff require either training or a refresher in the following areas: first aid, infection control, food hygiene, health and safety and the safe handling of medication. Most staff have had fire safety and manual handling training. The health care professionals who wrote to us, said the staff only usually or sometimes have the right skills and experience to support people. Care Homes for Older People Page 24 of 33 Evidence: The home now has a safer recruitment process. The personnel records of staff who have recently joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, the questions they were asked at their interview and their answers, their terms and conditions of their employment, two satisfactory references and an Enhanced Criminal Record Bureau Disclosure (CRB). (The application form contains details of the last two employers, but still does not ask for a full employment history). The home has its own induction process to help new staff when they start work; this covers a wide variety of topics. Staff spoken with were happy with the induction that they received. Care Homes for Older People Page 25 of 33 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. People have growing confidence in The Hollies as the management of the home is improving. Staff members must be given regular supervision to enable them to meet peoples needs. People control their own money and choose how they spend it; the environment is generally safe for people and staff because health and safety practices are carried out. Evidence: There has been some changes in the management of the home since our last visit. The Registered Manager is Mrs Judith Adams, although she no longer manages the home. There have been two temporary managers, the most recent leaving in April 2009; the new Manager, Ms Lynn Day, has worked in the home since July 2009. She is currently within her three month probation period; she must start the registration process with us as soon as possible. Care Homes for Older People Page 26 of 33 Evidence: Ms Day told us she is settling in well; she has already identified many areas which need to be improved and these were discussed during our visit. Some changes she has already made include re-starting activities, organising supervision sessions and staff meetings and improving care plans and risk assessments. The manager said since I arrived I have put some things in place and I have a list of intended jobs. I meet with [one of the owners] every week; they are very supportive. Every person we spoke with, and those who wrote to us, said they found the manager very approachable and they were happy to speak with her about any issue. People said they were always listened to and that Ms Day is trying very hard to improve things and resolve any issues. The are many positive comments about Ms Day including: the home is on the up now with the new manager and theres more being put right, Im quite happy with the new manager, we now have supervision and staff meetings and since we have had a new manager things have improved. The home have a system in place to ensure a Quality Assurance review is carried out; people are given questionnaires to complete so they may comment on the quality of the care and support provided by the staff team and there is a suggestions book which people can use at any time. We were given a copy of the last annual review, carried out in 2008; this shows the people were generally happy with the care and support they received. The Manager hopes to introduce regular house meetings where the people who live in the home can come together to air their views about any subject; family members will also be invited to these meetings. Peoples records are stored securely. The Manager told us they do 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 they have access to money when they require it; each persons money is stored securely and receipts are obtained when money is spent. We checked the money held for two people; these were both correct. Staff supervision sessions have recently been re-started. The Manager told us following the inspection that staff were supervised in October 2008, although there were no records of these meetings available during our visit; no further sessions took place until the new manager provided them in July 2009. Staff we spoke with said they have had a recent supervision meeting with the new manager, but could not remember the one before that. One person said I have never had supervision before. Care Homes for Older People Page 27 of 33 Evidence: The home is reasonably maintained and there are systems in place to ensure the health and safety of people living and working at the home. The temperature of hot water is tested each day. The last AQAA confirms that appropriate safety checks are carried out on the electrical wiring in the home, portable electrical appliances, the heating system, gas appliances, the stair lifts and other lifting equipment such as bath hoists and portable hoists. We looked at the homes fire log book. This shows there is a current Fire Risk Assessment in place; regular checks are carried out on the fire alarm system and other fire fighting equipment. We did note that the most recent fire drill recorded in the log book was on 06/08/09; there were no other records available on the day we visited so there is no evidence that regular drills are being carried out. Staff are also provided with fire safety training; only one member of staff still needs to complete this course. Care Homes for Older People Page 28 of 33 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 29 of 33 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 15 The Registered Person must complete the development and improvement of each persons care plan and their risk assessments. This would ensure staff have clear and accurate information relating to each persons care needs. 07/12/2009 2 12 16 The Registered Person must ensure the activities programme is developed and improved. This would ensure each person receives adequate social stimulation. 07/12/2009 3 30 18 The Registered Person must 07/01/2010 ensure every member of staff completes their training programme. This would ensure staff have the knowledge and skills to support people properly. Care Homes for Older People Page 30 of 33 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 4 31 9 The current Manager must 07/12/2009 start the registration process with us as soon as possible. This would ensure each person who lives in the home is provided with a safe and accountable service. 5 36 18 The Registered Person must 07/11/2009 ensure each member of staff is supervised regularly. This would ensure staff are being given support to provide good quality care to people who live in the home. 6 38 10 The Registered Person must 07/11/2009 ensure that regular fire drills are carried out. This would ensure people would know what to do in the event of a fire and help to keep them safe. 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 16 The Registered Person should update our contact details in the homes complaints procedure when next this is next reviewed. This would ensure that people are provided with up to date information should they wish to complain or raise any concerns. The Registered Person should continue to review the staffing levels in the home to ensure that they are 2 27 Care Homes for Older People Page 31 of 33 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 appropriate to meet the needs of the people who live here. 3 29 The Registered Person should ensure the homes application form is updated to request a full employment history of staff who are applying to work in the home. This may help to make the recruitment process more thorough and promote the safety of the people who live in the home. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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