Inspection on 08/07/08 for The Hollies

This inspection was carried out on 8th July 2008.

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

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies 28/11/06

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 28/09/2008.

CARE HOME ADULTS 18-65 The Hollies 81 High Street Yatton North Somerset BS49 4DW Lead Inspector Paula Cordell Unannounced Inspection 8th July 2008 10:00 The Hollies DS0000020231.V364988.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.V364988.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.V364988.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) janet.wheeler@brandontrust.org 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.V364988.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. 28th November 2006 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. Mrs Wheeler is the registered manager. The individuals have complex needs and may challenge the service. The aim of the home is to support the individuals to live in a homely environment and to participate in every day activities of their choice. The home is set in attractive gardens, close to shops and other local amenities. There are five single bedrooms. The home has transport to enable the individuals to access places further a field. The fee level for the home is £1450 per week at the time of publishing this report. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of the key inspection process. The last full (key) inspection was conducted in November 2006. The purpose of this visit was to review progress to the requirements and recommendations of the random visit in June 2007 and to monitor the quality of the care provided to the individuals living at The Hollies. In addition the Commission for Social Care Inspection conducted an annual review of the service, which highlighted concerns relating to staff training and the staffing numbers. The findings are contained in this report. There have been no complaints relating to the service but the home has made a referral in relation to safeguarding as a result of a serious injury sustained to one of the people living in the home as a result of an aggressive outburst of another. The home has worked closely with other professionals to address this concern. The visit consisted of gathering documentary evidence from care files and records, discussing the service with the staff who were on duty, and observing and chatting to the individuals living in the home. Further evidence was obtained from surveys sent to individuals receiving a service, relatives, professionals and the staff team prior to the visit. This information along with notifications in respect of incidents that effect the wellbeing of individuals living in the home and the annual quality assurance audit assisted in the planning of the visit ensuring the visit focused on the outcomes for people living in the home. The home has failed to meet one of the requirements made at the last inspection. This related to the home maintaining a record of restraint. Although the manager gave reassurances that where restraint is used this is only as a last resort and notification would be sent to the Commission for Social Care Inspection this remains unmet. No notifications have been received in relation to the use of restraint. The visit was conducted over seven hours and ended with structured feedback being delivered to the registered manager. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Individuals must have sufficient information to enable them to make a decision on whether to move to the home in the form of a statement of purpose and a contract of care. The contract must include a full breakdown of fees and who is responsible for paying them. Where individuals pay additional fees (transport costs) this must be included in the contract. Individuals must be assured that the staff are following the plans of care. One individual must be assured their safety when personal care is being delivered and would benefit from an assessment in relation to the need for grab rails in the bathroom. Individual’s finances would be better protected if there were two staff signatures and where possible they were encouraged to sign for their own expenditure. Where restraint is used this must be clearly recorded in the plan of care and a record maintained in respect of the restraint method used in accordance with the Department Of Health’s guidance ensuring the protection of the individuals living in the home. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 7 Individuals would benefit from the areas in the home being made more homely namely the hallway and the windowsill in the small sitting room. Clear documentation must be in place detailing the staffing arrangements for the home taking into consideration the needs and the numbers of people living in the home ensuring that there is adequate numbers of staff to support the people and their safety. The home must ensure that the registered nurses continue with their registration and that this is checked appropriately. 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.V364988.R01.S.doc Version 5.2 Page 8 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.V364988.R01.S.doc Version 5.2 Page 9 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): 1,2,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home does not fully describe the service provided at The Hollies. Individual’s contracts lacked details about the breakdown of fees and additional costs, which does not ensure an open and transparent service where individuals are supported to make a full and informed decision whether to move to The Hollies. EVIDENCE: There is a statement of purpose and a service user guide in place. An opportunity was taken to review the statement of purpose. The manager stated that this is work in progress and is presently being expanded to reflect more clearly what is being offered at The Hollies. Areas that needed expansion included the staffing making it clear that a registered nurse would be on duty at all times, and the staffing numbers in respect of the occupancy of the home and the range of needs of the people that the home presently and potentially could support. This is vital as the home has two vacancies and this would make it clearer to people who would like to move to the home, their relatives and purchasers. The statement of purpose must reflect the present service, which presently is a care home with nursing. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 10 The manager said that the organisation was planning to submit an application to vary the registration to remove nursing with the intention that the home would provide personal care only. This was discussed during the inspection in June 2007. However, no application to remove nursing from the certificate has been submitted. It was evident that the home has liaised with relatives and social workers as evidenced in the recent social services review conducted for the individuals living in the home about the proposed changes to move to a home that provides personal care only. The social worker has not foreseen any concerns in respect of the changes to the services for the three individuals and feels that the Local Community Learning Disability Team through the Primary Care Trust could meet this. However, one relative was concerned that the lack of clinical expertise of the staff may be have an effect on their relatives wellbeing in light that this has been the most stable placement the person has had. Relative comments in the completed surveys prior to the visit were positive about the care provided. Comments included “I do not want X to move, the home has provided a stable environment and we have seen a reduction in their anxieties. Another relative in the feedback echoed this during the recent review conducted by the social worker. Feedback from the social worker was that for two of the individuals the placement was appropriate, however one person may benefit from a service specifically designed for people with autistic spectrum disorder. Training will be discussed later in this report in respect of meeting the needs of the people living at The Hollies. The home currently has two vacancies, however no one has been identified to move to the home. There have been no admissions to the home for several years. There are systems in place to enable a full assessment to be completed prior to agreeing a place with a potential person ensuring that individuals have an opportunity to test-drive the service prior to moving in. Contracts were viewed for two of the individuals, one person’s contract was missing from their care file. The contracts were not in an accessible format and did not give a breakdown of the fees or include any additional fees charged (for example the transport costs). The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. There are some gaps and some inconsistency in how staff follow the plans of care, which could put individuals and staff at risk. There is a good level of involvement for the people living in the home. It is evident that the service strives to provide an individualised package of care, but could be holding on to more traditional forms of care planning, which could be hindering practice. EVIDENCE: Three care plans were looked at as a means of determining the processes the home goes through to support the individuals living at the Hollies. The Home uses Essential Lifestyle Planning in supporting people with the care planning process. This person centred approach demonstrates that individuals are supported in identifying what their needs are, ensuring their care is ‘individual’ and based on their active involvement and participation. The manager stated that further work is being completed on the plans of care to The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 12 make them more accessible to the individuals living in the home. Consideration should be taken to ensure that the more traditional care planning processes that presently guide staff link with the person centred plan that has been developed with the individual. It was noted that the person centred plan was to the back of the care file and not as accessible as the plans drawn up by the staff. A member of staff stated that they are in the process of organising a review for an individual later in the year and will be using an external person centred facilitator to assist with this process. It is evident that the home is moving in a positive direction. From reading the information and talking to staff it was evident that each person’s plan of care was tailored to the person. Information was being reviewed on a monthly basis by the staff with formal reviews with individuals on a six monthly basis. Although it was evident that individuals were consulted on a continual basis on what they wanted or needed. The local placing authority was conducting annual reviews with the individual and the care staff and where relevant relatives. From reading the reviews two areas were not clearly documented in the home’s care planning processes. One area related to bathing this had not been risk assessed in respect of one person. It was evident from conversations that the person was not being assisted in getting out of the bath consistently and the actions that staff were doing could put themselves and the individual at risk. The home must document safe handling procedures and seek advice from professionals on grab rails in the bathroom. The other related to ensuring that a person went on regular trips to places further a field. Whilst it was evident from conversations with staff and the individual that this was happening there was limited documentation in place to guide staff on the frequency and the purpose of the outings. Other concerns relating to consistency of staff were identified during the visit. When asked if people could access the kitchen and help themselves, a member of staff responded of course. There was no acknowledgement of a healthy plan for one individual and when this was mentioned the staff said that the person was not overweight and could eat what they liked. This did not follow the plan of care. Another example related to staffing arrangements for one individual who from the risk assessment and care plan it was clear that they needed two staff when going on trips further a field. However, three staff said that they would or have done this alone. This does not demonstrate a consistent approach and could put both the individual and the staff at risk. The home has consultation processes in place in order to seek the views of the individuals. House meetings take place monthly to discuss issues, holidays, menu planning and routines of the home. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 13 There were detailed written risk assessments, which helped to demonstrate actions are taken to ensure the home is safe for individuals and staff. Risk assessments also demonstrated individuals are encouraged to live an independent and fulfilling life and take part in activities both in and away from the home. It was evident that the risk assessments in place did not restrict individuals but encouraged people to be as independent as possible. However, concerns are raised on whether staff are consistently following them. Staff said all the individuals at The Hollies are able to self-advocate to some extent, and speak up and express their wishes. It was evident that the three individuals have close family that support them and are actively involved in their care. Relatives confirmed through completed surveys that they were kept informed of changes and involved in making decisions. An opportunity was taken to speak with the three people living at the home during the visit. One person said they “liked living at The Hollies and liked their newly decorated bedroom”, one person was more interested in talking about more important issues in that they wanted to go for a hair cut and the other was content to let the other two people talk and moved to another area of the lounge. What was very positive was the staff interactions. One person was continually asking about a future event and it was evident that staff were patient and effective in reducing the persons anxieties, clearly explaining when this was taking place. The people are very active in the day-to-day running of the home, they are involved in the majority of decisions about how the home is developed, and discuss things that are importance to them. This was clearly documented in the care reviews, house meetings and from conversations with staff. It was evident that the day-to-day routine is tailored to the individual. One individual said they were involved in household chores and shopping with staff support. Observations of the people living in the home were that they had the freedom to move around their home. Individuals were observed making a drink on their return from their day activities. Whilst the kitchen is locked when staff are not present individuals were seen using the star key to access this area. Staff said that this is risk assessed daily to ensure that the person is not at risk and depends on their mood/levels of anxiety. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Individuals have meaningful and active lifestyles based on choice. Good contact is maintained with the local community, relatives and friends. Individuals have a healthy and a balanced diet. EVIDENCE: Care plans and talking with staff evidenced that the individuals have meaningful activities both during the day, evening and at weekends. Presently the three people have a four-day week placement at a local day centre run by the Brandon Trust. It was evident that the activities were tailored to the individual. One person said they had been horse riding and one person said they do a cleaning job, which is paid. Certificates were seen of courses that people have attended at the local college. During the week there are varying days when there is one person in the home which enables the person to have one to two staff support. It is evident that The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 15 this “house” day is tailored to the individual and combines household chores with going to out to a place of the individual’s choice. This was documented in the daily notes and linked to the plan of care. Individuals confirmed they were supported to go to the shops, out for lunch and recently a trip to the cinema. Other activities included going to see a band and getting involved in village life. Two of the individuals have had a holiday to Devon with one person planning a holiday to Disneyland later in the year. It was evident that the holidays were planned and tailored to the individual. From the completed surveys from relatives, care plans and speaking with two of the people living in the home good links have been built with relatives with regular visits being maintained. One person confirmed they could use the telephone to maintain contact with family. The individuals have lived in the home in excess of ten years and have built good links with the local shopkeepers and their neighbours. This has been helped by some of the staff living in the local neighbourhood. Yatton is a small village with a number of shops and pubs. The day-to-day running of the home is dependent on the needs of the people living in the home and it is evident that staff are continually monitoring the wellbeing of the people living in the home. The routines of the home are very flexible and the people can make major choices in their life. This was confirmed in conversations with staff and care planning documentation. However, it was clear that there were some boundaries to ensure that the individuals are safe and to assist with their anxieties. It was evident that these were drawn up with other professionals. Care plans included how staff in relation to the challenges that may be exhibited should support the person. This included the triggers and positive steps that staff should take to reduce the person’s anxieties. Staff have received training this year on supporting people who can challenge the service. This had been identified as an area of concern in the annual service review through surveys from staff. Two staff had said they had not received any training in supporting individuals that challenge the service. It would appear that this has now been resolved as evidenced through staff training records and conversations with the staff on duty. Menus were viewed on this occasion. There was a good variety of food being offered. One person said they liked the food and could help themselves when they wanted. Individuals were observed making teas and coffees. A concern as discussed earlier in the report is that staff may not be consistent in ensuring one person eats healthily as per their plan. However, from conversations with staff meals are fresh and consideration is taken to provide a healthy balanced The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 16 diet. Fruit was available to people. A person did have fruit instead of a biscuit when offered by a member of staff as a healthier option. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s medication practices. EVIDENCE: Individuals’ care records included information that demonstrated that the people living in the home have access to a GP, dentist, optician and other health professionals. To support individuals with their needs the home liaises with other relevant professionals in the planning of care that is provided and to ensure the individual’s care needs are well met. Care plans included daily routines regarding their personal care needs and the way they preferred their needs to be met. The underpinning ethos at The Hollies is that support is offered to enable individuals to meet their optimum personal appearance and promote confidence and self-esteem. The majority of the people at The Hollies need minimal support with their personal care. For those who do require support, there is male and female staff available. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 18 Accident records were viewed and it was evident that the home was addressing incidents promptly and minimising any further risks where relevant. Staff have received health and safety training and first aid as evidenced in the training records and speaking with staff. The home is keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals in respect of Regulation 37. The procedures for the administration, storage, and disposal of medication were looked at. Ongoing medication is stored safely in a lockable cupboard. Records were seen demonstrating a robust audit could be completed on medication held in the home. This included medication entering and leaving the home (disposal). Medication administration records were clearly written and medication was signed for appropriately. A medication policy is in place but this was not viewed on this occasion. Registered Nurses are responsible for administering all medication in the home. There is no system at present to ensure that the staff are competent in the administration of medication. Staff have received training on the use of rectal diazepam. The manager stated the staff are waiting for training on a new medication that is less invasive. All staff have received epilepsy training. Clear protocols are in place to support individuals with epilepsy. Medical profiles seen identified current health needs and medication and included a current photograph. Whilst standard 21 was not reviewed on this occasion it was noted that end of life wishes were not recorded for two of the individuals and only in part for the third. This will be explored at the next visit to the service. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Individuals are listened to and whilst there are guidelines in place to ensure individuals are protected from harm, there is a lack of staff training on safeguarding, which could put people at risk. EVIDENCE: The Brandon Trust has an accessible complaints procedure, which is given to people who use the service with an explanation of how it can be used. The individuals and their relatives confirmed this by their responses to the survey received prior to this visit. The home maintains a record of complaints. There has been one complaint received since the last visit and this had been addressed with the complainant. It related to individuals going on holiday and that one person was not going till later in the year. However it was evident that this was the person choice in respect of location. 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. However, many of the staff have worked at the home for many years and did not complete this as part of their induction. Only one member of staff has attended a recent safeguarding training with the local authority and another completed this in 2002. All staff must complete this training. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 20 Staff spoken with during this visit were clear that they had to report concerns (abuse) and were aware that the Trust had a policy to guide them. Care plans as already mentioned detail how to support individuals with challenging behaviour. It was noted at the visit in June 2007 that the home failed to maintain a record of restraint in accordance with the guidelines from the Department of Health. It was noted that this is still an outstanding requirement. The manager stated that all restraint is recorded on a notification and sent to the Commission for Social Care Inspection. No notifications have been received. However, from talking with staff and the manager it was evident that they have used a guiding method to assist a person from one area to another. Staff have received training for this. Staff stated that this is only used as a last resort. The home must maintain a record of restraint detailing the date, the time, the restraint method used, who was involved, any injuries sustained and the length of time and why it was used. Further guidance can be obtained from the Department of Health’s guidance on restraint with people with learning disabilities. Where a known restraint method is used this must be written into the person’s plan of care and discussed with the individual in respect of consent and in conjunction with other professionals involved in their care. The Home has made one safeguarding referral due to behaviours that challenge which resulted in a serious injury to one of the individuals. Whilst the victim has moved to a more appropriate placement the staff are liaising with other professionals to ensure that the risk is minimized for the other individuals living in the home and staff. The social worker believes that there is still a potential risk, which is being monitored by professionals involved in the care of the individual. Staff are aware of the risks and monitor on a daily basis with guidelines in place to ensure that the other individuals are safe. This will be monitored through the notifications the home sends to the Commission for Social Care Inspection. Finances were checked in respect of the three people living in the home. Records were maintained of all financial transactions along with receipts. In relation to signatures there was in the main only one staff signature. Good practice would be for two staff signatures where individuals are unable to sign. However, the manager stated that the three individuals are able to sign. The home has an organizational policy to guide staff in respect of safe financial practices. The individuals have access to a motability vehicle, which is funded by one of the individuals. Two of the individuals contribute towards the petrol whilst the other pays for the lease and other costs related to the running of a vehicle. Records are maintained of the expenditure of the petrol, detailing all journeys. The manager stated that the lease on the vehicle is due to end in September 2008. Consideration should be taken to review the present funding to ensure that it is more equitable. Individuals have signed consent forms in respect of The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 21 the use of the vehicle. However, there has been no consultation with relatives or the funding authorities in relation to the additional cost or whether the individuals had capacity to agree to such a long-term decision. This additional cost was not detailed in the home’s contract. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The Hollies provides a safe, comfortable and clean environment for the individuals living there. However, attention should be paid to making the hallways more homely and inviting. EVIDENCE: The Hollies is situated in the centre of Yatton Village close to amenities and in keeping with the local neighbourhood. There are good transport links to neighbouring towns including Bristol, Weston Super Mare and Cleevedon. There are shops, a church and local pubs within close walking distance. Each person has his or her own bedroom, which is decorated to reflect the taste of the individual. One person’s bedroom is minimalist; risk assessments were in place to demonstrate the reasons and with evidence from staff that this had been in consultation with the individual. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 23 The communal area had recently been decorated and was homely and comfortably furnished. This was in contrast to the corridors, which were bare and cold. There were no curtains to the hallway window. Consideration should be taken to make these areas more homely without putting people at risk. There were two environmental requirements from the last inspection and these were followed up during this visit. The damp to the one of empty rooms has now been resolved and the home has developed a refurbishment plan for the home. As part of the refurbishment plan the home is intending to replace all carpets throughout communal areas and the hallway, replace the kitchen and decorate empty bedrooms as new people are identified to move in. It was noted that the paintwork in the small sitting room including the windowsill requires painting. The home maintains a record of maintenance and it was noted that repairs are responded to in a timely manner. On the day of the inspection the home had to deal with a power cut and a blocked toilet. Staff reduced the anxieties of the individuals and maintained a calm atmosphere within the home and promptly responded to these events. The manager said that she has done a risk assessment relating to radiator covers as it was noted that many have no guards to minimise the risk of scalds. The manager said that high-risk areas have been addressed. There is now a radiator cover in the small lounge, which is known as the “chill out” area. The individuals are encouraged to see The Hollies as their own home and are consulted in matters such as redecoration; one individual’s response was that they liked living there and was keen to show their newly decorated bedroom. The home was clean and free from odour. Cleaning schedules are in place and the individuals are encouraged to assist with the household chores with staff support. Chemicals are stored in accordance with the home’s risk assessment. The home has separate laundry facilities sited away from the kitchen. There is a sluice on the first floor. There is a pleasant garden area that is fully enclosed. It is evident that this is used by the people who live at the Hollies giving them an additional area to relax. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. Adequate and competent staff support the people living at the Hollies. Good support networks are in place for the staff including an ongoing training package. EVIDENCE: The staff rota indicated that the home provides 24-hour nursing care support, and have a minimum of two staff on duty during the daytime, and two at night. The staffing levels reflect the needs of the people living in the home 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 for example a planned trip or party and key workers work on the day the person is on their “home day”. Staffing, was raised as a concern by the local placing authority and the staff working in the home through surveys completed for the Annual Service Review and this visit. The manager stated that due to two vacant beds staffing has been reduced accordingly. This is being monitored closely as the home has reduced the staffing from three to two during the day. Staff on duty confirmed The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 25 that the present staffing numbers were adequate in light that individuals are out during the day and often one person is away at weekends staying with relatives. The manager stated that she is in the process of risk assessing the staffing levels and implementing a procedure in the event that additional staff are required due to the anxieties of the individuals. This must be clearly documented in the statement of purpose ensuring an open, transparent and safe working practices are adopted ensuring the safety of the individuals and the staff and kept under review as the vacancies are filled or where individuals are particularly anxious. There have been no new staff employed since the last visit. All information relating to recruitment is held at the offices of Brandon Trust and is subject to a separate inspection to ensure that a thorough and robust recruitment process is undertaken. During the last visit the inspector was able to confirm the recruitment process and induction training with the new staff. The inspector also discussed the Learning Disability Qualification with the new members of staff, who confirmed they were on the course. This was not followed up during this visit. 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. From training records it was evidenced that staff had attended statutory training updates and fire training. In addition all staff have recently attended a course to support individuals that challenge. Other training included supporting people with autism, person centred planning, epilepsy and two staff had attended training on mental health. Two of the individuals living in the home have a diagnosis of mental health in addition to their learning disability and consideration should be taken for more staff to attend a course in supporting individuals with their mental health. Attendance varied at training some staff had completed just their statutory training in the last two years whilst others had attended courses relevant to the needs of the people in the home. The Care Home’s National Minimum Standard states that staff should attend at least five days training per year, which is pro-rata for part time staff. The manager stated that all the staff either have a registered nurse qualication, or a National Vocational Qualification at level 2 or 3 or working towards completing this. The home has exceeded this standard to ensure that 50 of the workforce have a National Vocational Qualification or equivalent in care with 90 of the team have an appropriate qualification. Three members of staff stated that the manager meets up with them on a monthly basis to discuss their role and performance on a one to one basis in the form of supervision. In addition staff have an annual appraisal of their work performance, which enables them to plan for training and future The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 26 developments. In addition staff have regular monthly meetings to discuss matters relating to the running of the home and the care support. Records were maintained. Discussions with the registered nurses on duty during the visit highlighted a deficit in specific clinical training to enable them to ensure practice is current and to meet their registration requirements with the Nursing Midwifery Council. It was noted that the home does not maintain an up to date record of the registered nurses registration with the Nursing Midwifery Council ensuring that they are still fit to practice. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 27 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 good. This judgement has been made using available evidence including a visit to this service. Individuals benefit from a well-managed service. Good systems are in place to measure the quality of the service and develop the service further. Individuals are protected by the health and safety practices in the home. EVIDENCE: Mrs Wheeler is the registered manager for the Hollies. She is has dual registration as a nurse supporting both people with a learning disability and mental health. The manager has the required qualifications and experience to run the home. She has worked at the home for a number of years and has developed good relationships with the individuals and their families. The manager is very person centered in her approach. It is evident that she has the same The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 28 expectation for her staff team to ensure that the people receiving the service are pivotal to the planning (the focus). The home has good systems for measuring the quality of the service including routine audits on reviewing care planning processes, health and safety, medication, finances, staff supervisions, training to name a few. In addition the provider completes a monthly audit on the home in respect of Regulation 26 of the Care Homes Regulations. The home has developed a comprehensive business plan to develop the service further. Health and safety in the home was monitored both by the manager and a member of staff with this particular designated role. Health and safety training for staff was in place to ensure that individuals are protected and supported by competent staff. Fire records were viewed and found to be satisfactory including the fire risk assessment, fire training, staff participation in fire drills and checks on the equipment. The home has an extensive policy file to guide staff and support the individuals. As seen at previous visits to the home. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 X 3 X 3 X X 3 X The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 30 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement To ensure that the statement of purpose includes information as detailed in schedule one and reflects the service being offered. Contracts to include a breakdown of fees and any additional charges made. Ensure that staff follow the care plans and risk assessments. For example where it states two staff to support a person, or healthy eating plan for another person. For a risk assessment to be developed with clear guidelines for staff in respect of assisting a person with personal care. To consult with a professional in respect of installing grab rails in the bathroom. On any occasion on which a service user is subject to physical intervention, and then the registered manager must recorded the circumstances including the nature of the restraint. (Outstanding since 26/06/07) Ensure there is training for staff on safeguarding. DS0000020231.V364988.R01.S.doc Timescale for action 30/08/08 2. 3. YA5 YA6 5A 15 (1) 08/10/08 08/08/08 4. YA9 13 (4), 13 (5) 08/08/08 5. YA23 13 (8) 08/09/08 6. YA23 13 (6) 08/11/08 The Hollies Version 5.2 Page 31 7. YA32 18 (1) (a) 8. YA32 18 (1) (a) 9. YA35 18 (1) (c) (i) Maintain a record of the registered nurses registration with the NMC demonstrating that they can continue to practice as a registered nurse. To clearly document the staffing in the home ensuring that there is sufficient numbers taking into consideration occupancy and needs of the people living at the Hollies. For this to be recorded in the statement of purpose. For staff to have training in supporting individuals with mental health in addition to their learning disability. 08/08/08 08/08/08 08/11/08 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. 2. 3. 4. Refer to Standard YA5 YA23 YA24 YA24 Good Practice Recommendations For the contract to be accessible for the people living at the Hollies. For all financial transactions to include 2 signatures where possible for the individual to be encouraged to sign. Consideration to be taken to make the hallway more homely within a risk assessment framework ensuring the safety of the people living in the home. For the paintwork in the small sitting room to be repainted and the window sill repaired. The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI The Hollies DS0000020231.V364988.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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