Inspection on 17/01/09 for The Hollies Rest Home

This inspection was carried out on 17th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies Rest Home 04/02/08

The Hollies Rest Home 07/11/05

The Hollies Rest Home 21/06/05

The Hollies Rest Home 21/03/05

The Hollies Rest Home 23/11/04

The Hollies Rest Home 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hollies Rest Home 14/16 Park Road Southborough Tunbridge Wells Kent TN4 0NX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 1 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Hollies Rest Home Southborough 14/16 Park Road Tunbridge Wells Kent TN4 0NX 01892535346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : manager.hollies@regalcarehomes.com Regal Care Homes Ltd care home 31 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 31 The maximum number of service users to be accommodated is 31 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home The Hollies is a care home providing personal care and accommodation for 31 older people who are experiencing dementia. It is owned and operated by Regal Care Homes Ltd. The home employs care staff that work a rota giving 24 hour cover, which includes waking night staff. In addition to the care staff there are ancillary staff and a handyman. The home is located in Southborough, near Tunbridge Wells. It is close to shops and a bus route to the town centre of Tunbridge Wells or Tonbridge. The home provides accommodation arranged on three floors. The premises are detached. There are three lounge/dining rooms on the lower ground floor and a conservatory. There are bedrooms on all three floors. There are gardens to the rear and parking at the front. Care Homes for Older People Page 4 of 26 Brief description of the care home The fees range from about £421.09 to £650 Extra charges are made for: - Hairdresser prices according to service; Chiropodist; Papers,magazines, toiletries at cost; Transport to and from hospital varies approx £7.50 per visit. For more information about the fees and services please contact the Provider Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: This was a key inspection carried out on an unannounced basis by one inspector. A key inspection means that all of the key National Minimum Standards are assessed. The inspection included a site visit to the home which took about four hours. The last key inspection was carried out on 4.02.08. We looked at the Annual Quality Assurance Assessment, AQAA, completed by the manager. This is well completed and gives evidence of what the home does well, what could be better and how they intend to improve the service for people. We spoke to the manager, staff and service users, had a look around the home and sampled records. We made observations. We looked at any concerns or complaints Care Homes for Older People Page 6 of 26 received about the home, we listened to what people told us about the service and we looked at notifications of incidents and accidents. What the care home does well: What has improved since the last inspection? What they could do better: The AQAA shows they plan to improve information about the home to make it more meaningful. Some redecoration is planned as well as improvements to the garden. There are not enough suitable toilets and bathrooms for people to use. There are currently only two bathrooms in use shared by up to thirty one people and this is unacceptable. It means that people cannot have a bath or shower when they choose to and have to wait. A requirement has been made to address this. Care Homes for Older People Page 8 of 26 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their needs will be fully assessed before they move in so staff know they can meet the persons needs. Evidence: We found that the manager carries out clear detailed assessments before a person moves in. Families and friends are involved in this process, which keeps the person at the centre. The manager does this to ensure that the home can meet the persons needs. The assessment tool has been improved in that there is now space to record information about a persons life history like childhood and adolescence. This means that staff know more about people and can give better support. We found that any other relevant assessments including care management assessments are obtained so the manager has a good picture of the persons range of needs. Care Homes for Older People Page 11 of 26 Evidence: We found that there is good information available showing people what life is like at The Hollies. There are plans to make this more meaningful so people have the information they need to make a decision about moving in. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their health, personal care and social needs will be recorded and supported. Medication practice is safe protecting service users. People know they will be treated with respect. Evidence: We found that each person has a service user plan, which is developed from the initial assessment. We found that peoples health needs, social needs and personal care needs are recorded with action recorded that staff should take to meet those needs. Service users and their relatives are involved in developing and reviewing the plans so they have a say about their care. We found that plans are reviewed on a regular basis, which means that changing needs are picked up at an early stage. We found that risk assessments are completed if and when necessary keeping people safe. We found that there is an emphasis on encouraging and supporting people to do as much for themselves as possible. This means that people can maintain their skills. Everyone now has a key worker who knows them well and can act as a link between the manager, service user, health professionals and relative. Care Homes for Older People Page 13 of 26 Evidence: We found that every one has support to access health care professionals. Staff work closely with health professionals to ensure peoples health needs are supported. Peoples health needs are recorded in individual plans. There is good monitoring in place of things like fluid intake and weight so staff can be proactive and take action at an early stage if necessary. We found clear guidelines to show staff how to support things like diabetes. We found that the storage of medication is safe and tidy. The medication administration records have been improved since the last inspection. The records are in order and show the receipt of medication into the home and the administration of medication. We found that the manager checks medication records and storage regularly, which protects service users. We found that privacy and dignity is supported and respected. For example staff knock on peoples doors before entering and people can lock their rooms so they can keep things private if they wish. The manager noticed that a persons clothing had risen up and discreetly adjusted it for them to maintain their dignity. We heard staff speaking to service users with respect and using their preferred names. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities. Service users have support to exercise choice and maintain contact with friends and relatives. Food is wholesome and nutritious. Evidence: We found that service users are regularly consulted about what they might like to do with their day. Assessments are completed about activity likes and preferences and records kept of who enjoyed what. The home employs an activity coordinator who plans and organises events and activities. The manager said that more outings are planned so that people can get out into the community more. Recent outings include trips to local garden centres. Activities choices are displayed and the manager agreed that this could be made more meaningful so that every one can see and understand what is on offer. The manager was at the home during the visit with her dog. Service users were making a fuss of the dog and said they liked to see it. Visitors are welcome at the home and we saw different visitors coming and going. We found that visitors are made to feel welcome and are kept informed about their relatives. Relatives have the opportunity to be involved in care review meetings if they Care Homes for Older People Page 15 of 26 Evidence: wish and if service users agree so they are kept informed. We found that the home supports relationships and friendships. We found that wholesome appealing food is served. There is a choice of main meal and dessert and we saw people being given a choice. There are different dining areas that people can choose to use. We found that people are given the time and support they need in a discreet manner. The home employs and cook and kitchen assistants. The cook has been at the home for several years and spoke with knowledge about service users needs and the need for a balanced wholesome diet. Special diets can be catered for. Most people said that the food is good. Although the menu is displayed in text, it may not meaningful to everyone. We found that one person did not know what was for dessert and asked the inspector who did not know the answer. The manager agreed that a more meaningful menu could be displayed in a more prominent place so that people can see for them selves what is on offer rather than having to ask. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their complaints will be listened to and acted on. People are safeguarded from harm and abuse. Evidence: The manager said the home welcomes complaints as it gives opportunity to improve practice. Neither the home nor the Commission have received any complaints since the last inspection. We found that there are policies and procedures in place to safeguard people. This means that staff have guidance about how to respond to and report possible abuse. We found that staff have training in safeguarding people with more training planned. The manager has worked with the adult protection coordinator at social services during an adult protection investigation and was open and transparent. This investigation is now closed and the manager took appropriate action to safeguard service users. One person said I feel safe here. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and safe but must have enough suitable bathrooms and toilets for people to use. Evidence: We found that the home is safe and well maintained. There is an ongoing programme of redecoration and maintenance. There are various communal areas including a conservatory where people can spend time alone or in company. The lounges feel homely with pictures and photographs of residents on the walls. The conservatory has access to the rear garden that has seating and patio areas. Seven of the bedrooms are doubles, this means that nearly half of service users have to share a room. Dividing curtains are fitted for privacy. All bedrooms have a wash hand basin and two have en suite toilets. During the visit we found that one person had to use the staff and visitors toilet as all others were occupied. Although this meant the person did not have to wait it may mean the amount of toilets needs to be increased. There are five toilets for communal use and two bedrooms have en suite toilets to over thirty service users and staff and visitors. This is below the National Minimum Standard. Care Homes for Older People Page 18 of 26 Evidence: Orientation signs are in place so service users know where the toilets are. The manager said they plan to increase signs so people can find their way around more easily. There are four bathrooms for people to share. However two bathrooms are out of action due to leaks and a faulty bath chair. The manager said this has been the case for over one year now. This means that when the home is full over thirty people are sharing just two bathrooms and this is not acceptable. Especially as one of these bathrooms has a step up to it so cannot be accessed by everyone. The manager said plans have been drawn up to improve the two bathrooms that are currently out of action. Because of the impact on service users a requirement was made to ensure that there are an adequate number for suitable facilities for people to have a bath or shower when they wish within three months. We found that the home is generally clean although there is an unpleasant odour in some of the bedrooms. The manager is aware of this and is trying to address it with regular carpet cleaning. The manager said there are plans to replace a lot of the carpets with a more suitable floor covering. There was a requirement made at the last inspection to address odour issues. Although there is still an odour problem the manager is taking steps to address it. Two other requirements relating to the environment made at the last inspection have been met. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enough competent and trained staff supports service users. Recruitment checks are robust protecting service users. Evidence: We found that there is enough staff on duty to meet peoples needs. This means that people do not have to wait for support. There is always a senior staff on duty. There are separate kitchen, maintenance and domestic staff employed enabling care staff to spend their time with service users. There are waking staff on duty at night to support people during the night. The manager has recruited a deputy manager since the last inspection. This means that she and the staff have more support. The manager has completed a training analysis for each member of staff. This shows their strengths and needs and has allowed the manager to prioritise training for some people who need it. The manager observes staff at work to check their competencies ensuring they are working safely. There is an incentive scheme encouraging staff to work well together as a team and to attend and complete training courses. There is a training matrix showing what mandatory courses have been attended. More courses are planned to cover shortfalls. Staff also have training in areas relating to peoples needs like Dementia. The induction has been improved so all staff even any Care Homes for Older People Page 20 of 26 Evidence: agency staff complete it. This means that the requirements made at the last inspection relating to training and induction have been met. The home is now fully staffed so they do not need to use agency staff at present. There is now a permanent flexi bank of staff they can call on to cover any shortfalls. This means that people who use the service get a better continuity of care and support. We sampled staff files and found that recruitment checks are carried out before a person starts work at the home. This protects service users. The manager said that people have a look around before they start work so they get chance to meet service users. We found that staff have job descriptions and terms and conditions of employment and have supervision in line with the standard. Staff have the opportunity to attend regular staff meetings and have daily handover time. We observed staff speaking to service users in a respectful manner and giving discreet support when needed. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in service users best interests. Service users know their finances will be safeguarded. Peoples health and safety is protected. Evidence: The manager has been in post for just over a year and has applied to be the registered manager. This means she will go through the fit person process so people know she is a fit person to run the home. The manager has several years experience in the care sector and has the required qualifications and skills to run the home. The manager completed the Annual Quality Assurance Assessment, AQAA that all homes must now complete on a yearly basis. The AQAA gives detail about what the home does well and what could be better with evidence to support this. The AQAA shows how they intend to improve outcomes for people who use the service. The manager has a range of ideas about improving the service and plans of how to do this. The manager spoke with knowledge, understanding and empathy of service users Care Homes for Older People Page 22 of 26 Evidence: needs. The manager was at the home for the visit; on a Saturday, to meet some peoples relatives and chat to them. This means that relatives can be reassured that they can speak to the manager if needed at weekends. We found good quality assurance and quality monitoring systems in place. Recorded checks are carried out by the manager of things like medication records, the environment, equipment and care plans. An area manager carries out monthly visits to the home and makes spot checks and talks to service users about the service they are getting. This protects service users. A range of ways is used to seek peoples views of the service including residents meetings and surveys. Responses are collated and an action plan for improvement developed. Results and the action plan are published so people know how the home intends to improve based on their views. We spoke to the manager about how they safeguard service users monies. We sampled records relating to money and found that individual records are kept and checked and signed by a second person. Receipts are kept and records show all income and expenditure. The manager writes to appointees and relatives regularly to give them statements and keeps them up to date. This safeguards service users. The AQAA shows that the required checks are carried out of premises and equipment. There is a maintenance man who addresses house maintenance issues. Staff have training in areas related to health and safety including fire awareness, food safety and infection control. Staff have training in how to move and handle people safely and assessments are carried out to ensure people are safe when being moved. As previously mentioned the welfare of service users is compromised due to the lack of adequate bathing and showering facilities. This has been explained in the environment section of this report. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 21 23 There must be sufficient 30/04/2009 numbers of lavatories, baths and showers to meet service users needs. To ensure that people have access to a suitable bathroom when they want it without having to wait. To safeguard peoples health and welfare. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!