Inspection on 07/11/05 for The Hollies Rest Home

This inspection was carried out on 7th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Hollies Rest Home 17/01/09

The Hollies Rest Home 04/02/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Hollies Rest Home 14/16 Park Road Southborough Tunbridge Wells Kent TN4 0NX Lead Inspector Maria Tucker Announced Inspection 7th November 2005 09:30 X10015.doc Version 1.40 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 Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Hollies Rest Home Address 14/16 Park Road Southborough Tunbridge Wells Kent TN4 0NX 01892 535346 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) hollies@regalcarehomes.com Regal Care Homes Ltd Mrs Rosie Beatty Care Home 31 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (1) of places The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care of one service user is restricted to one person whose date of birth is 21/12/1940 21st June 2005 Date of last inspection Brief Description of the Service: 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 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 for several cars. The home employs care staff that work a rota, which including waking night staff. In addition to the care staff there are domestic staff and a handyman. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The inspection lasted from 09.25 until 15.15 the inspection was conducted by the lead inspector Mrs Maria Tucker. The pharmacy Inspector Mrs Jane Vaughn accompanied the inspector to inspect the medication. Time was spent meeting the manager and director of care and going through various records and documentation. About one and a half hours was spent meeting service users collectively and individually. Two relatives were spoken with. Due to the nature of some of the service users, it is difficult to gain a full picture of their quality of life, this was made through judgements from observations, speaking with staff and looking at records. A partial tour of the premises was made which included service users rooms and communal areas. The pre inspection documentation was received by the CSCI. 7 comment cards were received, comments included: • Communication could be better. Health professional • ….is not a good eater. The Hollies always try to give …something …likes. They even prepare special lunches. Relative. What the service does well: The Hollies provides a homely welcoming and calm environment and atmosphere for service users, staff, visitors and the cat that resides there. The food at the Hollies is home made traditional meals tailored to the service users tastes, with fresh vegetables, meat and home cooked cakes as snacks. Service users with challenging behaviours associated with their condition are managed very well. A specialist visiting the home during the last inspection commented, “There are excellent assessments made by the home in meeting peoples needs: behaviour is managed well; they will accept challenging behaviours”. Since taking over the home the providers have made substantial improvements to the building i.e. the conservatory and newly furbished kitchen. A service user told the inspector “I have had a new conservatory built”. The activities on offer and made available are stimulating and creative. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 standards 3, 4 were inspected during the last inspection 1 exceeded. Service users can feel confident that they will have their needs fully assessed and met in the home. EVIDENCE: An updated version of the statement of purpose and service users guide was given to the inspector. These documents were comprehensive and contain most items as required. Omitted is the number and size of rooms in the care home; the name relevant qualifications / experience of the registered provider. Relatives spoken with and shown these documents were familiar with them. The service users guide was not inspected as will need to have amendments made following changes to statement of purpose. The service users contracts contain all items required and were seen in service users files signed. These state that service users are admitted on a trial basis. Given the condition of some of the service users visits prior to admission are not always possible. Service users are visited for an assessment at their current location prior to admission. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Service users general health and well-being is met within the home. EVIDENCE: A service users care plan inspected contained relevant information and was comprehensive. Service users are supported with regular routine health appointments and district nurses visit as required. Staff support service users with appointments and due to the nature of the service users the lay out of the home extra staff are on the rota to accommodate the health and welfare and respond to any accidents or emergencies. During the inspection service users were supported and encouraged to walk using walking sticks and zimmers as required. One service user who went out for a walk commented that it was “lovely lovely weather”. The home have created a sensory area in the corridor, which gives service users something interesting and calming and ‘an outside feeling’ when walking past. The pharmacy inspector undertook an inspection of the medication at the request of the manager, following discussions during the last inspection on good practice and advice. Her findings are as follows: The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 10 Clear policies and procedures provide residents with appropriate support of their pharmaceutical needs. Records were not always completed fully, with incomplete handwritten entries that had not been double-checked. The Medication Administration Record file, whilst providing information about prescribed medication does not give sufficient additional information to support staff when administering “when required” medication. Storage was poor; most medication was stored on open shelves in the medication “room”. The storage of medication, out of the original boxes, on an open shelf on the trolley is unacceptable. Throughout the inspection staff were seen and heard to treat service users with dignity and respect. All the comment cards received from service users had been ticked to say they are treated well and with respect. Relatives spoken with said they had “peace of mind” they were “100 happy” that their relative was comfortable. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, standard 15 exceeded during the last inspection Service users have a relaxed comfortable lifestyle and the pleasure of home cooked meals and snacks. EVIDENCE: Relatives spoken with said they were made welcome they “come and go as we please”. The conservatory is used as a visitor’s room and a service user who chose to remain in their room stated that their relative visits them in their room. There is an activity coordinator who visits the home weekly and works with service users and staff providing a range of stimulating activities suitable for the service users and designed to meet individual needs and tastes. Visits to places of interest and trips to activities such as the theatre are organised. Activities in the home take place daily. Service users have jointly made collages that were on the wall. The inspector sat with some service users and looked through a photograph, reminisce book of activities and outings, which service users expressed they had enjoyed. One service user said, “We went to the train” another said “I like it here with my friend”. A service user who chose to remain in their room stating that they was “always a bit of a loner” and preferred their own company. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 12 The upstairs reception area is used for a weekly religious service. The home has many areas for service users to sit in and undertake various activities. The staff have tried hard to ensure that every area that service users have access to or walk past is interesting and stimulating. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 standards 16 and 18 were met during the last inspection Service users can feel safe in the home and secure in the knowledge that staff would take the appropriate measures to ensure this. EVIDENCE: The comment cards received had been ticked to say that no complaints had been made. Relatives spoken with were complementary of the staff stating they were “amazing” that they “handle things very well”. Service uses looked happy and relaxed and well cared for. The manger has received the new adult protection Kent and Medway protocols and has a copy of the overview of the mental incapacity bill. Leaflets were on display of advocacy services. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 standards 21, 22 were met during the last inspection Service uses live in a comfortable, homely, well-maintained environment. EVIDENCE: The home continues to have improvements made so that it is comfortable, homely, safe and stimulating. These have included new carpets being fitted; sink in the downstairs toilet; glass panel in a door and a door removed. The new conservatory has added extra space where service users can sit and relax or meet visitors in private, blinds have been put in for extra privacy. A service user expressed their pleasure at the conservatory explaining that they “had a new conservatory built” another service user commented that “I do like the colour” of the new carpet. The communal toilet has now had a sink fitted. One toilet was noted to be in need of redecoration and refurbishment so that it is to the same standard as the rest of the home. The handyman was working in the home. The home was seen to be in a state of good repair. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 15 The gardener was busy removing leaves and tending the garden, which was well kept. The fire officers visit report contained some recommendations. The manager explained that quotes were being sought for push bars to the conservatory doors, which was the only outstanding recommendation. Service users wander freely around the home making use of the communal areas. There is one sluicing facility. It has been recommended that professional advice be sought in respect for the policy and procedure for sluicing where this facility is not used. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,30 Service users are well supported by a range of staff to meet their needs. EVIDENCE: A staff file contained all items as required and included details and records made at the interview. Staffs are being recruited locally. The staff training has increased with more training available. Each staff member had a staff-training file. The staff training needs are identified and recorded. Staff have a pre training form to record what their aims and objectives of the training are and a course evaluation form, which enables the manger to collate information about the quality of courses. The staff certificates are displayed in the staff area. The home does not have 50 of care staff trained to NVQ 2 The rota did not indicate who was on call when the manager was not on duty. The care staffing levels as seen on the rota are 6 am and 5 pm, 3 waking night staff. The manager is supernumerary. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 standards 32, 36, 37 were met during the last inspection Service users benefit from a well managed home with a pleasant welcoming atmosphere and staff who are given clear direction and leadership. EVIDENCE: The home has an out of hours on call system. The manager provides the on call as does a staff member. The head of care is also available. It is very strongly recommended that this be formally recorded on the rota so that staff are aware whom to contact and when. The manager is registered with the CSCI and has been working in the care field for over 9 years. She is currently working towards the NVQ level 4 award. Service users were familiar with staff and the atmosphere generated by the interactions between staff and service users was positive; warm; friendly and encouraging. Service users spoken with were positive about the staff, nodding and smiling during conversations with the inspector. One service user commented, “Staff are very good here”. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 18 Relatives spoken with stated that they had “seen massive improvements in the last two and a half years”. Service users surveys are conducted and their views are actively sought. It is recommended that an easier format be devised i.e. pictorial. The pre inspection questionnaire lists policies and procedures that have been updated and reviewed. Service users who require support with finances are given assistance. A record of in coming and outgoing money is kept with receipts. Relatives spoken with confirmed that the home support with pocket money and that they had no concerns with the way the home manages this. The home has policies and procedures in place to ensure the health and safety of service users. The pre inspection questionnaire lists maintenance checks and records. These were spot checked during the inspection. The handyman undertakes jobs around the home, during the inspection was busy clearing leaves to make the grounds safe and doing tasks in the home. The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 2 X 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 20 No 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 OP 1 Regulation 4(1)(c) Schedule1 Requirement The registered person shall compile in relation to the care home a written statement referred to as the statement of purpose, which shall include all items listed. Medicine storage is improved in line with the Royal Pharmaceutical guidelines to provide lockable cupboards for all medication, including newly delivered medication and medication waiting for disposal. The medication room is fitted with a British Standard 5 lever lock. In view of the registration of this home to care for residents suffering with dementia, the provider is asked to risk assess the practice of leaving medication unsecured during medication rounds. Serious consideration should be given to obtaining a larger trolley The registered person shall having consulted the fire authority provide adequate means of escape, in that the recommendations made by the DS0000024029.V251988.R01.S.doc Timescale for action 20/12/05 2 OP 9 9.4 13(2) 9.1 13(4) c 20/12/05 3 OP 19.5 23 (4) (b) 20/12/05 The Hollies Rest Home Version 5.0 Page 21 fire officer is completed. 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 5 Refer to Standard OP 19.2 OP 26.1 OP 27.2 OP 28.1 OP 9.1 Good Practice Recommendations It is recommended that the communal toilet adjacent to the lift be redecorated and refurbished. It is recommended that professional advice be sought for the policy and procedure for sluicing. It is strongly recommended that the person on call back up be identified on the rota. It is recommended that a minimum of 50 of care staff be trained to NVQ level 2 or equivalent. Dispensing labels should not be attached to MARs. Handwritten entries should be completed fully, signed and initialled as correct by another member of staff. Guidance should be available for the administration of “when required” medication. It is very strongly recommended that the identified on call back up person be formally recorded on the rota so that staff are aware whom to contact and when. It is recommended that formats for seeking service users views be simplified, as are the results of these. 6 7 OP 31.7 OP 33.1 OP 33.4 The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Hollies Rest Home DS0000024029.V251988.R01.S.doc Version 5.0 Page 23 - 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. 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