Care Home: Hollies, The

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What the care home does well We looked at people`s care records and found that there are systems in place to assess and monitor individual needs to ensure that a suitable service is provided based on personal needs and preferences. We found that people are treated with dignity and respect in this home and their health, personal and social care needs are taken seriously. People told us they are satisfield with their home and they said staff are helpful and there is a friendly atmosphere. They told us they like their bedrooms and that their home is comfortable and kept nice and warm. They said the food is very good and that their special diets are well catered for and they are served drinks regularly. What has improved since the last inspection? On checking the medication system, we found that work has been carried out to ensure that medication is stored at a safe temperature as recommended by the manufacturers. Vents have been fitted to the medication room door and a fan has been provided. The temperatures here are monitored daily and recorded to ensure that a safe and consistent temperature will be maintained. What the care home could do better: Care plans were well written and there were good records of contact with doctors and health services. We recommend that health care plans be written for medical conditions such as diabetes, to give staff detailed guidance and ensure that people are receiving the support they need. We looked at how medication is managed in The Hollies and found that some drugs have been prescribed `as required`. We have recommended that care plans be written for all medication prescribed in this way to guide staff about how to give it safely and only when the person needs it. We have recommended that an internal audit of medication be carried out each month. This will help to ensure that all medication is accounted for and any issues will be identified and addressed without delay. We found there are systems for risk management in the home, however we have made two further recommendations. To avoid injury from bed rails, this equipment should receive frequent checks and be made safe as needed. Staff should be given guidance about using the rails to ensure they are competent to do this safely. The Hollies has a missing person procedure which sets out the action to be taken by staff in such an event. We recommend that for people who leave their home without an escort to follow their interests in the community, risk assessments be carried out and regularly reviewed to ensure they are able to continue to do this safely. Key inspection report Care homes for older people Name: Address: Hollies, The 7 Mornington Road Southport Merseyside PR9 0TS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Thomas     Date: 1 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Hollies, The 7 Mornington Road Southport Merseyside PR9 0TS 01704541506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr John Thomson Eslick care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home The Hollies is a care home for twenty four older people situated in Southport, close to shops and transport links to Liverpool. There is off street parking at the front of the building and a secluded garden at the back. Accommodation is provided on three floors, which can be reached by a passenger lift. Disabled access is provided at the rear entrance via the patio doors. The Hollies has two lounges and a dining room, which are comfortably furnished. The bathrooms are fitted with aids to assist those who are physically frail, and there is a call system for residents to summon assistance if necessary. To the side of the premises is the annexe or cottage, where visitors from out of the area may stay overnight if they wish. The annexe is not registered with the Care Homes for Older People Page 4 of 24 Over 65 24 0 0 8 0 6 2 0 0 9 Brief description of the care home Commission. Care Homes for Older People Page 5 of 24 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: The quality rating for this service is two stars. This means that people who use this service experience good quality outcomes. This un announced visit was just one part of the inspection. Before the visit, the manager was asked to fill in a questionnaire called the Annual Quality Assurance Assessment (AQAA) to provide up to date information about The Hollies. The manager sent us the AQAA when we asked for it and it gave us clear and detailed information about how the home is running. During our visit we (the commission) looked at various records and walked round the home. We spoke with a number of people who live there and the staff who support them. They gave us their views about The Hollies. We used a system called case tracking. This is a way of inspecting that helps us to look Care Homes for Older People Page 6 of 24 at services from the point of view of some of the people who use them. We track peoples care to see whether the service meets their individual needs. The fees charged in The Hollies range from £390-£410 per week with extra charges for chiropody and hairdressing. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 24 order line 0870 240 7535. Care Homes for Older People Page 9 of 24 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 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move in to The Hollies so they know that their needs can be met. Evidence: There is a good system to introduce people to the home with information provided and needs assessments done, so they know that their needs can be met in the home. We looked at the records for the person who moved in recently and this showed us that an assessment of the persons needs and preferences had been carried out by social services before they moved in. Staff from the home had carried out a further assessment of the persons health, personal care and social needs. This gave the home good information on which to base the persons care plan when they moved in. Care Homes for Older People Page 11 of 24 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. Peoples health and personal care needs were being met by staff who respected their privacy and dignity. Evidence: We looked at the care plans for two people and found them to be well written and clear. Care plans had been reviewed at least every month and altered if there was a change in the persons condition. This is to help ensure that people receive the amount of support they need and stay as independent as possible. People have the right to manage their medication if they are able to do this safely, subject to a risk assessment being carried out when they move in. Care plans had been signed by the person or their representative to give evidence that they have been asked about the way their care should be given and are in agreement. People we spoke with said the support they receive in the home is very good and they looked well cared for and comfortable in their home. Care plans showed us that people who live in The Hollies who need medical treatment have access to local doctors, district nurses, specialist health care and paramedical Care Homes for Older People Page 12 of 24 Evidence: services such as chiropodists, dentists and opticians. A summary of each persons health is contained in their care plan and clear records are kept of all contacts with health related services and the outcomes. We have recommended that the home improves the care records to detail how staff should support conditions such as diabetes. This is to give clearer guidance to staff and ensure peoples health will be supported properly and safely in the home. All medication accepted into The Hollies was being stored securely and staff who give out medication have received training. We looked at the medication prescribed for two people. All their prescribed medication was in stock and the administration records which are filled is as medication is given to them, were up to date. The records showed us that in some cases medication is prescribed as required. We have recommended that care plans be written for all as required medication to give staff guidance as to the circumstances under which the drug should be given to the person and to ensure it will be given safely and only when needed. We have recommended that an internal audit of medication be carried out monthly to ensure that all medication is accounted for and any issues will be addressed without delay. The temperature in the medication room was satisfactory during this visit. Vents have been fitted in the store room door and a fan provided. This is to improve ventilation and prevent the room becoming too hot, which could render some medication ineffective. Temperatures are monitored and recorded in this area to ensure consistency. For staff guidance there are procedures for privacy, dignity and confidentiality. People we spoke with had no concerns about the way they are supported and those people who need a lot of support looked comfortable and well cared for. We saw that toilet, bathroom and bedroom doors were kept closed during our visit to ensure privacy, and personal care records were secured in the office to protect confidentiality. Care Homes for Older People Page 13 of 24 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. Social activities and meals are both well managed and provide variation and interest for people who live in the home. Evidence: Peoples care files contained a summary of the social activities they have taken part in which have been updated each month. This gives good evidence of peoples experiences in their home and of the activities programme being followed. Social events and therapies had been arranged with each person according to their abilities and preferences. This means that people have the lifestyle they choose in their home and have a say in how to spend their time. There was good evidence in care plans that people continue to have contact with family and friends after they move in and people told us their relatives visit or they go out with them. Four people who were asked said they feel comfortable in their home and there is a friendly atmosphere. The hairdresser was on the premises during the visit and one person said she likes to get her hair done regularly as it makes her feel good. There are arrangements in place for people to be visited in The Hollies by ministers Care Homes for Older People Page 14 of 24 Evidence: from local churches and advocacy services. Peoples spiritual needs are recorded in their care plans and the manager said that contact with local clergy is reviewed and arranged according to the needs of people living there. One person told us that she has a lot of contact with friends from her local church, which is important to her. People told us they were continuing to do the things that interest them such as reading, drawing, crosswords and gardening. Care plans contained details of meal preferences, nutritional assessments and weight records for each individual. In this way staff will ensure that people receive a wholesome diet they like, and will refer people to their doctor if any sustained weight loss is noted. People told us they thought the food in the home is very good and they are offered choices and alternatives. One person who takes a special diet said this is always well catered for and she has no complaints about her meals. People said that drinks are served regularly and there is a choice of where to take their meals, some people being served in the lounge or in their bedrooms. The dining room has enough places for all the people who live in the home and the tables were laid with clean cloths, condiments and flower arrangements. During a visit to the kitchen we found evidence that there were good food stocks in the home, catering records were up to date and qualified cooking staff are employed. Care Homes for Older People Page 15 of 24 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 who live in the home were protected by the complaints and safeguarding procedures which were understood by staff. Evidence: The home has a complaints procedure which is given to people when they move in and displayed in the home. In this way people will know their complaints will be taken seriously and action taken to put things right if necessary. To guide staff, there are safeguarding procedures in the home and staff told us they had received training in safeguarding. Staff we spoke with knew about the complaints and safeguarding procedures and were able to discuss how suspected abuse would be reported for investigation. We have not received any complaints or safeguarding alerts about The Hollies since our last visit. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A suitably adapted, clean and comfortable environment is provided in The Hollies. Evidence: The Hollies is a converted dwelling house which is decorated and furnished in a comfortable and domestic style. There is a car park at the front of the building and well maintained gardens at the back. The home has two lounges and a dining room. A number of mobility aids are provided for people who are frail, including a passenger lift, hoist and assisted bathing facilities. There is wheelchair access into the main lounge at the back of the building. People have single bedrooms which are highly personalized and there are bathrooms and toilets throughout the building for their convenience. People told us they are comfortable in their home and it is always kept warm and clean. Domestic staff are employed and the building was hygienic and free of odours at the time of our visit. For staff guidance in how to keep the home safe and clean, there are procedures for control of substances hazardous to health and infection control. Records showed us staff have also had training and updates in this. Staff told us there is plenty of cleaning materials and protective clothing available for them such as gloves and aprons. We saw staff were following safe systems in the kitchen and laundry to keep these areas clean and avoid contamination. Care Homes for Older People Page 17 of 24 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. People are supported by a staff team who have received training and who are suitable to work in the home. Evidence: The manager confirmed that the home has no staff vacancies and the rosters showed that staffing levels are consistent in the numbers of care and ancillary staff throughout the day and night with management support. People who live in the home said there is always a member of staff available if they need anything and that call bells are answered without delay. The training records give evidence that staff have NVQ qualifications and receive mandatory training with updates. They also receive some training to give them a broader knowledge about supporting older people as some staff have done courses, for example on dementia and nutrition. We spoke with four members of staff who were able to discuss best practice in care giving and they said they receive plenty of relevant training and have good support from management. There is a rigorous recruitment procedure followed in this home to ensure that only people who are suitable will be employed. We looked at the staff files for the two people most recently employed and saw evidence of satisfactory criminal records bureau clearances and references. The records show that newly appointed staff are Care Homes for Older People Page 18 of 24 Evidence: supervised and receive induction training to help them develop the skills to support people properly and and in accordance with the homes statement of purpose. Care Homes for Older People Page 19 of 24 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 Hollies is managed in the best interests of the people who live there. Evidence: The manager is experienced in managing the care service and has a qualification in management. There was evidence that the manager keeps up to date with best practice guidance, for example such as regarding deprivation of liberty safeguarding, which is now included in the homes procedures. In this way peoples rights will be protected and promoted. To ensure people have a say in the way their home is run, there are systems for monitoring the quality of service. An independent audit is carried out once a year based on obtaining the opinions of residents, their representatives and staff. One of the ways in which this is done is through quality questionnaires which are given to them to fill in. We saw that peoples care plans are regularly reviewed by management and social services to ensure they are receiving all the support they need. Care Homes for Older People Page 20 of 24 Evidence: The manager confirmed that the home does not become involved in peoples financial affairs although for a minority, their personal allowance is held in safekeeping so they have access to money when they need it. To ensure the money is accounted for, the records give a total of credits and debits to each persons personal allowance account. The accounts are audited by the manager to ensure that peoples money will be accounted for. We saw in records that people living in the home have access to Court of Protection and advocacy services to ensure they have independent representation. In some instances, peoples family manage their finances or they are able to do this for themselves. We looked at the safety certificates to ensure the building and equipment are safe and well maintained. The certificates and fire safety records were up to date. Records confirmed that staff receive health and safety and moving & handling training so they have the skills to support people safely. There are systems for accident recording and for assessing risk to individuals and the the environment to keep people safe in their home. We have made two recommendations regarding risk management. Bed rails in place for one person did not have the protective bumpers in place which could place the person at risk of becoming trapped in the rails. To ensure bed rails are used safely and are the right option for the person, the following action is recommended. Safety checks on the rails should be carried out frequently, and staff receive training and instruction in their safe use. Although the home has a missing person procedure which sets out the action to be taken by staff in such an event. We recommend that for people who leave the home without an escort, an individual risk assessment be carried out and regularly reviewed. This is to ensure each person is able to do this safely and is not placed at risk when they go out alone. Care Homes for Older People Page 21 of 24 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 22 of 24 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Health care plans should be in place for medical conditions such as diabetes to guide staff and ensure people are receiving the support they need. An internal audit of medication should take place each month to ensure all medication is accounted for and any issues will be identified and addressed. Care plans should be in place for medication prescribed as required (prn). In this way staff will have the guidance they need to this give medication safely and as needed. Risk assessments should be carried out for residents who leave the home without an escort to ensure they are able to do this safely. To avoid people being injured, bed rails should receive frequent safety checks, and staff should be given guidance and instruction to ensure competence in safe use of bed rails. 2 9 3 9 4 38 5 38 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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