Care Home: Holly Court

What the care home does well We saw that care plans were generally quite clearly written to show how people could be supported to have their needs met. We saw that the environment was clean which made the environment pleasant for the people living at the home. We saw staff had some time to sit and chat with people and one staff member was supporting people to have their finger nails trimmed.We saw in the records that staff monitored people`s weight and there were records to show the involvement of the dietician. We saw that staff supported people to eat their meals appropriately encouraged people to be as independent as possible. What the care home could do better: The manager was reminded of the need to make sure care plans were updated when a person`s needs changed. The care plans should include more detail in relation to a person`s nutritional input during any 24 hour period particularly if they are assessed as "High risk" of malnutrition. We discussed the need to have a copy of an up to date photograph of a person in the care plan to show how the person currently looks. We talked about the possibility of having some storage area on the first floor where care plans and records could be held so that staff have access to the whole care plan readily. Random inspection report Care homes for older people Name: Address: Holly Court 8 Priory Grove Salford Gtr Manchester M7 2HT two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elizabeth Holt Date: 0 9 0 3 2 0 1 0 Information about the care home Name of care home: Address: Holly Court 8 Priory Grove Salford Gtr Manchester M7 2HT 01617080174 01617050656 hollycourt@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Michael McPherson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Healthcare Services Ltd care home 25 Number of places (if applicable): Under 65 Over 65 24 dementia Conditions of registration: 1 One named individual currently accommodated is below 65 years of age. If this service user leaves, the service user category will revert to DE(E). Date of last inspection Brief description of the care home Holly Court is a care home offering personal care only to 25 older people diagnosed with dementia. The home is situated in a residential area of Salford within close walking distance of local community facilities. Holly Court is a purpose built provision owned by Southern Cross Healthcare. The accommodation comprises of 25 single ensuite rooms and appropriate communal facilities on two floors. Catering and laundry are conducted from Laburnum Court, a provision in close proximity to the home and also owned and managed by Southern Cross Healthcare. Fees for accommodation at Care Homes for Older People Page 2 of 10 Brief description of the care home the home are £373.52 to £480.00 per week. Additional costs; Hairdressing, newspapers, toiletries, chiropody and aromatherapy. Care Homes for Older People Page 3 of 10 What we found: An unannounced Random Inspection visit was carried out to Holly Court on the 9th March 2010. The purpose of the visit was to look at issues raised at the last Annual Service Review. These were in relation to the any complaints made to the service since the last review. A concern had been raised with regards to a number of concerns, the staff were not assisting someone to have drinks, a person had received bed sores whilst in the care home, poor staff attitude , meals were left uneaten without staff supporting people appropriately. We arrived at the home at 10.30 am there were two staff on each floor and the deputy manager. Discussions were held with the registered manager to explain the purpose of the visit. The registered manager had a prior planned appointment and was unable to remain present during this inspection. The area manager visited the home and feedback was given by telephone to the manager the day after the visit. During the visit we looked at care plans, medication records together with the medicines held by the service, accident records, complaints records and staff training records. Time was also spent in discussion with people living at the home, two relatives, care staff and management. Health and Personal Care. We were told by the manager at the time of this visit that there were no people currently living at the home with pressure sores or wounds. Two care plans were looked at during this visit and the person to whom the care plan belonged to was spoken to. There were records of the assessment, care planning and daily record keeping for each person held on file. There was evidence to show care plans were generally updated and evaluated on a regular basis or when a persons needs changed. For one person who has significant weight loss, the care plan for nutrition included their likes and dislikes. A malnutrition universal screening tool (MUST) was in place which showed their weight had increased by 2.7kgs over a five week period. Staff spoken to stated this person, ate everything x was given and we give x milky drinks and high calorie snacks. The care plan had been updated to show recent advice from the dietician, including adding sugar to the prescribed complan and evidence of weekly weights were recorded. We discussed the recording of the monitoring of this persons food intake and recommended that the care plan was even more detailed in relation to this persons dietary intake or there was a record to show the additional supplements they were given during any twenty four hour period. This would clearly show the nutritional input this person was receiving. Two care staff spoken to could talk about this persons needs and how they supported them in a confident manner. There were records of visits from professionals including entries from visits by dentists, opticians and Community Psychiatric Nurses. The manager was reminded of the need to make sure the care plans were updated when a persons needs changed. An example was that a person needed two staff to support them with their personal hygiene needs and support to get dressed however the care plan stated one staff member only. A review of the care plans showed there were body maps in place. For one person there was no record to show this had been reviewed since July 2009. A recommendation was made for staff to update this to demonstrate the observations had been made. We saw Care Homes for Older People Page 4 of 10 that risks had been identified and risk assessments were in place. The photograph of a person who had significant weight loss, had not been updated in the care plan. The photograph on the medication administration record (MAR) had been replaced and a recommendation was made for the photograph in the care plan to be updated to show how the person looks currently. We saw that all care plans were stored on the ground floor apart from a folder of the daily statements. This means that staff may not always have access to the care plans and when completing the daily records are not reviewing or thinking about the persons identified needs. We talked about the possibility of having some storage area on the first floor where care plans and records could be held. We looked at the medication administration system to assess how safe it was for people. Medication was appropriately stored in a locked room. The sample of medication administration records looked at showed these were accurately completed. One recommendation was made for Lorazepam (a drug used generally for anxiety) which stated take one when required. Some further guidance should be given for staff to demonstrate when they should administer this. The manager said that regular audits were in place which were showing any shortfalls and they were then acting upon these. Following a recommendation made at the last key inspection in September 2008, improvements were seen in relation to the systems in place for the disposal of medication. One shortfall was seen in relation to respecting the dignity of people living at the home. One persons name was written in large letters across her cardigan in a permanent marker. The deputy manager did agree with this not respecting the persons need for dignity and stated she would address this. During the site visit people were seen to be appropriately dressed and generally attention was paid to their hair. Daily Life and Social Activities. On the day of this visit the lunchtime meal was served from a hot trolley and the dining tables were pleasantly laid. There was a choice of pork steak or haddock and vegetables. The dessert was a choice of cherry pie and custard or cream, yoghurts or fresh fruit and biscuits. Staff spoken said they had received some training in the dining room experienceand had found this useful. We saw that a staff member supported a person to eat their meal and sat next to them to do this. People were seen with plate guards or appropriate cups to support them to eat their meals with as much independence as possible. A visitor to the home asked a staff member what was on the menu for the day so she could tell her relative. The staff member was not aware although they did go to find out. It would be good practice if the staff knew in advance of the mealtime what was on the menu so this could be shared with the people before meal time. One person made a comment that the food was tasty. The activities organiser was on duty in the afternoon and people enjoyed some exercises to music and some one to one activities. Complaints and Protection. A recommendation was made at the last inspection for the manager to ensure all Care Homes for Older People Page 5 of 10 complaints were recorded, including the outcomes so that staff could identify any patterns and modify practice or procedures if necessary. We saw improvements in this area as there was a record of the three complaints received by the service and the action taken by the manager to address these. Staffing. A recommendation was made at the last inspection for prospective staff to give a full employment history, including the reasons for any gaps. Two staff members application forms were looked at which showed full employment histories. At the time of this visit there were 12 people on the first floor who were supported by a senior care worker and a care worker. On the ground floor there were 11 people supported by a senior care worker and a care worker. The deputy manager moved between the two floors. The staffing levels were sufficient to meet the needs of the people during this visit. Staff spoken to did raise some concerns that if the two staff on the floor were needed away from the lounge/dining room to support a person to have their needs met. They felt they were potentially leaving people at risk because the room would be left unsupervised. During this visit one person presented with behaviour towards another person living at the home which required the intervention of staff, however the staff were in the room at the time to deal with this situation. The staffing levels should be monitored and assessed to make sure peoples needs can be met in full. Staff spoken to were positive about the support they received from the management and in relation to the training they received. One person said, In the last six months I have had training in dementia care, fire, infection control, food and nutrition, safeguarding adults, first aid and medication. we have supervision from our manager and there are staff meetings where we can share ideas and plans for the residents. All staff spoken to were pleasant in their manner and were overheard talkng to people at the home in a pleasant manner. Management and Administration. A recommendation was made at the last inspection for the management to develop the quality assuarance programme to include an action plan to show how the staff can further improve the service provided to the people living at Holly Court. A discussion with the manager highlighted this had been addressed and on the 4th March a relatives meeting had been held to gather their views. We were told that surveys were due to be sent out to see if there were further ideas to improve the service provided. What the care home does well: We saw that care plans were generally quite clearly written to show how people could be supported to have their needs met. We saw that the environment was clean which made the environment pleasant for the people living at the home. We saw staff had some time to sit and chat with people and one staff member was supporting people to have their finger nails trimmed. Care Homes for Older People Page 6 of 10 We saw in the records that staff monitored peoples weight and there were records to show the involvement of the dietician. We saw that staff supported people to eat their meals appropriately encouraged people to be as independent as possible. 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 set out on page 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 7 Care plans, including body maps and photographs should be updated when a persons needs have changed to make sure they show the support the person needs and show an up to date picture. The care plans should include more detail in relation to a persons nutritional input during any 24 hour period particularly if they are assessed as High risk of malnutrition. The care plan should be kept together and be readily available for staff to read and add to. For as required medications, the guidelines on the medication charts should be made clear for staff so these medicines are given to people appropriately. The labelling of peoples clothes should be discreet to enable peolpe to have dignity. Staff should be aware of the days menu so they can talk to people and visitors about the meal choice of the day. 2 7 3 9 4 5 10 15 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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