Care Home: Holly Grange

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What the care home does well Holly Grange provides a homely atmosphere and is staffed by a committed team who have a good knowledge and understanding of individual care needs. One visiting professional said that there was an holistic approach to meeting individual needs, and that staff seemed to know the residents well and were always well informed. The service has established a good working relationship with local health care professionals and this ensures that treatment and advice is obtained when necessary. Staff were observed with residents and were seen to enjoy positive relationships with them. Residents spoke well of staff and the lifestyle they experienced in the home. Comments from residents included: "I`m very happy and I always tell the manager if I`m not happy. I like my room and I have brought all my own things". "It`s very homely here and the staff are lovely". "Staff are very good, they listen to me". "I can go as I please, staff are great and I enjoy the activities". There is a very good activities programme which provides residents with a range of lifestyle choices. The activities are carefully considered and there is an emphasis on discussing individual choices and preference with residents. The strength or this service is the commitment and dedication from the staff team. The manager and staff have been pro-active in ensuring that there has been stability during a period of change. What has improved since the last inspection? Information in the Annual quality Assurance document (AQAA) informed us that there had been improvements made to the environment. New carpet and flooring had been provided to some areas of the building. What the care home could do better: Residents need to be more involved in the review of their individual care plans. This will ensure that their views on how they want to receive support are fully considered. Care plans need to be reviewed so that all care needs identified are included in the care plans. Medication stock levels need to be audited so that an exact audit trail can be carried out at any time to ensure that medication is being administered in accordance with instructions. Photographs of residents need to be included on the records for identification purposes. The medication cupboard for storing controlled drugs must be replaced with one that meets current legislation. The menu`s and methods of providing meals should be reviewed to ensure that the quality and quantity is suitable for the residents in the home.There were shortfalls in some standards of maintenance in the home and certain areas of the building were suffering from an historic lack of financial investment and monitoring to ensure that the premises remain fit for purpose. There must be a review of management hours so that the registered manager has sufficient time to carry out managerial duties and to monitor care practices in the home. This Will ensure that the health and well being of residents is protected. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holly Grange Holly Grange 17 Oxford Road Dukinfield Tameside SK16 5PQ     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: Ann Connolly     Date: 2 7 0 2 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: Holly Grange 17 Oxford Road Holly Grange Dukinfield Tameside SK16 5PQ 01613300492 01613438730 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Monami Care (Cheshire) Limited Name of registered manager (if applicable) Mrs Patricia Ann Mee Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people 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 Dementia - Code DE Physical disability - Code PD (Maximum number of places: 10) The maximum number of people who can be accommodated is: 27 Date of last inspection Brief description of the care home 27 0 10 Over 65 0 27 0 care home 27 Care Homes for Older People Page 4 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 that included a site visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social care (CSCI) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives and visiting professional. Discussion took place with them to find out what they thought about the home and what they felt about how the staff supported them. A tour of the building took place and residents were asked for their comments and views about the environment. Care Homes for Older People Page 5 of 26 Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service about how they are meeting outcomes for people using the service. The information provided on this occasion was detailed and showed us that this was an organisation committed to the ongoing development of the service and staff team so that residents in the home benefit from positive outcomes. Surveys were sent out to residents and staff and there was a good response which gave us more information about this service. Since the last inspection visit the Commission have not received any recent complaints about the service. There was evidence during this visit that the manger was handling complaints well and followed correct polices and procedures for manging complaints and safeguarding issues. What the care home does well: What has improved since the last inspection? What they could do better: Residents need to be more involved in the review of their individual care plans. This will ensure that their views on how they want to receive support are fully considered. Care plans need to be reviewed so that all care needs identified are included in the care plans. Medication stock levels need to be audited so that an exact audit trail can be carried out at any time to ensure that medication is being administered in accordance with instructions. Photographs of residents need to be included on the records for identification purposes. The medication cupboard for storing controlled drugs must be replaced with one that meets current legislation. The menus and methods of providing meals should be reviewed to ensure that the quality and quantity is suitable for the residents in the home. Care Homes for Older People Page 7 of 26 There were shortfalls in some standards of maintenance in the home and certain areas of the building were suffering from an historic lack of financial investment and monitoring to ensure that the premises remain fit for purpose. There must be a review of management hours so that the registered manager has sufficient time to carry out managerial duties and to monitor care practices in the home. This Will ensure that the health and well being of residents is protected. 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 8 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 9 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. Information about the service is made available so that people can make an informed choice about their future care and support arrangements. An assessment of need is undertaken for all prospective residents prior to offering them a place in the home. Evidence: The statement of purpose and service user guide had recently been updated in July 2008 to reflect the change in ownership and to provide an updated overview of the facilities and services available in the home. This ensures that prospective residents have sufficient information to help them in making an informed choice about future care arrangements. Three care plans were looked at and all of these contained a pre-admission assessment. Care needs were identified and included the expected outcomes for Care Homes for Older People Page 10 of 26 Evidence: residents and gave staff the information they needed to provide care and support services. It was noted that some of the assessment information in one file had not been fully completed. The manager told us that she was aware of some shortfalls in some of the documentation, and said that a full review of care plans and assessment processes was being undertaken. Care Homes for Older People Page 11 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. Residents are treated with dignity and respect in this home. Their health, personal and social care needs are taken seriously. Evidence: Three care plans were looked at. These set out individual and personal care needs and included the action to be taken by the carer to ensure that all aspects of health care needs were met. Some care plans provided more details that others. For example, one care plan only provided information on two identified care needs. However, through discussion with the individual it was evident that there were other needs that had not been clearly identified. Risk assessments were in place so that staff were made aware of important risk issues and the strategies and interventions required to minimise risk. Discussions with staff showed us that they had a good understanding of individual care needs. One visiting Care Homes for Older People Page 12 of 26 Evidence: medical professional spoke highly of the staff team and their ability to respond appropriately and seek medical attention when needed. During this visit we noticed that some residents were wearing coloured wrist bands and we were informed that this so that staff could easily identify the levels of risk for the individual. This practice is institutionalised and does not promote the dignity of the individual person. The manager agreed to immediately remove the wrist bands. Information about risk should be written in care plans and staff should refer to these on a regular basis. Medication records were looked at. There was a record of the signatures of staff responsible for the administration of medication. Medication administration records (MAR) were filled in appropriately and records were in place for the receipt and disposal of medication. There was an overstock of medication and the manager was advised to carry out an audit of stock to ensure that the medication stored in the home matched the information on the MAR sheets. There were no photographs of residents on the medication records. It was recommended that photographs are included on the MAR sheets for identification purposes. A medication cabinet for the storage of controlled drugs was in place but this not meet the current regulations. The cupboard must be replaced Care Homes for Older People Page 13 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. An extensive social and leisure programme is offered to people living in the home. Limited menu options and catering arrangements means that there is limited choice available for preferred dietary preferences. Evidence: An activity organiser is in post and in addition a keep fit co-ordinator visits twice a week. There is an extensive programme of leisure activities available to residents. The activities are varied and offer residents the opportunities to participate at different levels which reflect their individual needs. During this visit a gentle exercises session was in progress and was well attended by residents. The activity offered opportunity to participate as a group and also on a one to one basis. All residents who were spoken to after the session said they thoroughly enjoyed the session. The activity organiser told us that many activities were offered in small groups or on a one to one arrangement when it was evident that this would be more beneficial for the individual participant. A monthly newsletter was produced so that residents were kept informed about the things going on in the home. The activity organiser is also responsible for producing a monthly report which is an evaluation of all activities, Care Homes for Older People Page 14 of 26 Evidence: resident participation and shows consultations with residents about how the activities have been received by them. The consultation process showed us that residents were consulted about their preferred activities. An imaginative approach is used to organising activities and we saw evidence where one resident had been supported to attend the orchestra on a one to one basis. One other resident was being supported to visit the local interest centre in order to research a local history project. A list of events was displayed on the notice board, other activities included art and craft, film shows, creative writing and visits to the local church. Historically the service has experienced difficulty in recruiting and retaining a full time cook. As a result of this, ready made frozen foods were purchased from a local supplier. The meal served during this visit was just adequate. The presentation was bland and the quantity was only just sufficient to serve the residents in the home. There was no opportunity to provide an extra portion had this been requested by a resident. We were only able to sample a spoonful because of insufficient quantities. The meal consisted of mashed potatoes, overcooked frozen cauliflower and minced beef. Menus for breakfast and the evening was more flexible offering some choice. Residents spoken to expressed satisfaction with the meals served. Meals were served in pleasant surroundings and staff were seen offering assistance and support where necessary in a discrete and sensitive manner. It was recommended that the menus and quality of meals are reviewed to ensure that residents are offered a wider choice and to make sure that the meals are nutritious. Care Homes for Older People Page 15 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. Policies and procedures are in place to protect people from abuse. Evidence: There was a policy and procedure in place for reporting and investigating complaints and information was provided to residents in the statement of purpose and service user guide on how to make a complaint. Residents are advised in these documents that their complaints will be responded to within 10 days. Residents who were spoken to said they felt confident in raising any issues of concern directly with the manager of a member of staff. In the last twelve months the service had received five complaints. A record was maintained of the issues raised and the action that was taken. There was a policy and procedure in place to respond to allegations of abuse. Most staff had received training in safeguarding adults. During discussions with staff they were able to demonstrate a good understanding of what to do in the event of any allegation of abuse. Care Homes for Older People Page 16 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. A homely environment is provided for residents. Bathroom facilities and plumbing systems are not sufficiently maintained for practical day to day use. Evidence: A Tour of the building took place. The main communal areas lead to a number of corridors which lead to bedroom accommodation. There was a lack of signs to direct people around the building or to assist residents in finding their bedrooms. Some of the bedrooms would not be suitable for people with poor mobility as corridors lead to a series of steps that need to be negotiated in order to access some of the bedrooms and bathroom areas. The lounge area had an institutional layout with chairs set against the walls and with a television set on a high shelf in the corner of the room. A table was positioned in the middle of the room and one member of staff was sat there observing residents. This also appeared institutional. The experience for residents would have been improved if the member of staff had sat with residents to chat and engage in meaningful conversation. The manager addressed this practice with the member of staff at the time of inspection, and she told us that the layout of the room would be reviewed. A full time maintenance person was employed on a full time basis. he had completed a Care Homes for Older People Page 17 of 26 Evidence: series of courses including hazard analysis. He was responsible for minor repairs and re- decoration. Some areas of the building were well maintained and pleasantly decorated, for example, the communal lounge and conservatory area. Other areas were poorly maintained. Bathrooms were outdated and poorly decorated. The plumbing and heating system presented a consistent challenge to the manager as it was not functioning properly on a consitent basis. The water flow in the main bathroom was slow and presented as a potential hazard if left unattended whilst filling a bath. A very hot radiator on the bathroom was not covered and presented a health and safety hazard. This was addresses during this visit, and a cover was fixed over the radiator to protect residents from a potential hazard. The building was clean and tidy and there was evidence that staff had received training in infection control. It was evident from discussion with the manager and from testing water supplies to main outlets, that there were problems with the heating and water systems in the home. The manager told us that the new owner was in the process of obtaining estimates in order to update the system. It was recommended that an audit of the building needed to be undertaken and that an action plan needs to be developed to show how the home is maintaining standards in the home to ensure that residents enjoyed a positive experience from their environment. Care Homes for Older People Page 18 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. The needs of residents are met by a well trained staff team. Evidence: During this visit there were sufficient numbers of staff on duty to meet the assessed needs of residents living in the home. There was a stable workforce with a low staff turnover, which helps to provide continuity of care. The staff training records were looked at. Nearly all staff had achieved NVQ level 2. There was evidence that mandatory training in health and safety and moving and handling had been completed by staff in 2008. Nearly all staff had completed training in dementia care. Staff who were spoken to said that training opportunities were always available. Three staff files were looked at and these contained all the required documentation which included Criminal Record Checks (CRB), references and identification checks. Residents in the home were complimentary about the staff. Some of their comments included: Staff are very nice, I can talk to them. Care Homes for Older People Page 19 of 26 Evidence: I like it here, everyone is so pleasant and helpful. Its a lovely home and the staff are lovely. Care Homes for Older People Page 20 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 manager of the home has the skills and experience to manage the home, but there are insufficient hours to ensure that policies and procedures and the day to day running of the home is consistently effective. Evidence: The registered manager has the appropriate skills and experience to manage the home, and there was evidence during this visit of a commitment to ongoing personal development. The recent change in ownership has increased the day to day responsibilities and task undertaken by the manager. Many of these tasks were completed by the previous owner. The manager must be given sufficient management hours to complete her managerial duties in a way that ensures the health safety and well being of the residents and the staff in the home. Currently she has eight hours per week for management tasks, the remainder of her time is spent supporting staff with care Care Homes for Older People Page 21 of 26 Evidence: duties. This arrangement must be reviewed urgently. Systems were in place to protect and support residents in the managing of their finances. a small amount of money was held by the home for small transactions. There was a full list of all expenditure with a running total and receipts to evidence any financial transactions. Large amount of money were held by client finances at Tameside social services. There was evidence of ongoing supervision programmes for staff. Staff told us that they felt well supported by the manager and felt they could approach her with any issues of concern. During this visit, there was no evidence available to confirm that the registered owner had made visits to comply with Regulation 26 of the Care Homes Regulations 2000. The registered owner should make visits to the home each month and should interview, with their consent, and in private, people who use the service and their representatives, and staff working in the home. This report should also include an inspection of the home, its records and events and records of any complaints. There was evidence to show that this service works well with us and continues to keep us informed of anything that affects the health and well being of the residents in the home. Care Homes for Older People Page 22 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 23 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 9 13 The medication cupboard for 21/05/2009 storing controlled drugs must be replaced with one that meets curreent legislation This will ensure that medication is stored safely. 2 19 23 The plumbing facilities throughout the home must be upgraded so that they are fit for purpose. This is so that residents can safely use bathroom facilities . 15/04/2009 3 33 26 The owner must arrange for 05/05/2009 regular visits to be made to the care home in accordance with this regulation. The owner must arrange to interview, with their consent, and in private, the people using the service, their representatives, and staff. A record must be maintained of these visits. Care Homes for Older People Page 24 of 26 This is so that the day to day operation of the home is monitored and so that the views of people living in the home are listened to and responded to. 4 33 10 Systems must be developed 30/04/2009 to ensure that the registered manager has an overview of the day to day operations of the home. This will ensure the health, safety and well being of residents is protected. 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 9 The medication records should contain a photograph of residents for identification purposes. This will ensure that residents receive the correct medication. Meals served in the home need to be reviewed to ensure that residents are offered a choice, and to make sure that they are nutritious and in sufficient quantity. A full audit of the building needs to be undertaken and any work identified must be included in a programme of routing maintenance and renewal of the fabric and decoration of the building. The registered manager must be given enough supernumerary hours to manage the care home in order to make sure that working practices are monitored regularly to ensure the health, safety and well being of the people who live there. 2 15 3 19 4 31 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). 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