Care Home: Holly House

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What the care home does well The residents and their relatives consistently speak very highly of the care provided and the quality of their accommodation. Examples include: • • • • • • “I think it’s a wonderful place” “It’s a very well organised place”. “We have a laugh”. “We have nice parties”. “They are jolly nice, no grumbles at all”. “They are very kind”.There is a very relaxed atmosphere and residents have a good rapport with the home’s managers and staff. Staff turnover is low and so staff get to know residents very well. Residents and visitors always comment positively about the cleanliness of the home and the quality of the food. The proprietors continually make improvements to, and maintain the environment to a high standard. Every resident has a plan of care which gives staff important information about how best to care for them. People who use the service have good access to outside health professionals. Staff understand the importance of reporting any potential safeguarding matters to the appropriate authorities so that residents are safe from harm.Holly HouseDS0000010640.V378489.R01.S.docVersion 5.2 What has improved since the last inspection? One requirement and one good practice recommendation were issued at the last inspection. These have both now been complied with. Medication is recorded accurately when received by the home. The names of staff who are qualified to administer medication is recorded on the front of the medication charts. What the care home could do better: No new requirements have been given as a result of this inspection. Four good practice recommendations have been issued as a result of this inspection. These relate to pressure care assessments, the recording of residents’ allergies, PRN medication protocols and fire drills for night staff. Key inspection report CARE HOMES FOR OLDER PEOPLE Holly House 24 Queen Anne`s Place Enfield Middlesex EN1 2PT Lead Inspector Mr David Hastings Key Unannounced Inspection 19th November 2009 09:30 DS0000010640.V378489.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Holly House DS0000010640.V378489.R01.S.doc Version 5.2 Page 2 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 Holly House DS0000010640.V378489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly House Address 24 Queen Anne`s Place Enfield Middlesex EN1 2PT 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) 020 8360 7622 020 8360 7622 mary@hollyhousecarehome.co.uk John Noel Holland Mrs Mary Alexandra Holland John Noel Holland Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Holly House DS0000010640.V378489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th October 2006 Brief Description of the Service: Holly House is a privately run care home owned by Mr and Mrs Holland. Mr Holland is also the registered manager. The home provides personal care and support for 16 older people of both genders. The home is in a large three-storey detached building, situated in a tree-lined avenue in the pleasant residential area of Bush Hill Park, near Enfield. There are restaurants, shops and a post office nearby and there are good public transport links to the area, including an underground station. The home has 12 single bedrooms and 2 shared rooms on three floors, all individually decorated. On the ground floor, there is a lounge and separate dining room. A lift provides access to the upper floors. A paved area at the front of the building provides some car parking. There is a large conservatory and an attractive garden at the rear of the premises. The home aims to provide a high quality of personal care and support for people who are over 65 years of age. The fees for the service range from £550 to £600 per week. Holly House DS0000010640.V378489.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This Key Unannounced inspection took place on Thursday 19th November 2009. In total the inspection lasted 6 hours. We were assisted by the registered manager and deputy manager who were open and helpful throughout the inspection. We spoke with 5 staff on duty during the inspection. We spoke with 10 residents of the home and we met 1 visitor. We observed the interactions between staff and residents. We inspected the building and examined various care records as well as a number of policies and procedures. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission. This information was used as part of the inspection. What the service does well: The residents and their relatives consistently speak very highly of the care provided and the quality of their accommodation. Examples include: • • • • • • “I think it’s a wonderful place” “It’s a very well organised place”. “We have a laugh”. “We have nice parties”. “They are jolly nice, no grumbles at all”. “They are very kind”. There is a very relaxed atmosphere and residents have a good rapport with the home’s managers and staff. Staff turnover is low and so staff get to know residents very well. Residents and visitors always comment positively about the cleanliness of the home and the quality of the food. The proprietors continually make improvements to, and maintain the environment to a high standard. Every resident has a plan of care which gives staff important information about how best to care for them. People who use the service have good access to outside health professionals. Staff understand the importance of reporting any potential safeguarding matters to the appropriate authorities so that residents are safe from harm. Holly House DS0000010640.V378489.R01.S.doc Version 5.2 Page 6 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 order line – 0870 240 7535. Holly House DS0000010640.V378489.R01.S.doc Version 5.2 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 Holly House DS0000010640.V378489.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home carries out an assessment of individual’s needs so that they know that the home is able to meet their needs before they decide to move in on a trial basis. EVIDENCE: Pre admission assessments were examined for three people who are now living at the home. The information was detailed and clearly outlined each person’s individual needs. The manager told us that he would normally carry out these pre assessments. There was evidence that these identified needs were also being recorded in each person’s individual care plan. People who use the service told us that they were involved in this assessment process and, where possible, had visited the home before moving in on a trial basis. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 9 The visitor we spoke with told us that the home had told him that he could visit the home at any time and that his family were impressed with the openness of the service. We also saw evidence that people have a review of their placement after 4-6 weeks to see if they would like to stay at the home on a permanent basis. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans clearly set out residents’ health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: A sample of four residents’ care plans was examined. The care plans included risk assessments for moving and handling, and the risk of falls for residents with mobility and sight problems. Each person has a nutritional assessment carried out to highlight any possible problems with eating and drinking. We have made a good practice recommendation that risk assessments are carried out for everyone in relation to pressure care. Most of the residents are very mobile and no one at the home has any pressure sores. We saw that the home Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 11 has organised pressure relieving equipment for some people as a preventative measure. The care plans were being reviewed monthly, and annual care reviews by placing authorities were carried out. In some cases, the care plans were signed by the residents and/or their representatives. Residents attended a range of healthcare appointments; for example, hospital outpatients, the G.P, optical, chiropody and dental services. One person has diabetes and the district nurse visits the home twice a day to support them. People we spoke with told us they were happy with the healthcare arrangements organised by the home. One resident told us that she could see the doctor whenever she needed to. She said the doctor visits the home or, “The boss takes you there”. The accident book showed that accidents were appropriately recorded and if necessary, these were followed up by referrals to the G.P or hospital. All residents were weighed monthly, and a quarterly review of their dependency levels were carried out to monitor their health and care needs. Satisfactory records were examined in relation to the receipt, storage, administration and disposal of medication. Records indicated that staff have undertaken medication training and only qualified staff administer medication at the home. We have issued two good practice recommendations in relation to medication to ensure that the home complies with current best practice. We saw a number of examples of supportive staff interactions with people and staff were able to describe to us how they ensure the privacy of people they support. People we spoke with told us that the staff were respectful and kind towards them. One resident told us that the staff, “Look after the guests very well”. Another resident commented, “There is a lot of personal attention given to people”. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides varied activities for people who use the service in order to keep them suitably occupied and engaged. Visitors to the home are encouraged and welcomed. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. EVIDENCE: The activities are led by the staff and by outside providers, and include armchair exercises, music therapy, bingo sessions and shopping trips. Some residents were seen reading newspapers and books. During the summer, residents went on various outing to local places of interest including strawberry picking. There is a large attractive and well-maintained garden for the residents to sit out in when the weather allows. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 13 A minister of religion also visits the home regularly and some residents attend church services. Residents can see relatives in private in their rooms or in the quiet lounge area. A payphone is provided for the residents’ use. Relatives told the inspector that they could visit at any time and they were always warmly greeted by the staff. Their visits are recorded in the visitors’ book. Residents who were spoken to said that they could choose to opt out of activities and chose when to get up or go to bed. They also said they were consulted about what they wished to eat. There was plenty of food available in the kitchen stores, fridges and freezers and was safely stored. The cook told us that she would design the menu and that this would be agreed and reviewed at residents’ meetings. The menu contained a good variety of meals and was balanced and nutritious. The residents said they were very satisfied with the catering and there was always an alternative option available, including vegetarian dishes. Fresh fruit was also available. The cook was interviewed and had an excellent knowledge of individual resident’s dietary needs and preferences including cultural or religious needs. The kitchen was inspected last year by the local environmental health department and was awarded four “scores on the doors”. One resident told us, “They cook a damn good dinner”. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that any complaint will be taken seriously and dealt with in an open manner and within set timescales. People who use the service are protected from abuse by clear policies and procedures and by a well-informed, trained staff group. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. All the residents and visitors we spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. We examined the complaints record. There have been a few recent minor complaints about the service. Records indicated that these concerns had been dealt with appropriately by the manager and included details of action taken. People we spoke with told us they were confident that the manager would deal with any complaints or concerns properly. One resident said the manager was very approachable and, “Anyone can talk to him”. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 15 Staff were able to describe how vulnerable people could be at risk of abuse in a residential care setting. All staff interviewed were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that we spoke to said they felt safe and well supported at the home. Records indicated that most staff have undertaken training in the protection of vulnerable people. A resident we spoke with told us, “I do feel safe”. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe and maintained to a very good standard. People who use the service are protected by clear policies and procedures in relation to infection control. EVIDENCE: A tour of the premises showed that the home was very well maintained and there was a high standard of décor throughout. The garden was well maintained and contained suitable furniture for residents to sit out. The furniture in the lounges was appropriate to meet the residents’ needs and was in good condition. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 17 Thermometers are provided in the bathrooms to ensure the temperature of the water is safe for residents. New electronic door closures have been provided throughout the home which means that residents can have their door open at night but these doors will close automatically if the fire alarm goes off. Several bedrooms were seen, which were very attractively furnished and decorated. There were restrictors on the windows. There was ample evidence of personal possessions and mementoes that residents had brought with them when they moved in. The laundry is a well equipped with washing and drying machines and facilities for ironing clothes. The home had a very homely atmosphere and was very clean and tidy. There were no offensive odours, and cleaning materials were safely stored. Disposable aprons and gloves were available for staff to assist in the control of infection. The home has extensive policies and procedures in relation to infection control and staff have undertaken infection control training. All toilets contained anti bacterial soap and paper hand towels to limit the risk of cross infection. One resident told us, “Every time I walk in the loo they are perfect”. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home work hard to meet the needs of the residents and are provided with excellent training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to protect residents at the home. EVIDENCE: The staff rota showed that there were sufficient numbers of staff on duty at all times to meet the residents’ needs. Residents said that staff were always available and were prompt to attend to them. One resident commented that the home is, “Well run with good staff and a good boss”. A number of staff have worked at the home for a long time and staff turnover is low. Staff undertake a written “Skills for Care” induction when they start work in the home, and at the time of the inspection, eleven out of fourteen staff had attained the National Vocational Qualification level 2. This exceeds the requirement for this standard. The registered manager and deputy manager are both assessors for this qualification. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 19 Staff records also showed that they had been trained in mandatory health and safety subjects. Other training included dementia care and adult protection procedures. Staff we interviewed were positive about the training opportunities available to them. Three staff files were examined from staff recently employed by the home. We checked these files to see if the home’s recruitment procedures were being followed so that residents are protected from unsuitable staff working at the home. The files examined contained all the information needed to protect residents including two written references, proof of identity and criminal record checks. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience excellent 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 knows the residents very well and understands their needs. Residents have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: Staff, visitors and residents were all very positive about the registered manager. Staff told us he was supportive and that he looked after both residents and staff. Residents told us he was approachable and understanding. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 21 We saw excellent interactions between the manager and staff, residents and visitors on the day of the inspection. Yearly quality assurance questionnaires are given to residents, their relatives and other stakeholders. The results of these quality assurance exercises are then published and made available to interested parties. An action plan is also developed so that improvements to the service can be acted upon. There are also regular residents’ meetings so that people can have a say in how the home is run. No money is held by the home on behalf of residents. Lockable storage is provided in each bedroom so that residents can keep money and valuable safely. Residents’ relatives or representatives deal with their finances. Satisfactory health and safety records were seen in relation to electrical installation, PAT testing, gas safety and equipment servicing such as hoists and lifts. We also checked records in relation to fire safety. Records indicated that staff were undertaking fire drills on a regular basis. However most of these drills were taking place during the day. It is vital that night staff have regular fire drills so they understand the action they need to take if a fire occurs at night. A good practice recommendation has been issued relating to fire drills for night staff. Fire training has been given to staff and staff confirmed they have undertaken this training. Records of checks for the fire alarm, emergency lighting and fire extinguishers were also satisfactory. Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 22 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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP8 OP9 Good Practice Recommendations The registered manager should ensure that all residents are assessed for the risk of developing pressure sores and that these assessments are reviewed regularly. The registered manager should ensure that any known allergies of residents are clearly displayed on each person’s MAR chart. Where none are known this should also be recorded on the person’s MAR chart. The registered manager should ensure that any “As required” medication (PRN) must include information for staff regarding when to administer it, recorded on the person’s MAR chart The registered manager should ensure that night staff receive fire drills at night so they are confident about what action they need to take. 3. OP9 4. OP38 Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 24 Holly House DS0000010640.V378489.R01.S.doc Version 5.3 Page 25 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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