Care Home: Holly House And Oak Field

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What the care home does well Thorough assessments are undertaken of each person who may be admitted to the home to ensure that the home is able to meet their needs. Care plans are individualised with clear instructions for staff to follow to support people. A varied programme of activities both inside and outside of the home is provided. The home also enables some people to develop more independent lifestyles which may result in them moving on from the home. The home has been maintained to provide a clean, safe and comfortable environment. New Staff receive a thorough induction training and half of the staff have achieved a National Vocational Qualification (NVQ). In addition staff receive training in a number of areas relevant to the needs of people using the service. The home is well managed with a variety of quality assurance and safety checks in place to ensure the well being of people who use the service. What has improved since the last inspection? The Statement of Purpose has been updated to provide more information about the range of needs that the home can meet. People using the service have better access to dental services. There has been an improvement in recruitment practices which are now more robust and so provide better protection for people who use the service. What the care home could do better: The home should obtain copies of assessments or care plans from a person`s funding authority before admission. An improvement is needed with the storage of controlled drugs so that the home complies with current legal requirements. Some improvements are needed around handwritten directions for giving medication and instructions for staff in giving certain types of medication. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Holly House And Oak Field 303 Gloucester Road Cheltenham Glos GL51 7AR     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: Adam Parker     Date: 2 5 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 27 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Holly House And Oak Field 303 Gloucester Road Cheltenham Glos GL51 7AR 01242522404 01242522404 manager.hollyhouse@pracscare.com.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tracs Ltd Name of registered manager (if applicable) Miss Sharlene Ellen Quinn Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: That the PD(E), MD(E), LD(E) Category refers to one named service user and will be removed when the service user leaves the home Date of last inspection Brief description of the care home Holly House and Oakfield is registered to provide care and accommodation for up to 12 people with a learning disability, physical disability and/or enduring mental health difficulties. It is run by TRACSCARE; a specialist provider of care for people with acquired brain injuries and learning disabilities. The home is situated on the outskirts of Cheltenham. There are local facilities nearby including shops, a post office and a college of further education. The home has been adapted from two properties. There are 12 single rooms, three bathrooms, two lounges, a dining room and a kitchen. A conservatory is used as an area for activities such as art and crafts. Care Homes for Adults (18-65 years) Page 4 of 27 0 12 12 Over 65 1 0 0 care home 12 Brief description of the care home Each person has a copy of the Statement of Purpose and Service User Guide; further copies are available in the hall and from the office. A copy of the last inspection report is displayed in the office. Fees for people living at the home range from 900 pounds to 1500 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 27 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An inspector carried out the inspection visit on one day in February 2009. The registered manager of the home was present for inspection visit that consisted of a tour of the premises and examination of peoples care files. In addition training was looked at as well as medication storage and administration and documents relating to the management and safe running of the home. An (Annual Quality Assurance Assessment) AQAA was completed by the registered manager and provided for the inspection. This gave us the information we asked for about the service. Two people were selected for inspection against a number of outcome areas as a case tracking exercise. During the inspection visit three people using the service were spoken to to gain their views. Care Homes for Adults (18-65 years) Page 6 of 27 The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. 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 set out 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. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 who use the service receive comprehensive assessments prior to admission to ensure that their needs can be met. Evidence: Although it was not checked in detail the homes Statement of Purpose had been updated following a requirement issued at the previous inspection and included information about the range of needs that the home can meet. The information gathered for the person most recently admitted to the home was looked at. The person was assessed at the care home they were living in another part of the country by an assessor from the head office of the registered provider and the registered manager of Holly House. This resulted in a comprehensive assessment report being completed before the person was admitted to the home. In addition an overnight stay was also arranged for the person at Holly House before the day of admission. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: Despite the thoroughness of the assessment completed and information being obtained from the previous care home and the local mental health services, no information had been obtained from the persons funding authority and attempts to obtain this information should be made for future admissions to the home. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 individualised approach to care planning with comprehensive risk assessment, gives staff clear information on how people can be supported to live their lives. Evidence: One persons care plan looked at indicated that the person needed a structured daily routine. Detailed actions were recorded for staff to follow in particular with how support would be given to enable the person to participate in activities both inside the home and in the wider community. Reactive management plans had been written for the management of challenging behaviour and these used positive interactions through the use of recognised techniques. A care plan for one person looked at as part of the case tracking exercise showed that they had been supported in their decision making with taking part in certain activities. Information about advocacy services was available in the home and these services had been used in the past. The AQAA document reported that All clients have a money Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: handling assessment in order to provide them with the correct level of support. An example of one of these assessments was looked at for one person. A number of risk assessments had been completed for such activities as smoking, support in the community and personal care. Risk assessments looked at were very detailed and comprehensive. Some risk assessments were linked to activities and took into account safety issues when the person was involved in cooking and making use of the kitchen. In the past the home has demonstrated that it has acted appropriately in relation to an unexplained absence of a person using the service. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 use the service are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. Evidence: On the day of the inspection visit it was noted that a number of people were preparing for activities outside of the home with varying degrees of staff support. Some of the people using the service had been taking part in educational courses and vocational training. The registered manager reported how one person had recently moved on from the home to a more independent style of living. All people using the service had free bus passes to enable them to access outside activities and the local community. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: An activities record for one person using the service showed that they engaged in a wide range of activities such as going for walks, puzzle books, swimming, crafts and attending church. One resident spoke of how they went shopping and helped with meal preparation. Staff support people to engage in activities in the community in the evenings if needed and one resident who is more independent went out alone to the Cinema and to lunch. People are also supported to maintain contact with family and friends. During the inspection visit two people were observed taking part in an art and craft activity with one member of staff who in turn was being assessed for their NVQ. The registered manager reported that subject to risk assessment some people were given keys to their rooms and front door keys although some chose not to keep these. The main meal in the home is offered in the evening except on a Sunday. The menu was chosen through discussion at meetings by the people who use the service. The menu included a vegetarian option and was changed every week for four weeks. An individual record is kept of the meals eaten by each person. As well as some people who help with meal preparation, other people contribute towards meals by growing salad in the garden. One person spoke positively about the meals provided and another stated that the food is good. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People who use the service have their health and personal care needs met although some improvement is needed with systems to fully ensure that their medication needs are met. Evidence: Care plans detailed the actions that staff needed to take to support people with personal care such as bathing, showering and changing of clothes. A daily record had been made of the personal care that people had received. There was evidence of peoples health care needs being met through contact with General Practitioners (GP) for health checks and injections. People had also been receiving input from a chiropodist and one person had been receiving dental treatment at the local hospital. One care plan recorded the input of a community mental health team in meeting a persons needs. The arrangements for medication storage, administration and recording were checked. Medication was stored securely with temperatures recorded that were being kept at Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: correct levels. The cabinet for controlled medication was checked and was not in line with current legal requirements in terms of wall fixings. The home should make the necessary improvements so that any controlled medication can be stored correctly. Examination of the Medication Administration Records (MAR) showed that there were no gaps in the recording of administration. However handwritten directions on the MAR had not been signed, dated or checked for accuracy and this included one unsigned handwritten entry for Lorazepam. Where medication is prescribed on an as required basis there were individual written guidelines for staff to follow for when to give the medication. Guidelines for the administration of pain reliving medication were good although the guidelines for medication such as Diazepam or Lorazepam should include more detail about when to give the medication in relation to what is known about a persons behaviour. One guideline looked at noted possible side effects although indicated that the medication was to be given for anxiety. Various weekly checks were in place on medication stock levels, recording, administration and disposal. The homes AQAA document told us how all staff receive accredited training in handling medication. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Systems are in place that safeguard people from possible harm or abuse and allow for complaints and concerns to be raised by them or on their behalf. Evidence: The complaints procedure was displayed in the home and included the contact details for the Commission. The homes AQAA document described how the complaints procedure is explained to people when they are admitted to the home. The home had a complaints register and the information about a recent complaint was looked at. This had been made by the family of a person using the service. Full details of the investigation and correspondence with the complainant were held on file. This demonstrated that the issues raised had been followed up and actions created for future improvement of the service. The registered manager reported that the complainants were satisfied with the investigation undertaken by the home. The home has a policy and procedure for dealing with allegations of abuse to people who use the service. This includes referring the issue to other agencies such as the local authority. In addition the home has a whistle blowing policy setting out guidelines for staff who may need to report any issues of concern. Staff in the home have received training in protecting vulnerable adults from an external trainer as well as the local authority Alerters training. In addition there is an annual in house training session on abuse prevention and reporting. Staff receive training on dealing with Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: challenging behaviour at induction. The homes AQAA document told us that they have a plan for preventing institutional practices. In addition there were robust procedures in place to monitor peoples individual finances and protect them from possible financial abuse with secure storage facilities available. Care Homes for Adults (18-65 years) Page 19 of 27 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 have the benefit of living in a well-maintained and clean, environment with personalised individual rooms. Evidence: A tour of the premises was undertaken. All areas of the home inspected were found to be clean, well maintained and decorated and smelt fresh throughout. The front lounge contained a television, information about the home and about advocacy services. The dining room where some people were eating their breakfast had been recently redecorated. A conservatory in the annex part of the building was in use as art and craft room, this had previously been used as a smoking room. Individual rooms looked at showed various degrees of personalisation. One room was equipped with some kitchen facilities for the use of any resident developing a more independent lifestyle although this room was empty at the time of the inspection visit. The laundry situated in an outbuilding had washable floor and wall surfaces and arrangements for hand washing. Care Homes for Adults (18-65 years) Page 20 of 27 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff training is undertaken in a number of areas to meet peoples needs with robust recruitment practices in place. Evidence: At the time of the inspection visit half of the staff at the home had achieved an NVQ with a further four undertaking this qualification. Staff had also completed training in epilepsy which is relevant to the specific needs of some of the people using the service. The homes AQAA document told us that the home had supported staff to undertake external training courses where a need for this had been identified. Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history against which any gaps in employment could be explored. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. Staff induction training is carried out over a twelve week period and during the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: inspection visit, some examples of completed training documentation were looked at. Induction training is in line with national specifications and leads on to NVQ. Areas covered in the induction training are Understanding the clients perspective and specific clinical subjects such as Acquired Brain Injury and Mental Health. Staff have a training evaluation form completed annually and the registered manager reported that attendance at training sessions is monitored. One person using the service described staff as Very good. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 home is well managed with a variety of quality assurance audits in operation and safety checks to ensure that the home is run in the best interests of people who use the service. Evidence: The registered manager has a background of working with people with a learning disability. She has achieved the registered managers award and an NVQ level four in Health and Social Care as well as a degree in Sociology. She had recently attended training in the Mental Capacity Act 2005. The home uses a variety of quality assurance checks. Records of visits made by a representative of the registered provider under the Care Homes Regulations 2001 were looked at and were very thorough and detailed with evidence that actions raised at one visit were being checked for completion at the next visit. The registered provider uses a quality assurance tool across all of its services although Holly House had not Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: recently been selected to be audited by this tool. Other quality assurance checks are made with Audits on a monthly or two monthly basis with the home being audited against various National Minimum Standards for Care Homes for Adults. A focus day is also held each year as part of the homes development plan. The 2008 focus day included input from people using the service and staff. The development plan identified various goals and who would carry out the work to achieve these. One area that had been identified was around meetings and how some people using the service who did not usually speak up at meetings would be able to have their views taken into account. Questionnaires had also been used in the past with responses being gathered from residents and staff. Staff have received training in safe working practices in the areas of fire safety, infection control, food hygiene and moving and handling although no specific moving and handling of people was being carried out in the home. First aid training had been booked for March 2009. Weekly checks were made on hot water temperatures with records kept. New central heating boilers had been installed in 2008. The electrical wiring in the home had been checked as well as portable electrical appliances. Work has been carried out in the home by an outside contractor in order to reduce any risk from Legionella. Cleaning materials were securely stored with no decanting from large to small containers evident. Staff have attended training in handling hazardous substances. Window restrictors are fitted to first floor windows with checks on these being made on a daily basis. Accidents had been recorded appropriately and thoroughly audited. Although there have been no security problems with the home it is recommended that a security risk assessment should be completed for the premises. A recent food hygiene inspection brought the homes rating with the local authority up from two to four stars. Care Homes for Adults (18-65 years) Page 24 of 27 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 Adults (18-65 years) Page 25 of 27 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 2 2 20 Obtain information about assessed needs from funding authorities for all people admitted to the home. Where handwritten directions are made in the medication administration record then these should be signed and dated by the member of staff making the entry and checked and signed by a second member of staff. Guidelines for giving medication on an as required basis should contain more detail particularly for Benzodiazepines. Review the wall fixings for the controlled medication cupboard to ensure that these are in line with current legal guidelines for care homes under the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. A risk assessment should be completed for the security of the premises. 3 4 20 20 5 42 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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