Care Home: Holly House (Barberry)

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Key inspection report Care homes for adults (18-65 years) Name: Address: Holly House (Barberry) Holly House (Barberry) 12 Ullet Road Liverpool Merseyside L8 3SR three star excellent service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lorraine Farrar Date: 2 7 1 1 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Holly House (Barberry) Holly House (Barberry) 12 Ullet Road Liverpool Merseyside L8 3SR 01517275823 01512833340 barberry@schealthcare.co.uk Not available Active Care Partnerships Ltd care home 15 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 15 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 15 Date of last inspection 2 8 0 6 2 0 0 7 A bit about Holly House (Barberry) Holly House (Barberry) is a big house in Aigburth. It is near to Liverpool city centre. It is owned and run by Southern Cross. They are a big company who support people across the country. Up to fifteen adults who have a learning disability can live there. People get support with their:Personal care Health Hobbies and interests Managing their behavior. Everyone living there has their own bedroom with a sink. People share bathrooms a shower room dining and living rooms. Outside there is a private back garden. There are also places to park a car. The house is near to local shops, pubs and transport. Staff, including Nurses are there all day and night to support people. 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: three star excellent 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 How we did our inspection: This is what we did when we were at Holly House (Barberry). Before we visited we sent the manager a form to fill in. She told us about how Holly House (Barberry) is run and about the paperwork they have got. We looked at everything we have been told about the house since our last visit. This all helped us plan the things we would look at when we visited. We met with some of the people who live and work there. This helped us to find out what it is like to live there. We looked at some of the paperwork in the office. This helped us to find out if Holly House (Barberry) is a safe place to live and to see if people get the support they need. We looked around the house at the:Kitchens Bathrooms and shower room Living room Garden. This helped us to find out if the house is clean and tidy and a nice place to live in. It costs nine hundred pound every week to live at Holly House (Barberry). If people need support from their own member of staff it costs fifteen pounds an hour. What Holly House (Barberry) does well. Staff who work at Holly House (Barberry) know the people who live there well. They are good at: Listening to their choices Helping them to make decisions Helping people to manage how they behave. There are enough staff for people to get out and about. Everyone has a care plan that they know about. This tells staff about the support the person needs and the things they like to do. People can do the things they enjoy doing. They don’t always have to do things together. Some of the places people like to go with staff are: Shopping To work To church To discos and the pub To volunteer walking dogs At home people get support to do things such as:Cooking Housework Washing their clothes. People get support to look after their health. Staff help them to make decisions about their health and to get help if they need it. If people are unhappy or want to complain they are confident staff will listen and help them. Staff have training to help them do their job well. The manager is good at making sure Holly House (Barberry) runs well for the people who live there. Staff do checks on the house and equipment to make sure Holly House (Barberry) is a safe place to live and work. What has got better from the last inspection . Staff have put together a new form to find out about people who are thinking about moving in. This will help to make sure staff know as much as possible about the support the person needs and wants. Health action plans are now in place for the people living there. These help to make sure as much as possible about the persons health is written down so they can get the support they need. What Holly House (Barberry) could do better. Leaflets and information to tell the people living at Holly House (Barberry) could be made easier to understand. Staff could sit with the people living there and check that they can understand the information easily. If not staff could work with people to change it. This would help to make sure everyone understands as much as possible about:How their home works Their rights. If you want to read the full report of our inspection please ask the person in charge of Holly House (Barberry). If you want to speak to the inspector please contact Lorraine Farrar You can ring us on:03000 616 161 You or someone you know can write to us at:Care Quality Commission Northwest Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. Sufficient information is provided to and obtained about people considering moving into Holly House (Barberry) to enable everyone to decide if it is the right place for the person to live. Evidence: The people living at Holly House (Barberry) told us that they like living there. One person explained, its my kind of place and another that, I like it here. I love it. Nobody new has moved into the home in the past year, therefore it was not possible for us to practically assess the support that would be provided. However the self assessment form completed by the manager confirms that before anyone moves in staff will meet with them and other significant people in their lives. A full assessment of the persons needs and choices would be carried out including obtained assessments from other agencies. In addition the person would be invited to visit the home several times and say overnight if they wished. A new assessment form has been devised by the home which they intend to use. Once completed this form will provide more information about the person than previous assessments used. For example it will provide clear information about the persons health and personal care, any needs or choices they have based on their culture, religion, disability, as well as other information about their lifestyle. The information obtained about people will help staff to decide if they can support the person successfully at Holly House (Barberry) and to plan how to do so. A service users handbook about Holly House (Barberry) is available for the people living there and anyone considering moving in. This gives people good information about things such as how to complain, their care plans, support with health and personal care, support Evidence: with their lifestyles and a clear explanation of what is abuse and bullying as well as a clear explanation of equal opportunities and what this means. Whilst this handbook provides good information to people about the services they can expect and their rights it is not always easy to read. Parts of it use pictures and easy to read words, other parts have a lot of small writing on one page or use italics. This could mean people do not understand as much as possible about the home. It does however state that information can be made available in other languages, can be read to the person or provided in picture formats. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work in partnership with the people living at Holly House (Barberry) to ensure that their needs, choices and decisions are recognised and support provided to meet these. Evidence: Individual care plans are in place for all of the people living at Holly House (Barberry). These had been signed by the person and in discussions with some of the people living there, they confirmed that they know about their care plan and who their named key worker is. A series of assessments are completed monthly with regards to the persons health and wellbeing. These include areas such as risk of falls, their skin condition and support needed. If the assessment indicates that the person needs support in a specific area of their life then a care plan is put into place. These are individual to the person and cover areas of their life such as smoking, managing their own behaviour and support with personal care and health as well as with the things they enjoy doing on a daily basis. Plans are reviewed regularly with the person and if applicable their family. The level of information in care plans provides clear guidance to staff in how to support people successfully. The regular reviewing with the person helps to ensure people are aware of and have as much say as possible in the support they can expect to receive. The people living at Holly House (Barberry) told us that they make everyday decisions for themselves, for example when they wish to get up or go to bed, you can stay up if you want. Records and plans evidenced that staff also work with people to support them to make bigger decisions for themselves. For example one plan contained agreement with the person to manage the amount of cigarettes they smoke daily, another plan contained Evidence: an agreement with the person to manage the amount of belongings they store within their bedroom. Where people are unable to make a bigger decisions for themselves staff work with other agencies to ensure that decisions are only taken after considering all options and that they are in the persons best interests. Information and staff support is provided to access outside advocacy agencies that will support the person to speak up for themselves. This all helps to ensure people have as much control over their own lives as possible and are supported to make as many decisions for themselves as possible. Care plans contain a series of risk assessments that are personalised to the person. These cover areas such as going out and about, hobbies and personal care. Information is recorded about the identified risk and the actions that need to be taken to reduce that risk. The assessments we looked at had been reviewed regularly and were up to date. These help ensure people are supported as safely as possible whilst going about their everyday lives. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Holly House (Barberry) receive support from staff to live an interesting and fulfilling lifestyle of their choice. Evidence: There are two activities coordinators employed at Holly House (Barberry) to support the people living there with their hobbies, interests and work. Records and discussions with the people living there showed that people are supported with a range of different activities. For example one of the people we spoke with explained that they enjoy volunteer dog walking, college classes, holidays and going to church and records showed they are supported with this. Other people are supported to exercise, look for employment, do work placements and go to local pubs and discos. At home people take part in everyday activities such as shopping, cooking, cleaning the car and housework. We saw a file that one of the people living there had put together with staff using photographs of the things they enjoy doing. This is very good practice as it enables people to be as involved as possible in planning the support they receive and in informing staff of the things they want support with. People get support to be involved in as wide a range of activities as possible within their local community. For example a draft plan of activities over Christmas included a local tea dance, carol service, organised city walk and local markets. The range of activities people are supported with are clearly based on their individual preferences and help to ensure people can lead an interesting and fulfilling lifestyle. Regular meetings are held with the people living at Holly House (Barberry). Minutes from Evidence: these showed that people are able to discuss a range of areas. For example the September 2009 meeting covered menus, holidays and activities. In October 2009 discussions included, holidays and the people living there wanting to attend fire training sessions. This is again good practice as it provides a way for people to become involved with how their home operates and the support they receive. Records showed that people are supported to maintain relationships with their family and friends and that staff will provide support for people to make decisions about contact with others and will also work with people on how to maintain and make appropriate relationships. Throughout our visit we observed that staff spoke respectfully to the people living at Holly House (Barberry) and gave them time to answer questions and make decisions. Staff knocked on bedroom doors and respected peoples right to privacy and spent time interacting with people. We observed that people spent their time at home where they chose to with some people spending time in their room and others socialising in communal areas. Where this is restricted for periods of time staff had a good understanding of how to support people with this and it was clearly documented within their care plan. The people living at Holly House (Barberry) told us that meals are, all right, excellent and good. They also confirmed that they always get a choice of meals and can have a drink or a snack whenever they want and that they go shopping for food and use the smaller kitchen to cook and bake. Menus are discussed at the monthly meetings with the people living there and a sample of menus showed that people are offered a varied diet including fruit and vegetables. A member of staff was able to explain how they cater for different diets based on peoples cultural or health needs and choices. Again this helps to ensure people are getting the support they need and choose. We observed part of the tea time meal and noted that staff promote a quite atmosphere where people have time to enjoy their meal. Staff were seen to provide one to one support discreetly and at an unrushed pace for one of the people living there. 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. Staff work with the people living at Holly House (Barberry) and other professionals to ensure people are getting the support they need and choose with their personal and health care. Evidence: The people living at Holly House (Barberry) told us that they get the support they need with their health and personal care. They explained that staff look after their tablets and that they get these on time, staff get the doctor if they are not well and will go with them to appointments. Care plans contain assessments that identity where people may have a potential issue with their health and personal care, following this a clear care plan is written that guides staff in how to support the person successfully. In addition records showed that staff support people to attend regular health appointment such as with the GP or Optician as well as more specialist appointment such as a Consultant. Where people do not wish to attend an appointment records show that staff clearly record this decision and support the person to go again at a later date. This all helps to ensure people are getting both the regular and more specialist health support that they need. Daily records also showed that staff monitor peoples health and seek advice if there are any changes. For example obtaining advice where it is noted someone is losing weight. Staff from Holly House (Barberry) had recently worked closely with staff from a local hospital to support one of the people living there during a hospital stay. This included staff from the home supporting the person in hospital twenty four hours a day. They had also put into place detailed, clear care plans of how the person would be best supported during this time and on their return home. This clear care planning provided good Evidence: guidance to staff on how to consistently support the person in a way that met both their needs and as far as possible their choices. The staff at Holly House (Barberry) who support people with medication are qualified nurses who have all received additional medication training. Medication is stored in lockable facilities with a fridge provided for medications that need lower storage temperatures. We looked at a sample of medication storage and records during our visit. We found that medication was stored correctly and a record made of medications given and received into the home. Clear records were in place of times people refused their medication or had it at a different time as well as records of agreements to alter the time people take their medication and guidance for giving medication prescribed as required. We looked at a sample of medication stored in the home and compared it with records of medication received and given to people. We found that these did not tally, for example one medication had one tablet too many in the packet when comparing medications received and given, another had several tablets over. The manager was asked to investigate these discrepancies and has written to us following our visit with the results of her investigations. She found that people had received their medication as prescribed and that discrepancies were largely due to recording errors such as not recording the amount of medication brought forward from the previous month. The manager has taken appropriate action by raising the issue with staff at a meeting and implementing a weekly count of medication. This will help to quickly identity any issues and rectify them if needed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Holly House (Barberry) are confident any concerns they have will be listened to and acted upon. This is backed up by clear policies and staff training that help to ensure people are safe whilst living there. Evidence: Information about how to raise a concern or complaint is made available to the people living at Holly House (Barberry) and their relatives via the service users handbook and a poster in the hallway. People are also given information about local advocacy services that help people to speak up for themselves. In addition staff are aware of and use new laws such as the Mental Capacity Act and Deprivation of Liberty laws to ensure people are supported and protected, when needed. For example they will refer people to be supported by an independent advocate whose role is to ensure that where the person cannot make a decision themselves, these decisions are only taken in the persons best interests. This all helps to ensure peoples rights are fully protected and that they are safe from harm. The people living at Holly House (Barberry) told us that if they were unhappy they would talk to staff and were confident that they would help. In discussions with staff they displayed a good understanding of safeguarding adults and the indicators to be aware of that may indicate someone was unhappy. Staff have training in safeguarding adults and a recent staff meeting included an awareness session on whistle blowing and how to report any concerns that staff may have. This open approach helps to ensure that the people living at Holly House (Barberry) are safe from harm and that any issues will be quickly noted and addressed. Systems and checks are in place within the home that ensure peoples money is safely managed and checked regularly. We checked a sample of this during our visit and found receipts and records to tally with money held. This helps to ensure that people are financially protected. 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. Holly House (Barberry) provides a safe, warm and comfortable home for people to live in, that provides adaptations to meet their needs. Evidence: Holly House (Barberry) is a large detached Victorian House near to the Aigburth area of Liverpool. Located off a main road the house provides access to public transport and is not far from Liverpool town centre. Accommodation is provided over three floors with bedrooms on all floors, there is a lift to the upper floors. All bedrooms are single and provide en-suite toilets. The people living there are able to personalise their bedrooms to suit their needs and choices. Due to the size of the building it does not appear as a domestic style house, however furnishings and fitting such as leather settees help to provide a comfortable environment. A small kitchen provides the people living there with the opportunity to cook, prepare drinks and snacks and do their washing. In addition to this the house has a dedicated laundry room and large working kitchen from which main meals are provided. The home also has two bathrooms, a shower room, and downstairs dining room for people to share. There are a number of adaptations and aids throughout the house to support the people living there with their mobility, personal care and safety. These include a lift to access upper floors a bath chair, accessible shower and grab rails. In addition windows have been fitted with perspex for safety and one of the bathrooms floors treated to deal with potential flooding. Outside there is off road parking to the front of the house. An enclosed back garden provides privacy and seating for people to use in warmer months. During our visit we noted that all areas of the house were clean, warm and tidy. In Evidence: discussion staff were able to explain how they minimise the risk of cross infection in the home and we found that suitable equipment and facilities are provided to help staff prevent or quickly deal with any outbreak of infection that may occur. 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. The people living at Holly House (Barberry) are supported by an experienced staff team who are able to work in partnership with them to meet their needs and choices. Evidence: The people living at Holly House (Barberry) told us that they like the staff who support them. One person described them as good whilst another explained, they are good to us. Throughout our visit we observed that staff spent time interacting with the people living here. They gave people time to make choices and decisions and were respectful when talking with people. We also observed that staff had built good relationships with the people living there and it was evident that they trusted staff to support them. In discussion staff displayed a good knowledge of how to support the people living at Holly House (Barberry). They were aware of how to support people with their health and personal care choices and lifestyles as well as how to support them to learn to manage how they interact with others and how to manage their own behaviour. The majority of staff hold a national qualification in care (NVQ) which helps to ensure they are up to date with current good practice. In addition records showed that staff undertake training to keep them up to date in how to support people safely and well. This includes training in areas such as food hygiene and fire as well as more specialist areas such as Deprivation of Liberty laws and equality and diversity. A member of staff from the home had recently been awarded runner up for Nurse of the Year award from the company for the support provided to one of the people living at Holly House (Barberry) with their health. The work that had been carried out in supporting people using Deprivation of Liberty laws evidences that staff are able to put the training they receive into practice in order to provide the support people need. Records showed that before anyone starts work at Holly House (Barberry) a series of checks are carried out on them. These include obtaining written references and a Evidence: Criminal Records Bureau Check. These checks help to ensure staff are suitable to work with people who may be vulnerable. Staff explained and records showed that new staff are supported to undertake a national induction programme when they start work and are assigned a senior member of staff to support them. This helps to ensure new staff learn the skills and confidence needed to support people and gives the people living there the opportunity to get to know staff who are supporting them. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holly House (Barberry) is well managed for the benefit of the people who live there. Evidence: The manager of Holly House (Barberry) is an experienced manager who has managed a care service for adults who have a learning disability for some time. Records and discussions with her evidenced that she undertakes regular training in both management and care issues in order to keep herself up to date. For example in the past year she has undertaken training in basic areas of care such as fire and infection control, more specialist areas of care such as the Mental Capacity Act and Deprivation of Liberty Laws and in management issues such as the disciplinary process. This helps to ensure she remains up to date with current good practice and can lead the staff team competently. In discussions with staff they told us that they find the management of Holly House (Barberry) both supportive and approachable. One member of staff explained, (I am) very comfortable saying what I need to say both at meetings and with the manager, and explained that they got support when needed. In discussions with the manager it was clear she had a good understanding of effective care home management and of promoting the rights of the people who live there. There are several systems in place at Holly House (Barberry) to check on the quality of the service they provide. This includes regular service user meetings and care plan reviews. A monthly visit is carried out by a senior manager from the organisation and a report provided. We looked at a recent report from October 2009 and found this covered all areas of support the home provides including, complaints, menus, service user meetings and the environment. No actions were identified as a result of these visit, Evidence: however the report format gives space for identifying and following up on any improvements required. Incident and accident forms are monitored regularly by both the manager and organisation. This helps to quickly identity and deal with any trends or patterns that may occur. In addition the manager explained that the company have sent out surveys to the people living there, the results of which are currently being put together. These along with meetings held with the people living there, help to ensure people can influence how their home is run and plan any changes. Records and certificates showed that regular checks are carried out on the building and equipment at Holly House (Barberry). These include checking the electrical supply, fire equipment and the lift. These checks help to ensure that Holly House is a safe place to live, work and visit. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 1 Information for the people who use Holly House should be reviewed to ensure it is easy to understand. This will help to ensure people can understand as much about the service and their rights as possible. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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