Care Home: Holly House (Kettering)

What the care home does well The home has good written information available and has comprehensive assessment processes. Staff are well trained and deployed and appear motivated in their work. The Induction and training programme is strong and ensures residents needs are well met by skilled staff. Many of the staff have worked at Holly House for some years. They were seen to care and work with residents in a kind and gentle manner, and really understood their needs. The home is clean and maintained to a high standard. Bedrooms are pleasant clean, safe and homely. The outdoor area is fairly spacious for people to move around safely. Relatives tell us they have confidence in, and praise for the staff and managers at Holly House. What has improved since the last inspection? Care plans are up to date including revised risk assessments. This will provide staff with full information when caring for individuals and ensure safe practise. Residents personal care items held in the bathrooms are now well organised and provide a cleaner environment. Staff have received a range of training since July 2008 around care, health and safety and adult protection issues. This new learning will ensure residents are protected and their health safeguarded. Staff recruitment practises have improved and staff supervision is more regular and ensures adults are protected. Some improvements have been made to ensure meals are varied and wholesome. The registered manager is still working on this. What the care home could do better: To provide an alarm call system in the sun lounge so as people can summon help when staff are not present. To seek firm controls around the administration and recording of controlled drugs. This will ensure safe storage and protect residents and staff. To provide regularly condiments at mealtimes for residents to choose from such as tomato sauce, vinegar, mustard. To provide serviettes where possible to aid the quality of a residents mealtime experience. To provide soap in the laundry area for staff to wash with in order to maintain good hygiene practises and protect residents and staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holly House (Kettering) 79/83 London Road Kettering Northants NN15 7PH     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: Helen Abel     Date: 2 5 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Holly House (Kettering) 79/83 London Road Kettering Northants NN15 7PH 01536414319 C Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Zenaida Bhatoolall Type of registration: Number of places registered: Mr Banesh Laxmilall Bhatoolall care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: No person falling within the category DE(E) can be admitted where there are 26 persons in the category DE(E) already in the home. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are 5 persons of category OP already in the home. The total number of service users in the Home must not exceed 26. Date of last inspection Brief description of the care home Holly House Care Home provides personal care and support for up to 26 older people within the category of Dementia DE (E), to include up to 5 older people within the category OP. Mr and Mrs Bhatoolall are the registered providers of the home, with Mrs Bhatoolall registered as the manager. Holly House provides accommodation on three floors, the home is a conversion of a large detached residential property with accommodation within the ground, first and second floors. A passenger lift and stair lift provide access to the first and seconds floors for people with limited mobility. Holly Care Homes for Older People Page 4 of 28 Over 65 26 0 Brief description of the care home House is situated close to Kettering Town Centre, and there is easy access to a range of community services and facilities. Service users healthcare needs are met by the community health care professionals The accommodation provides 8 single bedrooms, (6 with en-suite facilities) 9 double bedrooms, four communal sitting and dining areas, and an accessible enclosed garden. The current inspection report is available upon request from the office. Fees range from £359- 479 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection is based upon the outcomes for the service users. The method of inspection used is known as case tracking. This involves identifying three service users, adults with varying levels of care needs and looking at how these are being met by the staff. We were told that people who live at Holly House prefer to be called residents. The inspection process consisted of reviewing the last inspection report and any significant events since the service was visited, and the homes Annual Quality Assurance Assessment (AQAA). Upon our visit on Tuesday morning residents were finishing breakfast and were settling Care Homes for Older People Page 6 of 28 into the two communal lounges. Our visit took place over one day and the Inspector was joined by an Expert by Experience. She focused on talking with residents and visitors and briefly observed life at the home. She wrote a short report and extracts from this are included in the inspection report. The Inspector spent time talking with the staff, the registered manager, and provider, looking at care and staff records, and toured parts of the home. The quality rating for this service is 2 Star Good. 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.csci.org.uk. You can get Care Homes for Older People Page 8 of 28 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not move to the home without having their needs assessed, and knowing that these will be met. Evidence: The statement of purpose and service user guide have been updated. The statement of purpose is displayed near the front door with the complaints procedure and registration certificate. The Commission for Social Care Inspection (CSCI) current inspection report is made available from the office. A new residents care records were sampled and confirmed assessments are undertaken prior to him entering the home. Holly House has a strong commitment to diversity and at the assessment process stage individuals diverse needs are discussed, with a view to meet them wherever possible. Care Homes for Older People Page 11 of 28 Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are fully met maintaining their health and well being. Evidence: Residents care records were examined and contained a range of clear detailed plans. This includes a photograph of each resident, risk assessments, a needs and preference plan, bathing and showering details, health appointments, daily records and a social profile. The social profile tells the staff about the persons life before they came into the home. Residents are weighed monthly and are monitored. The Inspector suggested weighing records are held in the care plan as currently they are held in two places which could be confusing to care staff when monitoring residents weight and nutritional intake. The registered manager agreed to do ensure residents weights records were held only in the care plans. The Expert by Experience made the following observations. At no time did I notice any Care Homes for Older People Page 13 of 28 Evidence: of the staff being rude, losing their patience or being difficult with the residents. Whilst I was there I observed many of the residents being moved by wheelchair to be taken for their dinner. This was done courteously, kindly and with an explanation to the resident of what the staff member was doing and why. Some residents were walked to their seats with a staff member on either side. The residents all seemed to be well dressed and clean. Some wore bibs at dinner time and these were clean and I would have thought fresh that day. In respect of medication management the Expert by Experience commented further. During the mealtime a staff member administered medication to two residents at the table where I was seated. The tablets were in medicine cups. One of the residents asked what the tablet was for and was told. The staff member ensured that the tablets were taken by making sure the resident had a drink following the administration of the tablets. I was very pleased to notice that the staff member did not stand over the resident, she came down to their level so as to be able to make eye contact and speak to the residents face to face. Medication records and the storage of medication was in order. A designated medicine fridge is available needed for cold storage. All staff responsible for administrating medicines had received mediation training in September. This will ensure residents are protected by the homes policies and procedures for dealing with medicines. The Inspector recommended safeguards should be in place when care staff give controlled drugs to people. A witness to the controlled drug who also signs the controlled drugs register is desirable. Controlled drug can be target for theft and it is good practise to regularly check them. The controlled drugs register should include the balance that remains which can be compared with the quantity held in the controlled drugs cupboard. The registered manager agreed to consult with her community pharmacist on this matter. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy the lifestyle they have in the home and have contact with relatives and the community. Evidence: The Expert by Experience observed one resident who was very unwell lay on a special chair and the staff regularly went to talk to her and touch her. The staff members were very interactive with those residents who were awake encouraging them in playing games, jigsaws and looking at pictures and using a colouring book. After about half an hour to three quarters most of the residents were awake and this is when a fourth member of staff came in. One resident wanted to sing and this was encouraged with a staff member joining in the singing. There was no church service although two of the residents said that they had regularly attended Church and a Chapel previously. One resident was heard singing a Christmas carol beautifully. Twice a year a Roman Catholic Church representative attends the home. Those residents who were able to be taken out by the family enjoyed their time Care Homes for Older People Page 15 of 28 Evidence: visiting the town. They were taken by wheelchair. One of the residents, who could walk well, was allowed to visit a shop for her cigarettes and stamps across the road. Staff would monitor her crossing the road as they realised she did not always go by the crossing. This confirms it gives those residents a sense of freedom and achievement. In the sun lounge there were two residents who were reading, one was reading the newspapers, which she said she had delivered every day. The staff obviously knew what the residents liked to do and in what they were interested. This was shown clearly when a resident did not want to play a game the staff knew what to offer the resident next. At lunchtime residents were asked if they wish to have their food cut up and whether they wanted help in feeding themselves. Many of the residents had to be fed due to their health conditions. The Expert by Experience joined the residents for lunch of sausage, egg, chips and baked beans. It was hot and well served. The dessert was angel delight. The table on which she sat all were able to eat for themselves but help was given in cutting up the food especially the sausages. Many of the residents had problems with swallowing and were given a liquidised version of the sausages. The room was not large enough to hold all the residents for their meal sitting. This resulted in people being in different areas reasonably close, except for those in the sun lounge, which made it difficult for the staff as so many had to be fed. I understand that fruit was available for the residents who are able to help themselves. I did not see a menu written up or whether there were any other options. The Inspector discussed menu plans with the registered manager and she is in the process of updating menus. It was agreed the cook would soon be receiving some guidance around nutrition and dietary needs for older persons. The Inspector suggested condiments such as tomato and brown sauces to go with the meal option, are offered and serviettes are provided were practical. This would help residents exercise some choice and control over their lives. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents relatives and supporters tell us they are confident of the care, and are listened to, and taken seriously. Evidence: The complaints procedure is displayed at the front of the home on the wall. It is clear and easy to follow with timescales and names and addresses of people to contact. The same information is held in the statement of purpose and service user guide.There have been no complaints received since our last visit, or complaints received to the Commission for Social Care Inspection (CSCI). The Expert by Experience confirmed two visitors had said that the staff made them welcome and that they were offered tea or coffee. Both of the visitors had been coming for some time. They were very complimentary about the home and both used the word, wonderful, several times about the home and the staff. One of them considered the home very homely, and sitting in the lounge the Expert by Experience understood what was meant by this. This visitor had in fact recommended the home to a friend whose father was now a resident. Neither of the visitors had any complaints and very complimentary. Both clearly stated they considered that their parent would not be alive now if it had not been for the care and devotion received in the home. The registered manager confirmed a staff had received training since the last Care Homes for Older People Page 17 of 28 Evidence: inspection on challenging behaviour. For early next year adult protection training has been identified and will be arranged. These measures will help to ensure residents are protected from abuse. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, fresh and clean environment. Evidence: The Expert by Experience observed when arriving, the front door of the home needed painting. It was clean and there was an appearance of being sandpapered, but was unsure if this was wear and tear and felt it could be taken as an indication of the home as a whole. She observed there were no zimmers at the side of the residents in the large lounge but a couple of the men had walking sticks and most of the residents in this lounge were not able to get out of the chair without aid or walk without aid. In the sun lounge both residents had their zimmers available and could get up and walk if necessary. Two residents smoked. They both knew about the smoking policy and had a clear understanding of where they could smoke. The Expert by Experience was informed by those residents that they could choose for themselves when they wished to go to bed. She was also pleased to note that in the main lounge, and presumably in the sun lounge, there did not seem to be any particular designated chair for a resident. A couple of the residents who walked around were quite contented to sit in other chairs in the room and converse with the person in Care Homes for Older People Page 19 of 28 Evidence: the next chair. The Expert by Experience confirmed that the residents do make use of the garden during the warmer months and there was a large area where it would be easy to push wheelchairs. She noticed in the sun lounge with the toilet had no easily reachable toilet roll. There was no alarm cord in the sun lounge only in the toilet. If someone fell just outside or inside the toilet barring the door this could not be reached. The colour rings red and blue on the taps in the sun lounge toilet were incorrect. A note was above the blue tap stating that this was hot water. The registered provider agreed to attend to these issues. In particular call alarm systems should be made available in the sun lounge in order to maximise residents independence. The Inspector noticed all bedrooms were personalised, immaculate, clean, fresh and tidy. The Expert by Experience was pleased to see residents names on their bedroom doors. Residents benefit from homely comfortable bedrooms. It was noted that the laundry door was propped open at intervals. The registered provider confirmed he would request the fire contractor fit a slow release device. This will meet fire standards and keep residents safe. The manager is reminded to ensure hand soap is provided in the laundry area for staff to use after attending to soiled and infected laundry. Currently the practise is for staff to walk to the kitchen to wash their hands in the designated food handlers sink. Improving hygiene practises will ensure a clean and pleasant environment for residents and staff. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives tell us they are safe hands. Residents are protected by the home recruitment policy and procedures, and staff are trained to do their jobs. Evidence: The Expert by Experience confirmed when the owner and manager arrived, Mr Bhatoolall and Mrs Bhatoolall, they spoke to the residents who were very pleased to see them and informed me that they were very nice people. Staff were observed positively interacting with residents and were kind and gentle in their approach. The Expert by Experience commented when sitting in the sun lounge I was slightly hidden due to the position of the toilet facility. I chatted for some time and I only saw one staff member look in at residents. The registered provider and manager acknowledged because of the layout of the room this can happen and will be looking into improving the way staff moniter residents in this area. Staff recruitment records were sampled and were in good order with all the required police checks, references in place and an Induction ongoing. Staff supervision takes place regularly and a new staff member is being closely supervised for the first three months of work. If successful following on this period the new staff member will have the opportunity to study for a National Vocational Qualification (NVQ) in Care. Three Care Homes for Older People Page 21 of 28 Evidence: staff are doing NVQ level 3 and one staff member is doing NVQ 4 in Leadership and Management. There has been a wide range of training delivered to care staff since our last visit to the home. Such as medication, moving and handling, challenging behaviour, food hygiene and infection control, fire safety and first aid. This confirms staff are trained and competent to do their jobs. The Expert by Exeperince was pleased to note that there were both male and female staff members working in the home. I think this is a definite asset when dealing with a mixed community. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives tell us the home is well run and managed. Evidence: The registered manager is a qualified psychiatric nurse with many years experience working within the NHS, and has completed her National Vocational Qualification (NVQ) level 4 and qualified in management. She also qualified for the registered managers award. The registered provider is also a registered nurse with many years experience of nursing the elderly. The registered manager confirmed attending training at the home alongside the staff group of nine care assistants. She meets with her three team leaders regularly and is always kept informed of developments for each person living at the home. A recent meeting was held for relatives to discuss the last inspection report and she reported overwhelmingly relatives and friends of the home were very supportive of the Care Homes for Older People Page 23 of 28 Evidence: service on offer. Letters of commendations confirmed this. Relatives and residents surveys are carried out yearly and the registered manager is in the process of collecting completed surveys. She will look to measure success in meeting the aims, objectives, and statement of purpose of the home. The registered manager confirmed she currently does not hold any money for people living in the home. The health and safety checks are regularly undertaken and is confirmed in the annual quality assurance assessment. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 14 Alarm call systems should 05/12/2008 be made available in the sun lounge area. Residents will have the specialist equipment they require to maximise their independence. 2 26 13 Soap to be provided in the 05/12/2008 laundry area for staff to use after attending to soiled laundry. Staff should refrain from using the food handlers sink in the kitchen. This is for the person who is preparing and cooking the meals. To ensure residents benefit from a clean and safe environment. 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 Care Homes for Older People Page 26 of 28 1 9 Safeguards should be in place when care staff give controlled drugs to people. A witness to the controlled drug who also signs the controlled drugs register is desirable. Controlled drug can be target for theft and its is good practise to regularly check them. The controlled drugs register should include the balance that remains which can be compared with the quantity held in the controlled drugs cupboard. The Inspector suggested condiments, such a tomatoes sauce and brown sauce are offered and serviettes are provided, where practical. This would help residents exercise some choice and control over their lives. 2 15 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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