Care Home: Holly House (Milton Malsor)

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What the care home does well Holly House demonstrated that management of record keeping is robust. The information held in the care files for the people who use the service, were comprehensive, in good order and kept up to date. Care plans were reflective of people`s needs, gave clear guidance for staff to follow and reviewed regularly, thus promoting people`s well-being, independence and lifestyle choices. People told us they were happy with the quality of care and support provided by the staff, who were aware of their needs, were respectful and patient. People have good health care support when needed and records were reflective of any health treatments or appointments. The interaction between staff and the people who use the service was positive and respectful. People appeared to be comfortable and relaxed with the staff on duty. Staff appeared to have a good rapport with them, addressing them by their preferred name and familiar to their individual preferences and routines. People were able to continue to exercise their rights and choices with regards to daily living. People are supported to maintain contact with family and friends and able to receive visitors at anytime. Some people continue to observe their religious beliefs and attend the local church. Social activities and entertainment is arranged by the staff at the home and there are entertainers that visit the home. This shows people can take part in social events that are stimulating. People have a positive experience of mealtimes and enjoy the choice of meals provided. People were complimentary about the variety of `home-cooked` meals prepared by the Cook and the new menu cards placed on each dining table. Our findings during our site visit, the comments we received on the day supported the comments we received in the surveys from people who use the service, their relatives and staff, which included: "We are very happy with my mother`s care" "They provide to my mother the level of care and support that I was no longer able to give her at home" "We are always made welcome when we visit" "Provides awareness to visitors ensuring they are welcomed and find an appropriate place for a private visit" "This is new (the menu cards), not only do we know whats for lunch, we also know what day it is because its written here""The meals are very good here, always a choice" "... the home cooked food is very nutritious and tasty" People live in a comfortable and homely environment. People are encouraged to personalise their bedrooms. They are also are consulted about future plans such as decoration and changes being considered in the home that will affect them. All areas of the home are clean and tidy. There is a house-keeper who is responsible for the cleanliness of the home and a handy-man responsible for the maintenance. The recruitment, training, supervision and the management of staff was good on the day of our visit. There is a training programme in place, whereby staff receive regular training and updates to maintain their knowledge and skills in line with current best practice. The management of records relating to the people who use the service, staff and the management of the home are good. Information about the home: `Service User Guide`, `Statement of Purpose` and the `Complaints Procedure` have been updated and given to everyone living at the home. These are also displayed on the notice board in the dining room, along with the latest CQC Inspection Reports and social events and information. What the care home could do better: This was a positive site visit to Holly House. The statutory requirements made at the last Key Inspection have been addressed to ensure the health, safety and well-being of the people that live at Holly House. The majority of the recommendations have also been addressed. The current management arrangements: Interim Management Team, continues to oversee the day-to-day running of the home to benefit the people who use the service and ensure the management of staff. Random inspection report Care homes for older people Name: Address: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT one star adequate service 06/08/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rajshree Mistry Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Holly House (Milton Malsor) 36 Green Street Milton Malsor Northampton Northamptonshire NN7 3AT 01604859188 01923840278 info@hollyhouseresidential.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Parvin Kumar Menon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Parvin Kumar Menon,Mrs Madhu Menon care home 22 Number of places (if applicable): Under 65 Over 65 22 22 dementia old age, not falling within any other category Conditions of registration: 0 0 Holly House (Milton Malsor) care home is registered to provide personal care to male and female service users who fall within the following categories: Old age: not falling within any other category (OP) - 22 Dementia: over the age of 65 years (DE(E)) - 22 The maximum number of persons to be accommodated at Holly House (Milton Malsor) is 22 Date of last inspection 0 6 0 8 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Holly House is a residential care home situated in the village of Milton Malsor, south east of Northamptonshire. The home provides accommodation and personal care for up to 22 older people. Holly House is a large detached property with car parking space to the front and to the rear of the property. The accommodation consists of single bedrooms with en-suite facilities and a communal lounge and dining room. There is a large garden to the rear, which is accessible and has a seating area. The range of fees for 2010/2011 were provided by the Interim Management Team; starting at £480.00 to £550.00 per week. Further information about Holly House and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. The findings of the most recent inspection carried out by the Care Quality Commission (CQC) can be found in their Inspection Report, which is available at the home or accessible via our website: www.cqc.org.uk Care Homes for Older People Page 3 of 13 What we found: We as it appears throughout this Random Inspection Report refers to the Care Quality Commission (CQC). This Random Inspection of Holly House consisted of pre-planning the site visit, which included the review of the last Key Inspection Report dated 6th August 2010, the significant information we received about the home. We reviewed the Annual Quality Assurance Assessment (AQAA), which is a self-assessment tool completed by the Registered Manager and sent to us prior to our site visit. The AQAA demonstrated how peoples needs are met, the range of services and facilities offered to people and the staff team. It also told us the improvements that have been made and the improvement planned for the future. We also reviewed the responses and comments received in the surveys from people who live at the home, their relatives and staff. This was an unannounced Random Inspection and this site visit took place on 16th June 2010, starting at 10.30am and lasting 3 hours. This site visit was carried out by two Compliance Inspectors. The purpose of this Random Inspection was to check compliance with the statutory requirements made at the last Key Inspection. This Random Inspection also considered the management of the home and in preparation for the registration transfer to the new Health and Social Care Act 2008. During our site visit we were assisted by the Interim Management Team, which included the Senior Carer, in the absence of the Registered Manager. We looked at the information people receive about the home: the Service User Guide and the Statement of Purpose. We read these and found that they have been updated since the last Key Inspection. This was consistent with the information we received in the self-assessment completed by the Registered Manager prior to the our site visit. The Service User Guide and Statement of Purpose provides people with information about the home and range of services and facilities available to people who live at the home. It tells people about the process of moving in, the quality of care that they can expect to receive, social opportunities and events; and who to speak with if they are unhappy or have a complaint. We spoke with the people who use the service about their experiences of moving to the home. We spoke with a number of people individually and in small groups. They told us that they or a member of their family had visited the home before choosing to move in. This supported the surveys we received from people who use the service and their relatives, in which they confirmed that they were given information and had the opportunity to visit the home to help them decide if Holly House was the right place for them. We spoke with two people who live at the home specifically during our site visit to find out what their experience has been with regards to the quality of care and their choice of lifestyle. They said they were happy with the care and support they receive, staff respect their choices, preference and their privacy. This supported the responses and comments we received in the surveys from the people who use the service and their relatives. The comments we received included: Care Homes for Older People Page 4 of 13 Keeps me safe and warm, well fed and looks after me. Give me my medication, cleans me up. Dresses me and even shaves me My mother seems happy at Holly House and she says the staff are nice and nothing is too much trouble Takes good care of our mother We read the care files for the two people we spoke with. The care files were well organised and divided into sections, which made it easier to find specific information, such as personal details, residents background information, needs assessment, risk assessments and management plan, moving and handling assessment, care plan, daily/weekly plan, reviews and dairy sheets for medical visits and appointments. The quality of information contained in both care files appeared to be up to date and had pertinent information relating to the individuals. The records were dated, signed and cross referenced to individual needs and management plan to minimise risk such as moving and handling or falls. The signed contracts are held in a separate file, kept in the Registered Managers office. People who we spoke with told us about their preferred daily routines and choices that they make. For example one person choosing to stay in their bedroom, preferring to listen to the radio, and the times they rise and retire to bed. The daily plans we read were reflective of individual choices and preferred daily routines. Staff we spoke with were familiar to individual routines. This demonstrated that peoples rights and choices were known and respected. The Senior Carer told us the District Nurses do visit to provide health support with regards to dressings or medication. People that we spoke with confirmed they are able to see the GP when they need to and usually appointments are made in advance. This supported the records in the care file, which contained details of medical visits and appointments made. This shows people have access to medical support to ensure their health needs are met. We did speak with the District Nurse after the site visit. They told us that whilst there had been concerns in the past with regards to peoples health needs, they found at a recent visit to the home, people appeared comfortable and content. The comments received were: Generally have found most of the carers very friendly On Tuesday, assisted by ...., very good atmosphere in the home, friendly carers, light hearted atmosphere, clean home, clean residents and a number of relatives were visiting We do not anticipate visiting the home at present as ...... is currently in hospital The staff demonstrated a good understanding of peoples individual needs, daily routines and preferences, such as their ability to maintain their own personal care, well-being, prone to falls, need occasional reminders and choosing to stay in their own room. It was evident staff referred to the care plans as they were able to tell us when the care plan changed and why, which was consistent with what was written in the care file. Care Homes for Older People Page 5 of 13 The people we spoke with at length also told us they have walking aids to help them move around the home freely. They also told us staff are prompt at responding to call bell, which indicates there are sufficient numbers of staff on duty to respond. We discussed with the Interim Management Team consideration should be made to the positioning of the call bell kept at the end of the bed for one person that we spoke with. The Interim Management Team informed us that a new more sophisticated call bell system is to be fitted at the home that will allow greater versatility for example touch sensitive strips and an alert button, which can be carried on the person. We observed how people chose to spend the morning. The majority of people sat in the lounge; watching television or talking with the person sitting next to them or staff. A member of staff was seen encouraging people to take part in a choice of activity. We also noted that some people preferred to stay in their room either reading, listening to the music or watching television. This showed choices made by people were respected. Some of the comments we received during our site visit and in the surveys with regards to peoples experience of the care and the staff included: .... the carers are always respectful.... ... I get all the help I need ... very friendly, very helpful... ... is well looked after very well, she enjoys her food and her room is always tidy They are always very attentive to her needs, the staff are very well trained and understand the needs of my mother The notice board in the dining room displayed information such as the Activity Programme. There was an activity planned for each day and member of staff responsible. There is an Entertainer booked to visit on 23rd June 2010. The Interim Management Team confirmed that this is a trial visit and people who use the service can decide if they want the Entertainer to do regular events. This showed people who use the service can influence the social events arranged at the home. We found out that people were able to continue observing their religious beliefs. One lady attends the local village Church on a Sunday as someone comes to collect her. They told us they like to go out but that staff have advised her not to try to and go outside without being accompanied because they are aware she is prone to falls. This is reflected in her care plan and guidance to staff. Thus, shows individuals and staff are aware of any risks. We spoke with the Cook who has worked at the home for many years and clearly was aware of peoples preferences of meals and dietary needs. The Interim Management Team showed us the new picture cards that have been introduced to aid people in making choices about meals, activities and also prompts to encourage them to maintain their independence as far as practicable with regards to personal care tasks. The main meal of the day is lunch. People were seen moving to the dining room, some walked independently and others were assisted by staff. A group of ladies were impressed with the menu cards set on each dining table and they complimented the meal Care Homes for Older People Page 6 of 13 they ate, which was roast chicken or vegetarian alternative with potatoes, vegetables, followed by a choice of deserts. We saw staff assisting two people with their meals, sat in the lounge and showed respect, patients and were sensitivity with regards to peoples dignity. The complaints procedure was displayed on the notice board in the dining room and included in the Service User Guide and the Statement of Purpose. The Interim Management Team confirmed that the complaints procedure has been updated with the support from the Management Consultant. The complaints procedure clearly set out the process by which people who use the service and visitors to the home could raise issues. The information gathered from the self-assessment completed by the Registered Manager stated no complaints were received since the last Key Inspection. We looked at the complaints folder and noted no complaints had been received, since the self-assessment was completed and sent to us. The Care Quality Commission has not received any new complaints since the last Key Inspection. During our site visit people living at the home told us they would be able to tell staff if there was a problem and were confident it would be resolved. This was consistent with the responses and comments received in the surveys from people who use the service and their relatives. Comments included: Whats to complain about, they look after us very well Not needed to complain and if there is a problem you just speak to the Manager, staff or him (pointing at the Interim Management Team) The staff on duty that we spoke with showed a good understanding of what is meant by safeguarding and their responsibilities. Safeguarding means the protection and promotion of vulnerable people at risk from harm or abuse. Staff said they had attended training in safeguarding and the training records viewed confirmed this. Staff described to us what they would do if they suspected abuse, witnessed an incident or were told about an event, in that they would tell the person in charge. Staff also were confident to report to the person in charge or contact the emergency services. For example, if a person using the service had a fall or needed urgent medical treatment. This showed people who use the service are protected by trained staff who are aware of procedures and their responsibilities in protecting and promoting their well-being. Holly House is located in a village setting and blends in with the other local properties in the area. On the day of our site visit the ambiance in the home was welcoming and relaxed. People were sat in the lounge, dining room or chose to remain in the privacy of their bedroom. We spoke with two people in the privacy of their bedroom and found the bedrooms were clean, comfortable and personalised. The information we gathered from the self-assessment told us that the home is regularly maintained. The self-assessment detailed the annual maintenance and servicing of the equipment and appliances, electrical tests, heating, lighting, fire and emergency equipment. The home also employs a handyman, who is responsible for carrying out minor repairs and maintenance. The Interim Management Team told us that they are Care Homes for Older People Page 7 of 13 looking into replacing the existing call bell system with a new, more sophisticated touch sensitive system as part of the improvement plan. We spoke with staff on duty with regards to recruitment, training and supervision. They told us they were appointed after satisfactory pre-employment checks were attained and trained into the job role. They also confirmed that they do have regular supervision, previously with the Registered Manager and more recently with the Senior Carer and the Interim Management Team. This supported the information we gathered from the selfassessment and the responses received in the surveys from staff with regards to recruitment and training. We checked four staff files and found all contained evidence of satisfactory preemployment checks: two written references and a criminal records bureau (crb) check. This is a check to assess the suitability of the applicant to work with vulnerable people. Where appropriate, overseas staff were employed with valid work permits. Staff files also contained confidential records of supervision meetings. This showed the recruitment process and supervision was robust. Staff we spoke with said they have regular training, which was consistent with the responses and comments received in the staff surveys. The staff training certificates contained in the files and the training matrix viewed showed staff had attended a range of training this year, such as food safety, manual handling, first aid, pressure ulcer prevention / management, fire training and appliances and infection control. The majority of staff have also attained National Vocational Qualifications (NVQ) level 2 and above. We also noted that training was already booked in September 2010 with regards to health and safety, dementia care mapping and personalised care, mental capacity, end of life and palliative care. These would be provided through training organisations and the Management Consultant for the home. This showed staff skills and knowledge is maintained to protect and promote peoples wellbeing. We wanted to find out whether the management of the home was beneficial for the people that live at the home. At present there is an Interim Management Team, managing the home with the some guidance from a Management Consultant. We spoke with the members in the Interim Management Team with regards to their roles and responsibilities and viewed the staff rota. We found that they had clear responsibilities in relation to management of the day-to-day care and support for the people who use the service and administrative tasks. The staff rota was reflective of the staff on duty and staff spoken with were aware of their daily duties and key areas of responsibilities. This showed the staffing and the management of the home on the day of our site visit was good. Holly House recently had a Residents and Relatives meeting. People who use the service confirmed they have meetings regularly and are asked about their opinion of the service they receive, meals and menu, issues or concerns and improvements being made to the home. The Interim Management Team told us that although no quality assurance surveys has yet been carried out since last year, they do receive cards and letters of compliments and thanks. We read some of these, which were complimentary about the quality of care people experienced. This supported the comments we received on the day and in the surveys from the people who use the service and their relatives. Care Homes for Older People Page 8 of 13 The Interim Management Team also told us that the Management Consultant had recently carried out and audit on the home, which included information and medication and found these to be satisfactory. This shows that the home has taken steps to ensure people receive a quality service. What the care home does well: Holly House demonstrated that management of record keeping is robust. The information held in the care files for the people who use the service, were comprehensive, in good order and kept up to date. Care plans were reflective of peoples needs, gave clear guidance for staff to follow and reviewed regularly, thus promoting peoples well-being, independence and lifestyle choices. People told us they were happy with the quality of care and support provided by the staff, who were aware of their needs, were respectful and patient. People have good health care support when needed and records were reflective of any health treatments or appointments. The interaction between staff and the people who use the service was positive and respectful. People appeared to be comfortable and relaxed with the staff on duty. Staff appeared to have a good rapport with them, addressing them by their preferred name and familiar to their individual preferences and routines. People were able to continue to exercise their rights and choices with regards to daily living. People are supported to maintain contact with family and friends and able to receive visitors at anytime. Some people continue to observe their religious beliefs and attend the local church. Social activities and entertainment is arranged by the staff at the home and there are entertainers that visit the home. This shows people can take part in social events that are stimulating. People have a positive experience of mealtimes and enjoy the choice of meals provided. People were complimentary about the variety of home-cooked meals prepared by the Cook and the new menu cards placed on each dining table. Our findings during our site visit, the comments we received on the day supported the comments we received in the surveys from people who use the service, their relatives and staff, which included: We are very happy with my mothers care They provide to my mother the level of care and support that I was no longer able to give her at home We are always made welcome when we visit Provides awareness to visitors ensuring they are welcomed and find an appropriate place for a private visit This is new (the menu cards), not only do we know whats for lunch, we also know what day it is because its written here Care Homes for Older People Page 9 of 13 The meals are very good here, always a choice ... the home cooked food is very nutritious and tasty People live in a comfortable and homely environment. People are encouraged to personalise their bedrooms. They are also are consulted about future plans such as decoration and changes being considered in the home that will affect them. All areas of the home are clean and tidy. There is a house-keeper who is responsible for the cleanliness of the home and a handy-man responsible for the maintenance. The recruitment, training, supervision and the management of staff was good on the day of our visit. There is a training programme in place, whereby staff receive regular training and updates to maintain their knowledge and skills in line with current best practice. The management of records relating to the people who use the service, staff and the management of the home are good. Information about the home: Service User Guide, Statement of Purpose and the Complaints Procedure have been updated and given to everyone living at the home. These are also displayed on the notice board in the dining room, along with the latest CQC Inspection Reports and social events and information. 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 2. Care Homes for Older People Page 10 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 13 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, 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 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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