Care Home: Holly Lodge Residential Home

What the care home does well The home is well managed and staff members are well supported. Although some parts of the environment were looking a little tired, on the whole it was clean, tidy and homely. One staff member stated, `what it lacks in the decorative department it makes up for in many ways`. People liked the meals provided and described them as, `home cooked` and `good, regular, specially cooked food`. The staff team supported residents to be independent and make their own decisions. People were seen coming and going as they pleased and the home was described as a friendly place. Two residents have been assisted to find volunteer work. Health and social care professionals thought highly of the home and stated the staff did a very good job in supporting people with, often, complex needs. One health professional said, `the best residential home for people with mental health problems in the Bridlington area`. Minor complaints were recorded and dealt with quickly to prevent them escalating. The home has a very high percentage, 89 percent, of care staff members that have gained a national vocational qualification (NVQ) in care at levels 2 and 3. What has improved since the last inspection? Although care plans have improved to include strengths and goals, they could be improved futher. See below. Residents` meetings take place to enable people to make suggestions. The provision of equipment for people to make themselves hot drinks has been provided as a result of requests. The small lounge originally used for people to smoke in has been redecorated and refurbished into a single bedroom. This has decreased the number of shared bedrooms in use. Medicines are stored appropriately including those requiring refrigeration. The Commission is notified of any incidents affecting the welfare of residents. The recruitment processes have improved. The manager is more aware of what consitutes safe practice when employing people after a check against the register barring them from working with vulnerable people but, prior to the return of the full criminal record bureau check. Prepared food in the fridges and freezers was accurately labelled. What the care home could do better: Assessments of need completed prior to admission and plans of care produced from them, could have more detail aboout residents` mental health needs and preferences for care and support. A health action plan would bring together residents` physical and mental health needs and focus attention on access to the range of NHS services. Handwritten instructions on the medication administration records or changes in dosage following consultation with the prescriber need to be signed and witnessed. This will help to avoid mistakes and ensure the correct information is recorded. Staff support some residents with activities of daily living but this is in an ad hoc way rather than planned intervention. Building in this support into care plans, and having staff time set aside to support people with activities of daily living and leisure pursuits, would help to enhance residents` independence, wellbeing and self-esteem. Employment of a cook would free up care staff time. It would be preferable for people to have their own individual shavers but if residents decide to share them they should be cleaned between use. Communal bathrooms and toilets should have paper hand towels to prevent the spread of infection. A redecoration and refurbishment plan needs to be completed with timescales so they can be monitored. Mental health training could be more prominent in the homes` training plan to ensure that care staff have up to date information. Key inspection report Care homes for adults (18-65 years) Name: Address: Holly Lodge Residential Home 8 - 10 Station Avenue Bridlington East Yorkshire YO16 4LZ     The quality rating for this care home is:   two star good service 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: Beverly Hill     Date: 2 0 1 1 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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 Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Holly Lodge Residential Home 8 - 10 Station Avenue Bridlington East Yorkshire YO16 4LZ 01262678508 F/P01262678508 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Michelle Lee care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Holly Lodge consists of two adjacent detached properties conveniently situated for all main community facilities including the public transport network. The smaller of the two properties provides accommodation for up to six people who require a more independent environment and the main building accommodates thirteen people. All the residents have been assessed as having mental health needs. Emphasis is placed on providing social care and emotional support for people although some people do require some physical care. The main aim of the home is to help people recover their self-esteem and confidence and develop their independent living skills. The registered managers office is located in the smaller of the two properties. Both properties have three floors. The main building has a stair lift providing access to the upper floors. Ramped access is used to the main entrances. Peoples private accommodation consists of eleven single and four shared bedrooms. The main house has a bathroom on the ground floor and a shower room on each of the first and second Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 19 2 6 1 1 2 0 0 8 Brief description of the care home floors. The smaller house has a bathroom incorporating a shower on the first floor. There are sufficient toilets throughout. The Statement of Purpose, service user guide and the latest inspection report, are displayed in the home, for people to look at. The current weekly fees to live at Holly Lodge are £333.69p. Additional charges are made for chiropody and hairdressing, and personal items like newspapers and toiletries. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 *stars. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 26th November 2008 and a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Holly Lodge. We also had discussions with the registered manager and staff members. We received ten surveys from residents, seven from staff members and six from professional health and social care visitors to the home. Comments from the discussions and surveys have been used in the report. We looked at assessments of need made before people were admitted to the home, Care Homes for Adults (18-65 years) Page 6 of 33 and the homes care plans to see how those needs were met while they were living there. Also examined were, medication practices, risk management, activities and leisure pursuits organised, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how residents were included in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The provider had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Holly Lodge, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Assessments of need completed prior to admission and plans of care produced from Care Homes for Adults (18-65 years) Page 8 of 33 them, could have more detail aboout residents mental health needs and preferences for care and support. A health action plan would bring together residents physical and mental health needs and focus attention on access to the range of NHS services. Handwritten instructions on the medication administration records or changes in dosage following consultation with the prescriber need to be signed and witnessed. This will help to avoid mistakes and ensure the correct information is recorded. Staff support some residents with activities of daily living but this is in an ad hoc way rather than planned intervention. Building in this support into care plans, and having staff time set aside to support people with activities of daily living and leisure pursuits, would help to enhance residents independence, wellbeing and self-esteem. Employment of a cook would free up care staff time. It would be preferable for people to have their own individual shavers but if residents decide to share them they should be cleaned between use. Communal bathrooms and toilets should have paper hand towels to prevent the spread of infection. A redecoration and refurbishment plan needs to be completed with timescales so they can be monitored. Mental health training could be more prominent in the homes training plan to ensure that care staff have up to date information. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people had their needs assessed prior to admission, which enabled staff to determine whether their needs could be met in the home. More detailed information about mental health needs and how people preferred to be supported would enhance the information available to staff. Evidence: We examined three care files during the visit, one of which was for a person recently admitted into the home. We wanted to check out the admission process and the information staff received about any potential resident prior to admission. There was evidence that the home received a care plan produced by the local authority and the manager had also completed an assessment. Generally the assessment covered all areas but the section on mental health needs should be much more detailed. This will enable staff to have full information about peoples needs in order to make a decision about whether needs can be met in the home. Some preferences regarding how people wished to be cared for and supported were indicated, but again this could be more detailed. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: There was evidence that the manager kept the assessments under review. One person was admitted in 2005 and the assessment was reviewed and updated in Dec 2008. A similar process of updating had been completed for the assessment in the third file examined. It is good practice to keep the assessment up to date so staff have accurate information to plan care updates. The majority of people admitted to the home had low level physical needs and received care and support in relation to their mental health needs. They were able to participate in assessments and the formulation of their care plans. The assessment completed for the person recently admitted was signed by them to evidence this participation and agreement. The registered manager advised that when assessing people to see if their needs can be met in the home, they do take into consideration the needs of the other residents and dynamics of the group. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs planned for and were supported to make decisions about aspects of their lives. Evidence: All residents within the home had a plan of care to guide staff in how they were to support people. The care plans were produced in a timely manner after admission and included needs identified at the assessment stage. The care plans indicated when residents could manage tasks themselves and what their strengths were but also advised staff to monitor particular areas of need due to fluctuating mental health issues. The care plans also identified goals but when checked with the manager these were goals identified by the staff and we were unsure if these had been agreed with residents. As the people living in the home had predominantly needs associated with their mental health and were quite independent in other areas, this section of the plan should be very detailed. However, some care plans were more comprehensive than Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: others. In discussions with the staff and manager it was clear that they were very knowledgeable about peoples mental health needs and preferences for care and support but this information had not been consistently included in the plans of care. We received six surveys from professional visitors to the home and all praised the staffs knowledge about their residents and the mental health conditions they experienced. However, one social care professional wrote, they know all the residents very well, but this is not evidenced on service user plans. There was clear evidence that people made their own decisions and took managed risks. People were observed coming and going and spending time in their own rooms or out and about the home and local area. One person likes to spend time away visiting friends and staff had plans in place should they miss transport home. People spoken with confirmed they made their own decisions about aspects of their lives. Bedrooms were personalised depending on taste and style and meetings were held at which residents were able to make suggestions about how the home was managed. Some people chose to smoke and although the room designated for smoking had been utilised as another bedroom, an area had been arranged on the patio and plans were in place to have this covered. We received ten surveys from people living in the home and all stated they were able to decide for themselves what they want to do during the day, in the evenings and at weekends. One resident had a risk of low blood sugar levels and although this was mentioned in their care plan there was no risk assessment to determine the level of risk. This was mentioned to the manager to address. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some residents were able to lead active lives. However, additional staff time to support particular residents in daily living activities, and leisure and occupational pursuits, would enhance the quality of life for them. Evidence: There was evidence that people accessed community facilities and could participate in activities and occupational pursuits but this was an area that could be improved even further. One resident was supported to maintain family relationships and previous friendships by spending time with them away from the home. People were observed coming and going and those spoken with stated they went out and about the town on their own when they were able to and used local shops and cafes. Staff had completed assessments for some residents regarding road safety to be assured there was minimal risk. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Two residents undertook volunteer work and others accessed local clubs and resource centres. One resident was also a member of the British legion. Staff had identified some preferences for leisure pursuits, for example one person liked to bake and iron their own clothes and another enjoyed watching the boats in the harbour. One resident was a keen artist and staff supported them to ensure they had equipment to hand. They also enjoyed outdoor pursuits such as camping holidays. One resident spoken with said they had the opportunity to cook but had decided they did not want to. They preferred to help out with the recycling the home was involved in. The home had installed a computer with internet access in the dining room and about five to six residents enjoyed using it. Some people have bought their own television and other entertainment such as DVD players, which they keep in their room. Some enjoyed games in the evenings such as scrabble and dominoes. Staff were aware of which residents liked to assist with activities of daily living such as laundry and food shopping but because the home did not have a separate cook, and care staff completed cooking, their time for these activities was limited, as observed on the day of the site visit. One person spoken with stated they would like to do their own laundry but had not been shown how to use the washing machines yet. Social assessments of peoples likes, dislikes, past interests and current interests, and abilities, would help staff to identify more clearly how to support people and to tailor occupational stimulation to further suit their needs and wishes. Recording who participates in activities and whether they have enjoyed them would help staff with future planning. The staff could be more proactive in supporting people with their independent living skills, such as housekeeping, washing and ironing, preparing meals and tidying their bedrooms. These could be discussed with residents and be part of their care plan activity. This will assist people to maintain existing skills and support them in developing new ones. The manager supported some residents to budget their weekly allowance to ensure they had a supply of money for their purchases. This was detailed in care files and confirmed by residents that they preferred this level of support. Care staff cooked all the meals in the home. Breakfast could be either bacon and eggs or cereals and toast. Lunch consisted of two choices and was the main meal of the day. The manager confirmed that the evening meal had been moved from 4pm to 5pm at the request of residents. Surveys received from residents, and discussions with them, confirmed they were generally happy with meals. Comments were, they feed you well, good food, I can make my own drink in the day, I like the cooking, Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: they provide good, regular, specially cooked food and you get plenty to eat and its good cooking. However, one person did state in a survey when asked what could be improved, food - seems to have deteriorated. We observed breakfast being served up until 10am, as people wandered down from their bedrooms at various times. Residents were provided with tea and coffee making facilities on a trolley in the dining room and most made use of this independently. The dining room was a little cramped but the residents were happy with the arrangement of tables. Care Homes for Adults (18-65 years) Page 17 of 33 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. Peoples health needs were met although a comprehensive health action plan would maintain all health needs in one document and assist staff when planning care and support from health services. People received their medication as prescribed, although handwritten changes to the medication administration records should be witnessed and confirmed by the prescriber. Evidence: There was evidence that peoples health care needs were met although the care plans produced could pull together all the health needs in one clear health action plan that stipulated when appointments were due and how specific health professionals were involved. Residents were registered with a GP and dentist and were visited by community psychiatric nurses for support. One of the files examined detailed that health screening had taken place and the person had recently seen their consultant. We received six surveys from health and social care professionals and all had very positive comments about how the home ensured that peoples needs were met. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Comments were, makes attempts to meet individual needs not just a standard set of needs or the homes needs, one resident was placed at Holly Lodge and despite constant behavioural problems the staff and manager did extremely well to provide the placement and give them an excellent service, the care team appear to understand the different mental health illnesses providing the appropriate care needed for each person, I am impressed with the care they provide, they support people with multiple and complex needs and it maintains residents at their level of mental health and respond if this should dip. When asked what the home does well one professional stated, personal care and patients rights. People spoken with, and surveys received from them, also stated their health needs were met and staff treated them with privacy and respect, I am happy with everything, they look after me well and theyve (community psychiatric nurse) discharged me now - they came to see if I was settled and I am. One staff member was observed shaving two residents in the dining room with the same electric razor. The residents agreed to the task but they could have been offered this in a more appropriate setting and the razor cleaned between use. This was mentioned to the manager to check out and address. Medication was stored appropriately and stock controlled well so that people did not run out of their medication. This meant that people received their medication as prescribed. However, there were some recording issues that need to be addressed. There was evidence of medication review as there were several medicines on the medication administration record (MAR) that had been crossed off as no longer required or the dosage changed. These handwritten changes need to be signed by staff and a witness, and confirmed by the GP. Codes were not used consistently to describe the reason why medication was omitted. One resident was prescribed Gaviscon medication to be taken when required, but there was no record of them having been offered the medication. There was also an incident observed when the staff member administering medication left the tablets in a pot on the dining room table for the resident to take later. The MAR was signed but the staff member did not witness the tablets had been taken. Policies and procedures need to be followed when administering medication. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home helps to protect vulnerable adults from abuse by staff training and adherance to policies and procedures. Evidence: The home had a complaints policy and procedure on display in the hall and staff in surveys, and those spoken with, were aware of what to do if people raised any concerns with them. Residents spoken with named particular staff members or the manager as the people they would talk to if they had any concerns. A precis of the complaints procedure can be found in each residents bedroom to remind them of their right to complain. The home had not received any formal complaints since the last inspection. Records were maintained of everyday niggles or requests from residents and they evidenced that these were addressed. The Commission had not received any complaints about the home since the last key unannounced inspection. The home had a copy of the multi-agency policy and procedure on safeguarding vulnerable adults from abuse. The manager had attended local authority training specifically for managers and most staff had completed basic safeguarding training. Staff were aware of what to do and who to report to should they have any concerns about poor or abusive practice. Staff had also completed deprivation of liberty safeguards and how to manage behaviours that could be challenging to others. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: Staff recruitment had improved since the last inspection and employment checks were carried out prior to the start of employment. One staff member had started work after an initial check against the register barring people from working with vulnerable adults but before the return of the full criminal records bureau check (CRB). The manager was aware that the staff member must not work unsupervised until the CRB is returned. There was an instance when a previous employer was not contacted about a staff members work history. The manager is to follow this up. Care Homes for Adults (18-65 years) Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home were tired and in need of updating but overall the home was clean and tidy and residents were comfortable. Evidence: The home consists of two adjacent houses with three floors in each. Number 10 Station Avenue has one shared and five single bedrooms. The home has a kitchen equipped with a kettle, fridge and a table and chairs and residents are encouraged to make themselves a drink whenever they choose. There is no lounge but the entrance has two comfortable chairs if residents decide they want to sit in this section. Most residents prefer to remain in their own bedrooms or use the lounge and dining room in the other house. There is a bathroom with a shower on the first floor and a toilet on both the ground floor and first floor. This bathroom is due to be completely refurbished in December. The managers office is located on the first floor. Number 8 has three shared and six single bedrooms. Communal areas consist of a lounge and a dining room. Most people tend to congregate in the dining room, where there are coffee and tea making facilities set out on a trolley. This house has a bathroom and toilet on the ground floor, a shower room and four separate toilets on the first floor and a shower and toilet on the second floor. The shower room on the first floor is also due for a complete refurbishment in December. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: The home was personalised and bedrooms had privacy locks and lockable facilities. There was an intercom system in bedrooms that staff and residents can use to speak to each other. There were privacy screens in shared rooms. People spoken with were very happy with their home in general and their bedrooms. Five residents stated the home was clean and fresh, always and five stated this was, usually. Comments were, I had my own bedroom decorated to my choice, friendly home - very clean and the room is good, Im a thousand times better off here than the last place. The provider has produced a redecoration and refurbishment plan. This told us that in 2009 parts of the home were redecorated such as, the dining room, kitchen, hallways and several bedrooms in house number 10 and new carpets were purchased for the stairs and hallway. Other items purchased were, laundry equipment, a new stair lift, several new beds, a computer with internet access and a new television for the lounge. The room used for smokers has been redecorated and used as a single bedroom and a seating area outside, designated for people wishing to smoke, is to be covered. The home had laundry facilities in line with the requirements of the residents. Some parts of the home were in need of updating and communal bathrooms and toilets need paper hand towels instead of towelling ones to prevent the spread of infection, but generally the home was clean and tidy. One person did comment in a survey that the home could do with security gates at the rear of the property and one residents bedroom door had a glass section that required a privacy curtain. Care Homes for Adults (18-65 years) Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No catering staff meant that care staff had to prepare meals. This diluted the time they had to support people with their activities of daily living. Although parts of the staff training system was excellent, there must be more focus on mental health training and ensuring mandatory updates. This will help to ensure the staff team have up to date skills and knowledge for their roles. Evidence: Staff rotas were examined and indicated there were 2-3 carers on duty during the day as well as the manager, who worked 8am to 5pm. There were two carers from 5pm when the manager left and two staff at night, one of whom had a sleep-in duty. The home also had two domestic staff. However, as the care staff also completed catering duties for each meal, this diluted their care support. We also witnessed care staff having to multi-task in the mornings, for example, one staff member was preparing lunch but also had to stop what they were doing to ensure a resident had their medication. The home needs to have a designated cook to free up care staff time to enable them to more fully support residents with activities of daily living and leisure pursuits. Staff surveys confirmed this. When asked what the home could do better the comments were, we need more 1-1 time with residents that are more dependent, more staff for 1-1 and there is never enough staff to take residents out. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The staff surveys did convey how committed the team was in ensuring a positive environment for residents. Comment were, we encourage residents to make decisions for themselves and promote their independence, residents views are taken into consideration - they choose what they do each day, there is a good relationship between staff and residents and staff do things in their own time, it is a warm and friendly place to work and it is a good caring home with a good level of support and helps residents achieve a good standard of life. Residents agreed and stated, everything is alright, they have thought of everything, friendly home - very clean and I like the home and the staff are nice. Health and social care professionals also had positive comments about the staff team, I have never witnessed or heard reported high expressed emotion from the staff there is respect for residents as individuals, staff are helpful and friendly, good listening skills, home cooked meals and social interaction with clients and social inclusion is supported and encouraged. Staff training records indicated that out of nine care staff, eight had completed a national vocational qualification (NVQ) in care. Three had completed level 2 and five had gained level 3. This was an excellent achievement and meant the home had 89 percent of staff trained to this level. Staff had completed specific training such as how to manage behaviours that were challenging, dementia awareness and deprivation of liberty. They had also gained a wealth of knowledge about mental health needs of residents from contacts with health professionals (confirmed by them in surveys), although there was no specific mental health training organised for staff to complete. The manager was advised to look into this especially for new staff and for others wanting to update their skills and knowledge. It was difficult to audit mandatory training as records were unclear. The manager provided information to us after the inspection and highlighted that some mandatory training updates such as, first aid, basic food hygiene, safe handing of medication and health and safety were due for renewal. A plan was made and training booked for the new year. New staff completed skills for care common induction standards to ensure they had a basic understanding of their role and how to support vulnerable people. Their competence was signed off by manager on completion. Care staff received formal one to one supervision with their manager and they were on target to receive six sessions a year. The supervision covered discussions about particular residents, care plans, exchanges of information and also included observations of practice. We received seven surveys from staff members and five Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: stated they met with their manager, regularly, two stated this was, often. The manager and staff team at Holly Lodge have all been in post for several years and staff turnover is very low. This helps to provide some stability for the residents. We looked at the recruitment records for one new staff member. Application forms were completed and employment history documented. Checks were made against the register barring people from working with vulnerable adults and full criminal record bureau checks (CRB)were made. The manager was aware that staff are not allowed to work unsupervised until the return of the full CRB. Two written references were obtained. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, with residents feeling included and staff feeling supported. This enabled a positive environment for people and has led to good staff morale. Evidence: The registered manager has been in his current position for 15 years, although has worked at Holly Lodge for twenty-five years. He is knowledgeable and enthusiastic about his role. He has completed his Registered Managers Award and an NVQ at level 4 in care and management. He has also completed an NVQ assessors award, deprivation of liberty safeguards, dementia awareness and how to manage behaviours that may be challenging. He has a supportive network via the providers and other company employees. We were unable to see the reports of visits to the home completed by the responsible individual, although the manager confirmed these were completed and were held in a file that the provider had with them. These need to be held in the home and available for inspection. He knew the residents mental health conditions and needs very well and professional visitors commented, A very well run home - has the residents interests at the heart of Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: all they do and an excellent establishment. Staff received formal supervision and felt supported by the manager, its run well by the manager - he always has time for residents and staff, I feel at ease when speaking to the manager - hes very good at his job and although there are rules there does not appear to be any. The home had a quality assurance system that consisted of audits and questionnaires to people. These cover meals, communication, the environment and care practices. There was evidence that results of surveys returned in October 2009 had been analysed but plans to address shortfalls had not been completed yet. There was also minutes to be seen of residents and staff team meetings. At one meeting residents had requested tea and coffee making facilities in the second house (there was already facilities in the house for more independent people), and these had been provided. Residents told us that staff did listen to them and tried to provide what they requested. The home uses an external fire safety company for staff training and all staff had up to date training. Just after the inspection the manager sent us information to evidence that staff training updates that had lapsed in health and safety, first aid and basic food hygiene, had been arranged for three dates in January 2010. Due to recording shortfalls in medication the local pharmacist had visited the home to give advice and refresher training in how to use the monitored dosage systems. The homes annual quality assurance assessment was received on time and told us that gas appliances, the fire alarm system and equipment, and portable appliances were all serviced in September 2009. The central heating was serviced in August and the chair lift in March 2009. Since the last inspection food stored in the fridge and freezers was labelled correctly. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 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 20 13 Staff must ensure that 31/12/2009 policies and procedures are followed when administering medication and only sign the MAR when they are sure the medication has been taken. This will enable staff to be sure that medicines are taken by the person they were administered to and avoid loss or diversion. 2 33 18 There must be adequate numbers of catering staff. This will ensure care staff have sufficient time to complete important tasks, such as medication without interuption and have more time to support residents with activities of daily living. 31/12/2009 3 35 18 Training regarding the mental health needs of residents must be built into the training plan. 31/03/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 This will ensure that new staff have sufficient information to support people and existing staff can update their information and practice. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The section on mental health needs in the homes assessment of need should be completed in more detail and peoples preferences for care and support could be included more fully. This will enable staff to have a full picture of what the persons needs are and how they wish to be supported. Care plans should be more detailed about peoples mental health needs and be more person centred including preferences about how people wished to be supported. Staff could provide more time to support people with their leisure pursuits and faciliate access to community services. This would help people to find activities and occupations that they enjoy and feel part of the community. The staff could be more proactive in supporting people with their independent living skills, such as housekeeping, washing and ironing, preparing meals and tidying their bedrooms. These could be discussed with residents and be part of their care plan activity. This will assist people to maintain existing skills and support them in developing new ones. Residents should have their own individual shaving equipment but when they decide to use the homes electric razor it should be cleaned thoroughly after each time it is used. Health action plans would draw together health needs, and 2 6 3 14 4 16 5 18 6 19 Care Homes for Adults (18-65 years) Page 31 of 33 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 how they are to be met, into one document and help staff when planning care and support from health services. 7 20 Handwritten changes to the MAR should have a witness signature and be confirmed by the GP and codes should be used in a consistent way when medication is omitted. The home should ensure the redecoration and refurbishment plan for the next year is followed. This will ensure continuous improvement of the environment for residents. Communal bathrooms and toilets should have hand paper towels to prevent the spread of infection. The reports of visits completed by the responsible individual to ensure that the home is being managed well should be held in the home and available for inspection. 8 24 9 10 30 41 Care Homes for Adults (18-65 years) Page 32 of 33 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. 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. 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