Care Home: Holly Tree Lodge Residential Care Home

What the care home does well Care plans were developed from the pre admission assessment to ensure people were supported appropriately and their needs were met. A positive rapport between the staff and the people using the service was observe throughout the day. A positive rapport was also observed within the staff team and staff that were spoken with said the communication between the staff was good, they felt they worked well together as a team to ensure people`s needs were met Comments received from the relatives spoken with included " there have been some big improvements, we feel the care here is good, we are always contacted if there are any issues or concerns with mum`s health". What has improved since the last inspection? Daily records are now in place to record the clinical fridge temperatures. This ensured the fridge was working effectively. The staff recruitment files seen had full employment histories recorded on their application forms. This enabled the employer to clearly identify any gaps in employment that needed to be explored. All equipment and appliances at the home had been serviced as required, to ensure safe working practices were maintained. Staff and one visitor that was spoken with commented on the improvements they have seen at the home since the Acting Manger came into post. This included the general deployment of staff, staff appraisals and a better organised work force. Staff spoken with felt that the acting manager was approachable and worked well as a team member. What the care home could do better: The home did not have a controlled drugs register. This was a requirement that was made at the last inspection. The controlled drugs held at the home were now recorded in a book, that used the same format as a controlled drugs register, but was not by definition (of the Royal Pharmaceutical Society`s guidance) a controlled drugs register. At the time of this inspection the home did not have any controlled drugs that needed to be recorded in a Controlled Drugs register by law. However if in the future the home has any drugs that by law must be stored in a CD register, the current system in use would not be acceptable as it is not secure. The Acting Manager stated that a CD register had been ordered by their community pharmacist.Since this inspection visit the acting manager has confirmed that a CD register is now in place at the home. Although a thermometer was in place to record the temperature of the clinical fridge, it did not record the minimum and maximum fridge temperatures to check the clinical fridge was running at the correct temperature. The Acting Manager stated that a clinical fridge with a built in minimum/ maximum thermometer had been ordered by their community pharmacist. No further improvements have been made regarding exit from the conservatory to the garden area, as there is small step that is not suitable for the less mobile person or someone that uses a wheelchair. A handrail has been fitted outside the French doors that lead to the garden but this was blocked by the door when open, so making this handrail inaccessible. Key inspection report Care homes for older people Name: Address: Holly Tree Lodge Residential Care Home 2 Thornhill Road Derby Derbyshire DE22 3LX     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: Angela Kennedy     Date: 2 9 0 4 2 0 1 0 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 Older People Page 2 of 30 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 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Holly Tree Lodge Residential Care Home 2 Thornhill Road Derby Derbyshire DE22 3LX 01332382660 01332382671 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Holly Tree Lodge Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia over 65 years - code DE(E) Date of last inspection Brief description of the care home Holly Tree Lodge is a 27 bedded home for people of both sexes aged 65 years and over who have dementia. Holly Tree Lodge was originally a private dwelling that has been extended on several occasions. The home is located in a residential suburb of Derby, close to several main routes into the city. The home has two storeys, and accommodation is located on both floors, whilst lounge and dining areas are on the ground floor only. Holly Tree Lodge has five shared rooms, one of which has ensuite facilities, and 17 single rooms, a number of which have ensuite facilities. Residents Care Homes for Older People Page 4 of 30 Over 65 27 0 Brief description of the care home have access to a well-maintained garden area. The fees at the time of this inspection ranged from the Local Authority rate for people that were funded to GBP394 a week for those that were privately funded. Items not covered by the weekly fee included; toiletries, chiropody, hairdressing, dental treatment, clothing and transport and staff escorts to hospital appointments. Care Homes for Older People Page 5 of 30 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: This key inspection was unannounced and took place over one day. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The inspection was focused on assessing compliance with defined key National Minimum Standards. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers that is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. Care Homes for Older People Page 6 of 30 Two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at support plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Discussions with the people living at the home were limited to a few people, as many where unable to express their views. Those that were able to express their views were spoken with and one survey was returned from a person living at the home. The comments received in this survey and on the day of the inspection visit are included within this report. One relative was spoken with on the day of this inspection visit The information provided in this discussions is included in this report. Some of the staff team were spoken with to gain their views on the service, the support they provided and the training and support given to thm. Nine staff surveys were returned. The comments from discussions and within the surveys are reflected within this report. The acting manager was available throughout the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home did not have a controlled drugs register. This was a requirement that was made at the last inspection. The controlled drugs held at the home were now recorded in a book, that used the same format as a controlled drugs register, but was not by definition (of the Royal Pharmaceutical Societys guidance) a controlled drugs register. At the time of this inspection the home did not have any controlled drugs that needed to be recorded in a Controlled Drugs register by law. However if in the future the home has any drugs that by law must be stored in a CD register, the current system in use would not be acceptable as it is not secure. The Acting Manager stated that a CD register had been ordered by their community pharmacist.Since this inspection visit the acting manager has confirmed that a CD register is now in place at the home. Although a thermometer was in place to record the temperature of the clinical fridge, it did not record the minimum and maximum fridge temperatures to check the clinical fridge was running at the correct temperature. The Acting Manager stated that a Care Homes for Older People Page 8 of 30 clinical fridge with a built in minimum/ maximum thermometer had been ordered by their community pharmacist. No further improvements have been made regarding exit from the conservatory to the garden area, as there is small step that is not suitable for the less mobile person or someone that uses a wheelchair. A handrail has been fitted outside the French doors that lead to the garden but this was blocked by the door when open, so making this handrail inaccessible. 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 Older People Page 9 of 30 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 30 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. People can be confident that the home can support them, as accurate assessments are undertaken before admission is agreed. Evidence: The providers self assessment stated that a full pre admission assessment was undertaken with family input, so that the information provided is accurate in ensuring the persons individual needs can be met. Both individuals care files seen had a completed needs assessment in place that addressed their social, emotional and health care needs. This included an assessment in place from their care manager. The care plans seen demonstrated that this information was then used to develop the care plans for each person. Information within the survey received also confirmed that this person had received a contract of residency. Care Homes for Older People Page 11 of 30 Evidence: Staff surveys also confirmed that they were given up to date information about the needs of the people they supported. This ensured that they were able to support people effectively. Staff spoken with on the day of this inspection visit said the communication between the staff was good, they felt they worked well together as a team to ensure peoples needs were met. Care Homes for Older People Page 12 of 30 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. Peoples health and personal needs are met by the service and the service supports people to take their medicines in a safe way. Evidence: As confirmed in the providers self assessment care plans and risk assessments were in place within the files of the two people case tracked. The care plans that were seen had been reviewed monthly, to ensure any changing needs were identified. The information provided in the care plans seen varied. One person had been living at the home for a few years and had more detailed information. This information clearly instructed the staff team on what this person was able to do independently and areas where they needed some support, either by prompting or through physical support. This ensured that this persons strengths and abilities were identified and enabled the staff team to support them in retaining those skills, without compromising the care they received. The other person case tracked, who had moved into the home recently had care plans Care Homes for Older People Page 13 of 30 Evidence: in place for all of their assessed needs, however the information provided was not as detailed. For example their care plan regarding personal care stated that they required assistance of one member of staff. It did provide staff with information on the persons capabilities to enable staff to support them in retaining their independence and skills. Prior to this visit the acting manager told us of plans to hold a meeting, which will enable all family members, if they wish, to have an input in their relatives care plans. There was no signatures in the two files of the people that were case tracked to demonstrate that relatives had been involved in the formulation of the care plans. The risk assessments seen addressed areas of risk that had been identified through the care plans, to ensure peoples safety was maintained. Such as a moving and handling assessment, a mobility assessment, a risk of falls assessment, fire evacuation assessment, skin integrity and nutrition and weight records. One of the people case tracked had a risk assessment in place regarding falls that did not correspond with their care plan regarding falls. This was discussed with the acting manager, who stated that this would be looked at and amended appropriately. Records were seen to demonstrate that appropriate systems were in place for individuals to access health services, such as G.P, dentist, optician, chiropodist, physiotherapy, continence assessment nurse and district nurse team. All care staff have now undertaken medication training. Medication practices were generally satisfactory. Medication records were completed accurately and indicated that medications were being given as prescribed. The supplies held corresponded with the medications listed on the records seen. Care plans regarding medication were in place within the files of the two people case tracked. The home did not have a controlled drugs register. This was a requirement that was made at the last inspection. The controlled drugs held at the home were recorded in a book, that used the same format as a controlled drugs register, but was not by definition (of the Royal Pharmaceutical Societys guidance) a controlled drugs register. At the time of this inspection the home did not have any controlled drugs that needed to be recorded in a Controlled Drugs register by law. However if in the future the home has any drugs that by law must be stored in a CD register, the current system in use would not be acceptable as it is not secure. The Acting Manager stated that a CD register had been ordered by their community pharmacist. Care Homes for Older People Page 14 of 30 Evidence: Since this inspection visit the acting manager has confirmed that a CD register is now in place at the home. Although a thermometer was in place to record the temperature of the clinical fridge, it did not record the minimum and maximum fridge temperatures to check the clinical fridge was running at the correct temperature. The Acting Manager stated that a clinical fridge with a built in thermometer that recorded the minimum and maximum temperatures over a 24 hour period had been ordered by their community pharmacist. Records seen demonstrated that privacy and dignity was upheld for individuals. Care plans reflected how individuals privacy and dignity was to be maintained. Observations of staff with people living at the home were positive and demonstrated a relaxed atmosphere with a good rapport between the staff and the people using the service. Comments received from the relative spoken with included the staff are very supportive to both me and my mum, theyre very good. Discussions with the people living at the home were limited, but those that were able to express their views were positive about the standard of care provided. Care Homes for Older People Page 15 of 30 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. People were able to keep in touch with their family but their social well being was not actively promoted. Evidence: The information in the records of the two people case tracked, regarding their individual preferences in relation to social activities, cultural interests, meals and religious needs varied. One persons information was detailed regarding their religious, spiritual needs, their dietary preferences and their social interests. The other person had limited information. The providers self assessment stated that entertainment was provided to the people living at Holly Tree Lodge. It was confirmed by one person living at the home that someone came into the home each week to provide exercise classes and that a musical entertainer also visited the service on a monthly basis. However this person did say that they felt that apart from these occasions there was few activities to participate in on a day to day basis. This person confirmed that they continued to use the local voluntary support service whilst in town. This was pre booked by staff when this person wanted to go shopping and then the person was met in Derby by a volunteer who supported them to shop for a maximum of 2 hours, when they then Care Homes for Older People Page 16 of 30 Evidence: returned to the home in a taxi. On the day of this inspection visit an exercise class took place. A hair dressing service was available at the home on a weekly basis and was at the home on the day of this visit. Discussions took place with the acting manager regarding the activities that were available to people on a daily basis within the home and the local community. The acting manager confirmed that there was no scheduled activity plan or activities coordinator at the home. The providers self assessment told us that the service had its own vehicle to support people in accessing the local community. Discussions with staff indicated that some people were supported to visit the local shops or town when possible. However no records were kept of activities, trips out or events to demonstrate that peoples social needs were being met. Photographs remained in place on the board in the reception area of activities and events that had taken place. However it could not be determined from these photographs when these activities had taken place. The acting manager confirmed that the local Church no longer visited on a regular basis to provide hymn singing. She confirmed that the last visit was at Christmas. It was confirmed that ministers visited specific people as requested. The lack of a designated activities coordinator has clearly affected the day to day activities available. Discussions with staff confirmed that as the care staff were responsible for undertaking activities, any urgent care issues could affect or disrupt any activities planned. The providers self assessment stated that people living at the home were able to receive visitors in private if they wished to do so. The visitor that was spoken with confirmed this and said that they were made to feel welcome. Information within the care plans seen showed us that people were able to choose the time they retired to bed and rose in the morning and where they spent their time during the day. Observations of people throughout the day of this inspection visit confirmed this. The providers self assessment stated that a qualified chef was employed at the home. Care Homes for Older People Page 17 of 30 Evidence: Menus were seen on the notice board in the reception area.The menus demonstrated that alternatives were available. The font size used on the menus would not be suitable for anyone with poor or failing eyesight and no pictorial menus were available for the people using the service, which may support people that were no longer able to read, in choosing their meals. Dietary requirements were recorded in the care plans of the people case tracked along with any food preferences they had. Only one person was able to confirm their opinion of the meals provided. Although the menu stated that hot options, as well as sandwiches were available at the teatime meal, this person felt there could be more options at tea time. Diabetic diets were catered for and soft diets as required. Care Homes for Older People Page 18 of 30 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. Peoples concerns are fully addressed and the practices in place ensured people using the service were protected from abuse. Evidence: The providers self assessment stated that all complaints were dealt with promptly and in confidence. This was demonstrated to us following concerns that were raised last year by two relatives regarding care practices. These concerns were reported to the Derby City Safeguarding team to investigate. The provider took immediate action to address these concerns satisfactorily. One relative who made the complaint was spoken to and confirmed that they were very happy with the standards of care now provided at the home. The acting manager told us that no further complaints have been received. A complaints log was in place at the home that included columns for recording any actions taken and the outcome of complaints. A complaints policy was displayed on the notice board in the reception area. This policy included details of how to contact the Care Quality Commission. Comments from one person living at the home and the visitor that was spoken with indicated that they would report any concerns they had to the acting manager and they appeared confident that any issues they had would be addressed. Care Homes for Older People Page 19 of 30 Evidence: The homes self assessment said that staff were provided with training in Safeguarding adults.Staff spoken with confirmed that they had attended training and stated that they had found this training to be informative. The staff spoken with demonstrated a good understanding of the procedures to follow in the event of any safeguarding concerns. The Safeguarding policy at the home was is in line with Local Authority policy, who takes the lead in safeguarding adults investigations. This ensures that all staff have information on the local authority guidance and procedure to follow. Since the last key inspection no other safeguarding referrals or investigations have been undertaken, other than the one mentioned above. Care Homes for Older People Page 20 of 30 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. The home is well maintained for the people using the service and the practices in place ensure their safety is not compromised. Evidence: A partial tour of the building was undertaken. A clean and pleasant odour was noted throughout the home. From discussions held with one person living at the home, one visitor and one of the housekeepers it was confirmed that good housekeeping was maintained. The providers self assessment told us of the improvements undertaken at the home, such as updating some of the furnishings around the home and new carpets to some of the bedrooms. A new television and Nintendo WII have been purchased and as stated earlier in this report the home now have their own vehicle. Photo identification was in place on bedroom doors, to support people in locating their bedrooms. Other than this there were few visual cues to support people with dementia. Such as tactile boards, memory boxes and other activity and orientation products. The home has adequate bathing, toilets facilities and a wet room. There is a call Care Homes for Older People Page 21 of 30 Evidence: system in every room and a passenger lift for people to access the first floor. Wander mats were provided in bedrooms for individuals that required them and those who are unable to use the call bell system. Doors such as the laundry, kitchen, the office and the treatment room had coded locks to ensure the safety of individuals was maintained. The laundry room housed suitable equipment to ensure the laundering needs of the people living at the home could be met. The acting manager confirmed that a new washing machine had been purchased. The laundry was staffed every day including weekends. In general people were supported to maintain their dignity by ensuring their appearance was good with clothes well ironed, however it was noted that one person had food on their trousers following the lunch time meal but this person was not supported to change their trousers. The garden was well maintained with secure grounds and seating provided. No further improvements have been made regarding the exit from the conservatory to the garden area, as there is small step that is not suitable for the less mobile person or someone that uses a wheelchair. A handrail has been fitted outside the French doors that lead to the garden but this was blocked by the door when open, so making this handrail inaccessible. The acting manager confirmed that this door was not used to enter the garden. An alternative door was available and this was used for anyone wishing to sit in the garden. Care Homes for Older People Page 22 of 30 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. Sufficient numbers of staff are available to meets the needs of the people using the service. Appropriate employment checks ensure the safety of the people living at the home is maintained. Evidence: As stated in homes self assessment the rotas demonstrated that there was sufficient staff available day and night to ensure the needs of the people using the service are met. Staff spoken with also confirmed this. The recruitment records for two members of staff were seen and demonstrated that thorough recruitment checks as required by law had taken place to ensure the staff employed were safe to work with the people using the service. Following the complaint that was made last year, (see Complaints and Protection section of this report) the acting manager sent us her improvement plan. This informed us of areas that she felt needed improving and the actions that she was taking to make these improvements. Such as the daily routines with regards to the carers duties, this is now more structured, which ensures staff are aware of their duties and responsibilities on a daily basis. Care Homes for Older People Page 23 of 30 Evidence: Staff Induction is now more structured and ensures staff are supported and guided to undertake their job competently. Records of induction training were seen. It was stated by the acting manager that the staff had undertaken mandatory training courses, but evidence of this training was not available in all staff files, such as training certificates. The acting manager confirmed that the previous training company used had not sent certificates out to staff following training. For this reason the home have now changed their training provider and the acting manager stated that all of the staff team would be undertaking all of the mandatory training again to ensure evidence was in place of training undertaken. The acting manager was in the process of implementing a new training file, in which all staffs certificates and details of training will be held. Staff that were spoken with were able to confirm that they had undertaken mandatory training as required. This included Safeguarding Adults, Infection Control, Moving and Handling, Care Of Substances Hazardous to Health, Food Hygiene and fire safety. Certificates were in place to demonstrate that Fire training had been provided. One member of staff spoken with confirmed that they were booked onto training in dementia awareness and palliative care. From discussions with staff it was confirmed that staff felt their understanding of dementia care could be improved with further training, especially in areas regarding suitable activities for people with dementia. The homes self assessment said that out of the 15 permanent care staff there are 7 staff with NVQ2 or above. The acting manager had commenced training to achieve a management qualification. Care Homes for Older People Page 24 of 30 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. Opinions are sought and acted upon to develop the service in their best interests of the people that live at the home. The maintenance of equipment and safety checks in place ensures that peoples health, safety and welfare are met. Evidence: The acting manager has been in post since October 2009. As stated within this report the concerns that were raised regarding the care practices, have been addressed by the acting manger and provider. The acting manager confirmed at this inspection that she intends to continue managing Holly Tree Lodge for the foreseeable future and she confirmed that she was in the process of applying for registration with the Care Quality Commission. The providers self assessment stated that the ethos of the home is open and transparent. One visitor that was spoken with also confirmed this and commented on the improvements at the home over recent months. Staff that were spoken with Care Homes for Older People Page 25 of 30 Evidence: confirmed there was a positive staff team and high staff morale. Staff felt that they were well supported by the management team. Quality assurance systems were in place to ensure the home is effective in meeting the needs of the people using the service. Surveys had been undertaken by people using the service or their relatives in January 2010. The acting manager confirmed that both herself and the provider have audited these surveys. She discussed the actions that had been taken following this audit. It was confirmed by the acting manager that the results of these and actions taken were not published. Discussions took place with the acting manager as to how this could be achieved, such as within newsletters or putting results and actions in minutes of relatives meetings. This would ensure people using the service, their representatives and other interested parties were informed of the quality assurance processes in place, to demonstrate how the home is managed in the best interests of the people using the service. Satisfactory systems were in place for managing individuals monies, which were held by the home for safe keeping. This ensured the finances of the people living at the home were safeguarded. Staff meetings were held for both senior staff and all staff that worked at the home.This ensured that everyone employed had an opportunity to express their opinions and discuss any issues or changes in practice. It also ensured that all staff were kept up to date with any service changes. Since the last inspection the acting manager has commenced supervision sessions for staff and all staff have had appraisals. Records of appraisals were seen along with supervisions done.This ensures that the staff team were provided with the support and guidance required to undertake their duties and support people effectively. The policies for the home had been reviewed and this was evidenced on the policies seen. A sample of service certificates and fire safety checks and assessments were checked and corresponded with the information provided prior to this visit. All records and certificates seen were up to date, which demonstrated that safe working practices were in place. Care Homes for Older People Page 26 of 30 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 27 of 30 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 30 18 Evidence must be available 27/08/2010 to demonstrate that staff employed have received appropriate training that relates to their job, such as mandatory training and training specific to the needs of the people using the service. This will demonstrate that staff have the necessary skills and knowledge to meet peoples needs and work in a safe way. 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 7 7 Evidence should be in place to demonstrate that relatives had been involved in the formulation of the care plans. Information within care plans should identify the individuals strengths and abilities. This will enable the staff team to support them in retaining their skills, without compromising the care they received. Page 28 of 30 Care Homes for Older People 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 3 4 7 12 Risk assessments undertaken should not conflict with the information provided to staff in the care plans. An activities co ordinator should be appointed to ensure activites can be planned, carried out and recorded on a daily basis. Information should be gathered from needs assessments and discussions with relatives and friends regarding individuals preferences in relation to social activities, cultural interests, meals and religious needs. Picture menus should be used to support people in choosing their meals. The exit from the conservatory to the garden area should be improved to ensure it is accessible for everyone. The environment should be further enhanced to support people with dementia, such as tactile boards, memory boxes and other activity and orientation products. The results and actions of quality assurance audits should be published and made available to people using the service, their representatives and other interested parties to demonstrate how the home is managed in the best interests of the people using the service. 5 12 6 7 8 15 19 22 9 33 Care Homes for Older People Page 29 of 30 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. 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