Care Home: Hollybank

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What the care home does well Residents are being provided with the information, which they require, to enable an informed choice as to where they would like to live. The home is able to demonstrate that it is assessing and meeting the needs of residents admitted to the home. Residents are having their care needs reviewed and reassessed. Prospective residents, their friends and relatives, are able to visit to assess the suitability of the home. Residents` care plans, detailing their health, personal and social care needs (and how these are being met) are being drawn up with the involvement of residents and their relatives/representatives. These are being reviewed on a monthly basis. The home is ensuring that residents` health care needs are being fully met. Residents are being protected by the home`s medication policies and procedures. All staff receive medication training. Residents are being treated with respect and their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 8The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are able to raise any concerns they may have. The legal rights of residents within the home are being protected and promoted. Residents are encouraged and assisted to vote if they wish. The home`s policies, procedures and practice are generally providing residents with protection from abuse. Training is being provided. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents` rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents` personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home`s residents. Residents` safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. The registered manager, with the support of the deputy manager, is managing the home in a caring, competent and responsible way. The financial interests of residents are being safeguarded by the home`s policy, procedures and practice. Residents can be assured that staff are being appropriately supported in meeting their needs. The interests of residents are being safeguarded by the home`s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? Residents are being provided with more varied range of opportunities for leisure and social activities. These are in accord with their social, cultural and religious interests and needs. Statutory adult protection training has been updated since the last inspection. CARE HOMES FOR OLDER PEOPLE Hollybank 5 Abbots Lane Kenley Surrey CR8 5JB Lead Inspector Peter Stanley Key Unannounced Inspection 17th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hollybank Address 5 Abbots Lane Kenley Surrey CR8 5JB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8660 4213 020 8668 5087 hollybank2@aol.com Mrs Valerie Jane Taylor Mrs Valerie Jane Taylor Care Home 17 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (17) of places Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category 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: Old Age, not falling within any other category - Code OP 2. Dementia - Code DE (Maximum number of places: 4) The maximum number of service users who can be accommodated is: 17 20th April 2007 Date of last inspection Brief Description of the Service: Hollybank is a residential care home registered with the Commission for Social Care Inspections (CSCI) to provide personal care for up to seventeen older people. In May 2007, the registered provider made an application for a variation to the Home’s registration, so as to be able to admit up to 4 older persons with a diagnosis of (mild to moderate) dementia. An inspector from the Registration Team completed two site visits, and, following a number of recommended actions to meet the needs of persons with dementia, a variation was approved in September 2007. The home is a large detached domestic house providing 15 single and I double bedrooms. The home occupies a hillside site with sloping grounds to the front and back. The home has a single lounge and a separate dining room. The home has the usual facilities including toilets, bathroom (including assisted baths and a jacuzzi type bath) laundry, sluice, plus a kitchen and small office. This is an older property. The communal areas are not large but are homely and comfortable. The bedrooms with en suite toilets are very attractive. There are two bedrooms on the lower floor. These are large rooms and overlook the garden. The home was renovated in 2006, with a new extension providing three en suite, single Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 5 bedrooms to the home. A conservatory, overlooking the garden, was added in 2008 providing a pleasant area for residents to sit. There is a patio area with outdoor furniture and an outdoor decking area off the residents lounge. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection of the home took place over one day. Both the registered manager, Valerie Taylor, and the deputy manager, Debbie Barrett, were present during the course of the inspection, the deputy manager being principally involved in the detailed discussion of the relevant issues and standards discussed. As part of the inspection, an inspection of the premises was completed, and checks on health and safety certification were completed. The inspector spoke with a wide cross-section of residents, including three residents who had been admitted to the home in recent months, and to staff on duty. Care records and other documentation were examined, and the records of four recently admitted service users were case-tracked. Information was also available from the Annual Quality Assurance Assessment (AQAA), which is completed by the home’s manager. The inspector received completed questionnaires from eight relatives and one resident. The feedback received was generally positive, with very favourable comments being made about the home and the support being provided. Relatives felt that Holly Bank offered a comfortable, homely and welcoming environment, and a good standard of care with caring and helpful staff. Feedback indicated that relatives feel very welcome when they visit the home, and that there was respect for individuals’ privacy and dignity. Food was perceived as being very good, with options to suit individuals’ preferences or dietary requirements being offered. Where there was a problem with a resident’s health, communication with relatives was generally felt to be good. One relative did, however, feel that the home should have been more pro-active in calling out the GP on a couple of occasions when her mother felt unwell. The home has, however, provided an assurance that all residents are being checked on a daily basis for any medical problems that might require a doctor’s visit. While the home has been making efforts to develop the range of activities available, there were some comments that suggested that individual residents could at times feel isolated and under-stimulated. There was a feeling, expressed by two respondents, that residents were not always being encouraged to participate as actively as they might in the daily routines of the home. One relative felt that her aunt would benefit from being involved more in domestic tasks such as helping to prepare food, or laying tables for lunch. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 7 The home has, however, been evidenced to have taken steps to extend the range of activities available to residents, and to have tried to encourage participation where this is the individual’s choice. As a result of this inspection, there are 4 requirements, 1 of which have been carried forward from the previous inspection. What the service does well: Residents are being provided with the information, which they require, to enable an informed choice as to where they would like to live. The home is able to demonstrate that it is assessing and meeting the needs of residents admitted to the home. Residents are having their care needs reviewed and reassessed. Prospective residents, their friends and relatives, are able to visit to assess the suitability of the home. Residents’ care plans, detailing their health, personal and social care needs (and how these are being met) are being drawn up with the involvement of residents and their relatives/representatives. These are being reviewed on a monthly basis. The home is ensuring that residents’ health care needs are being fully met. Residents are being protected by the home’s medication policies and procedures. All staff receive medication training. Residents are being treated with respect and their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Residents are being encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 8 The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are able to raise any concerns they may have. The legal rights of residents within the home are being protected and promoted. Residents are encouraged and assisted to vote if they wish. The home’s policies, procedures and practice are generally providing residents with protection from abuse. Training is being provided. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. The registered manager, with the support of the deputy manager, is managing the home in a caring, competent and responsible way. The financial interests of residents are being safeguarded by the home’s policy, procedures and practice. Residents can be assured that staff are being appropriately supported in meeting their needs. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with the information, which they require, to enable an informed choice as to where they would like to live. Generally, residents are being provided with clarification by the home of the terms and conditions of their placement. However, three recently admitted residents have yet to receive a written contract. The home is able to demonstrate that it is assessing and meeting the needs of residents admitted to the home. Residents are having their care needs reviewed and reassessed. Prospective residents, their friends and relatives, are able to visit to assess the suitability of the home. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Service User Guide and Statement Of Purpose have been reviewed and revised in Oct 2007, and again in February 2008. Information regarding the home has been updated so as to include reference to the home’s variation for the admission of up to 4 older persons with dementia. The registered provider and manager have been in the process of making the Service User Guide and Statement Of Purpose accessible to those residents who have a diagnosis of dementia. The Home has also set up its own website so as to provide a readily accessible source of information about the home. Prospective residents are welcomed to visit the home and stay for a trial period if they wish before making a decision to stay permanently. Where an individual is unable to visit the home then a member of the staff will visit them to discuss a possible stay in the home. Unplanned admissions are avoided. The inspector received comments from a number of relatives, which indicated that they have been given all relevant information, and that they are made to feel very welcome when they visit the home. The inspector was informed that there have been five new admissions to the home since the last inspection. The residents’ files were examined. The relevant care management assessments and care plans were evidenced, together with the home’s own assessments and risk assessments. The inspector also evidenced that care reviews had taken place following the initial settling in period, with the resident, his/her close relatives and their care manager attending. The inspector spoke to a wide range of residents, including 3 residents who had been admitted within recent months. This indicated that residents were generally very satisfied with the support being provided, and that staff were perceived to be caring and considerate. The residents who had recently moved in expressed favourable views about the home and the support provided, and felt that they had settled in well. The home should provide a written contract to all residents, detailing the terms and conditions of their placement. However, inspection of the files of recently admitted residents indicated that three had not, as yet, received a contract. A requirement applies. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans, detailing their health, personal and social care needs (and how these are being met) are being drawn up with the involvement of residents and their relatives/representatives. These are being reviewed on a monthly basis. The home is ensuring that residents’ health care needs are being fully met. Residents are being protected by the home’s medication policies and procedures. All staff receive medication training. Residents are being treated with respect and their right to privacy is being maintained. Residents can be assured that, in the eventuality of their death, their wishes will be respected and that they and their family will be treated with care, sensitivity and respect. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home maintains a Personal Fact File for each resident. This is compiled with the involvement of the resident following their admission and provides details of individuals’ nearest relatives and contact details, a brief summary of the resident’s life history, details of their interests and beliefs, likes/dislikes, and preferred choice of food and drink. These are designed to assist in raising the awareness of staff to individuals’ life histories, needs and choices. Care plans are being maintained in separate files and provide considerable detail regarding residents’ assessed care and support needs. Care plans generally indicate the involvement of residents in developing them. There was evidence of care plan reviews taking place with care plans being updated and amended when necessary. Care plans are being reviewed on a monthly basis. Risk assessments are being carried out by the home as part of the Home’s overall assessment. The inspector examined a sample of care plans and risk assessments, including those of five recently admitted residents. These evidenced that there is detailed and comprehensive recording of individual needs, preferences and risks. The home is evidenced to be meeting the health needs of residents. Residents’ medical history and current needs are detailed within residents’ files. Staff undertake a basic period of induction, and receive training in developing their awareness of residents’ health needs, and in the reporting and recording of any changes that are observed. Discussion with residents, and inspection of care plans and daily logs indicate that there is generally good practice in terms of identifying and meeting residents’ health care needs, and that individual needs are being identified and addressed. Views expressed by relatives indicated that communication regarding any health or other concerns is generally good. One relative did, however, feel that on two occasions when her aunt was unwell, the Home did not respond quickly enough in calling out the GP and that this only took place once she had herself requested this. The home has, however, provided an assurance that residents are checked daily for any medical problems that may require a doctor’s visit. Inspection of residents’ records, and discussion with the deputy manager, indicate that where health concerns arise, these are being addressed. The inspector examined the accidents record and noted that appropriate actions, including seeking professional medical help, had been taken where there had been a fall or other accident that had occurred. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 15 The home has generally developed good links with health care professionals, with periodic visits from a chiropodist, and access being arranged for local optician and dental appointments. The home’s residents are registered with a number of local GP practices, and there are visits from GPs and district nurses as and when required. The home has sound policies and procedures in place for staff to follow to support safe medication practice. Blister packs are used and kept in a locked cupboard. The inspector examined a sample of medication profiles and medication administration (MARS) sheets, and found these to be in good order and appropriately maintained. A locked cabinet within a locked cabinet is available for the storage of controlled drugs should any resident require these. It is the home’s practice for any staff member, undergoing training in this area, to regularly observe an experienced staff member administering medication; and once trained, to be observed administering medication by an experienced staff member, so as to ensure accuracy and safe practice. Accredited training in the ‘Safe handling of medication’ is being provided for all care staff. No staff member can undertake the administration of any medication until this training has been completed. Following a recommendation from the previous inspection the home is now ensuring that two staff are present for all administration of medication to residents, one to administer and one to observe to ensure accuracy. Recording sheets evidence that this procedure is being followed. The views expressed by both residents, and relatives, indicates that the privacy and dignity of residents are generally being well respected in this home. Staff were observed to knock on residents’ doors before entering and to be respectful of individuals’ wishes and needs. Generally, management and staff at the home are perceived to be considerate, caring and respectful, with visitors feeling that their need for privacy is being respected when they visit. The inspector met three residents who prefer to spend most of their time in their rooms rather than in the communal areas, their wishes in this regard being respected. Residents are able to have meals in their room if they so wish. The wishes of residents regarding the eventuality of their death are recorded on residents’ files, and religious and other beliefs regarding their death and funeral arrangements are respected. The home informs and involves relatives where potential life-threatening concerns arise. There have been two deaths at the home since the last inspection. These events have been dealt with in a caring and appropriate way, with the management and staff being respectful of relatives and other residents’ sensitivities. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with more varied range of opportunities for leisure and social activities. These are in accord with their social, cultural and religious interests and needs. Residents are being encouraged to maintain contact with their family and friends and to retain links with the local community. Residents are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. The meals provided are wholesome and appealing and are served at times, and in places, which are convenient for residents. EVIDENCE: Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 17 The home provides a varied programme of activities. This includes weekly visits from musicians or entertainers, reminiscence therapy and bingo sessions. Activities include a regular weekly activities session, organised by a visiting group (Total Fitness), which includes activities such as exercises, quizzes, and games. Depending on the wishes of residents, occasional outings may be arranged to the theatre or concert hall. These have previously included outings to a pantomime or concert at the Fairfield Halls. There are also occasional trips out for tea and shopping for those residents who are interested. The inspector was advised that the Home organises the occasional party for residents to celebrate Christmas or special birthdays, to which relatives are invited. Following the last inspection, the inspector recommended that staff give more attention to engaging residents in conversation, games and activities, and in providing some stimulation in their day. Within the last year, the home has made efforts to extend the range of activities available to residents. There is a notice board of daily activities, and residents are encouraged to participate whenever possible. The home keeps a record of the activities in which residents are choosing to participate. A staff member initiates informal activities sessions two or three afternoons a week. These include reminiscence, and games such as cards and dominoes for those who wish to participate. A log of activities is being maintained, listing the activities undertaken and the residents who attend each session. The home also arranges showings of films on DVD in the seating area within the new conservatory. An activities programme is displayed in the main lounge where most activities take place. The home has its own Charter of Rights This details the home’s commitment to respecting choice and the personal autonomy of residents. Residents are given assistance in exercising choice and control over their lives, and are encouraged to manage control over their own finances wherever possible. Residents attend regular monthly meetings where forthcoming activities and menus are discussed, and residents’ likes and dislikes aired. Views expressed were, again, generally positive with residents feeling that there is flexibility in their daily routines and are able to exercise choice in their daily lives. This includes where and how to spend their time, their choice of clothes, food and the layout of their rooms. Residents are able to take meals in their own rooms if they so wish. The atmosphere in the home is perceived to be open, welcoming and accepting of their individuality. Views expressed by relatives indicate that the home is welcoming to visitors and that they are encouraged to maintain their contact with family and friends. While there is no separate room for receiving visitors, residents are able to receive visitors in their own rooms, or to go out with relatives or friends for tea or a visit somewhere. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 18 Residents expressed generally very favourable views about the food that is served, meals being home cooked and using fresh vegetables and produce. Meals are served in the communal dining room. This presents as being clean, homely and pleasantly arranged. Meals can, alternatively be taken in the resident’s own room, or in the lounge, if he/she so wishes. The registered person and staff are very committed to ensuring that residents receive good wholesome meals. Residents are able to make their choices from the menu the night before or at breakfast. Menus are discussed at residents’ meetings, and preferences expressed. The home provides a choice of breakfast, a cooked mid-day meal and a lighter evening meal. Drinks are provided when required and snacks can be obtained upon request. There is a four weekly rotational menu within the home, which provides for a varied, wholesome and nutritious diet. The home has a varied lunchtime menu with two fresh main food options each day. There is also a choice of dessert. Any individual dietary requirements are recorded and catered for. The home has had to adjust to meet the communication needs of persons with dementia, and is providing photographic menus of the food that is on offer. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are able to raise any concerns they may have. The legal rights of residents within the home are being protected and promoted. Residents are encouraged and assisted to vote if they wish. The home’s policies, procedures and practice are generally providing residents with protection from abuse. Training is being provided. EVIDENCE: The home’s complaints policy meets the criteria required by this standard. This is available for residents, relatives and others, together with a copy of Croydon’s complaints procedure. A copy of the Complaints policy and procedure is kept near the front door, in the reception area, together with the home’s complaints and suggestions book. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 20 The inspector spoke with a cross section of residents. No concerns were raised, and feedback indicated that residents would feel able to raise any concerns that arise. There have not been any complaints made to the home since the last inspection. In keeping with a previous recommendation, the home maintains a record of any concerns or compliments, one concern having been noted since the last inspection. The registered provider facilitates monthly residents’ meetings, which assists in identifying any concerns that service users may have. The home aims to fully protect residents’ legal rights by involving family and friends in respect of their contracts, benefits and monies, and in attending reviews. The deputy manager has advised that the home does not act as an appointee on behalf of residents, but that where the resident is unable to manage his/her finances this responsibility is undertaken by a relative, solicitor or social services. Independent advocacy can be sought if a resident has no friends or family. The home maintains records of expenditure, with monies being reclaimed where appropriate. The deputy manager has previously advised that residents are enabled to participate in the civic process, being encouraged to vote in elections if they so wish. One adult protection concern has arisen within the last 12 months, appropriate procedures having been followed, the allegation having proved to be unfounded. The home has an appropriate adult protection procedure in place, together with a copy of Croydon’s Adult Protection Policy and Procedures. The home has a ‘whistle-blowing’ policy in place together with a copy of the General Social Care Council’s Code of Conduct for staff to reference. All staff undertake training in adult abuse, and have received updated statutory training (on 20/11/07 and 27/11/07) in adult protection and adult abuse. This, training has been evidenced with the relevant certification. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Risk assessment of the home is in place for their protection. Residents’ rooms present as being safe, comfortable and pleasantly decorated, reflecting individual residents’ personal identities, and being suited to their individual needs. Residents have access to safe and comfortable communal facilities. Sufficient bathing, washing and toilet facilities are being provided for the home’s residents. Residents’ safety is being assured through the provision of sufficient aids and adaptations. Residents are living in a home that presents as being clean, pleasant and hygienic. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home is a large detached domestic house providing 15 single and I double bedrooms. The home occupies a hillside site with sloping grounds to the front and back. There is a pleasant, large lounge, a separate dining room, and a new conservatory. All communal rooms have had their door surrounds painted yellow so as to assist recognition for those residents who present as being confused. The inspector completed an inspection of the premises. Residents’ bedrooms present as pleasantly arranged and decorated, and personalised to reflect individuals’ identities and tastes. Each door has the name and a photograph of the resident on the outside, so as to ensure that both residents and staff are clear as to the occupant’s identity. Following the recent variation, enabling the admission of some residents with dementia, recognition boxes have been fitted on the outside of those rooms where these are felt to be necessary. These boxes include items of a personal nature which those residents, who experience confusion, can easily recognise. Including the three rooms in the annexe, seven single bedrooms and the one double bedroom have ensuite washing and toilet facilities. The home has accessible toilets on all floors, with raised toilet seats and grab rails being provided to assist the service users. All toilet doors are clearly labelled, and have had fluorescent green strips placed around the frames, so as to make them easily distinguishable. Washing and bathing facilities meet the individual needs of the residents. The home has had thermostatic valves fitted. These are set to ensure that the water temperature does not exceed 43 degrees C. Weekly checks of water temperatures in the home are being carried out, and recorded appropriately. A conservatory has been added to the annexe in order to provide additional seating facilities, and a pleasant place to sit and relax. This provides an alternative seating area for residents. Two new patio areas have also been created, new garden furniture having been purchased. The garden has been made more accessible for residents, and has been made more secure with the Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 23 securing of the side entrance, and the renewal of fencing around the perimeters. The inspector spoke with a number of residents, most of whom (about 12) were sitting in the communal lounge. The lounge has been redecorated with new pictures and mirrors. Residents expressed their general satisfaction with the home environment and with the facilities provided. The inspector spoke with a recently admitted resident who expressed his satisfaction with the home, and with his room. The room presented as pleasantly decorated and laid out, and personalised to reflect the individual’s identity. The inspector inspected a number of other rooms, three of which were with the permission of the residents who were present. The rooms all presented as meeting the standards required, and the three residents who were present all expressed their satisfaction. Picture signage has been placed on residents’ bedroom doors, and fluorescent green strips have been placed around door frames and light switches. Bath hoists, grab rails and raised toilet seats are present throughout the premises. The home has a call alarm system, which can be operated from all rooms within the home. The home was assessed by an occupational therapist in 2004, as a result of which grab rails on sections of the stairs, leading to the rear fire entrance, were put in. A stair lift was installed in 2005, this having been risk assessed for all residents who use this. This is being regularly serviced on a six-monthly basis. Heating, lighting and ventilation throughout the home present as satisfactory. Lighting is domestic in character and in keeping with the homely atmosphere. Most residents have table or wall-mounted bedside lamps. Fluorescent green tape has been affixed around all light switches in residents’ rooms so as to make these clearly distinguishable. The home presents as being clean and hygienic and to be meeting the necessary standards of cleanliness and hygiene. Staff at the home are provided with infection control training, and clear guidelines in this area are in place. The home received four stars from a recent environmental health inspection. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s residents. Residents are being safeguarded by satisfactory recruitment policy and procedures, and by the necessary recruitment and criminal records checks. Staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Statutory training sessions in adult protection have been held, but need to be evidenced. EVIDENCE: Staffing levels are being maintained in line with Care Home Regulations, and as appropriate to the number and assessed needs of the home’s service users. There are presently 13 care staff and four auxiliary staff, which includes two cleaners and two cooks. There are 17 residents, most of whom are physically Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 25 very frail, and who have a range of associated disabilities, and including some who have a dementia-related diagnosis. All of the staff undertook Dementia Care training in August 2007, and the Deputy Manager has acquired best practice guidance in respect of accommodating residents with a diagnosis of Dementia. Person-centred dementia training has recently been completed. The staff levels on the day of inspection were generally observed to meet the agreed staffing levels. On duty were the registered manager, deputy manager, two care assistants, and an ancillary worker. The rotas indicate that staff levels are being maintained at the required level of 3 throughout the day on weekdays, and at weekends. The staff rotas indicate that, for the overnight shift, there is one waking and one sleep-in staff member who are on call. Of 14 care staff, 8 currently possess an NVQ Level 2, three of whom have achieved an NVQ Level 3. The deputy manager advised that a further 3 care staff are working towards an NVQ Level 2, and one senior staff member (who currently has an NVQ Level 3) is working towards an NVQ Level 4. The home is meeting the 50 target of staff with an NVQ Level 2. The inspector spoke widely with residents. Views expressed indicated that staff are seen to be friendly and caring, and that residents’ support needs are generally being well met. The inspector also canvassed the views of relatives through the use of questionnaires. These indicated that relatives find staff to be caring and welcoming, and that the needs of individual residents are being generally well met. No concerns were expressed. From his observations, the inspector found staff to be caring and attentive in their interactions with residents. The home has appropriate recruitment policies and procedures in place. Since the last inspection, there have been six new staff appointed. The inspector examined the relevant staff files and evidenced that all the necessary criminal records, identity and recruitment checks had been completed. The home has an induction programme, which provides a structured and ongoing programme of basic training. The programme evidences validated knowledge of the home’s policies, procedures and key areas of learning and practice. Induction records for new staff members are being maintained. The home has a training and development programme in place for which the deputy manager, Deborah Barrett, has responsibility. Records are in place for all staff training, and a rolling programme of staff training and refresher courses is available for all staff. This includes training in medication, adult protection, health and safety, manual handling, food hygiene and infection control. Some staff members complete emergency first aid as part of their NVQ2. Following a requirement from the last inspection, two training sessions Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 26 in adult protection have been provided by the LB Croydon (on 20/11/07 and 27/11/07). These need, however, to be certificated, so as to evidence that staff have completed this training. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 33, 35 to 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager, with the support of the deputy manager, is managing the home in a caring, competent and responsible way. Generally, the home is demonstrating that it is meeting its aims and objectives and that it is being run in the best interests of residents. However, the Home’s Development Plan for 2007-08, which needs to more clearly detail the outcomes for residents, has yet to be completed. The financial interests of residents are being safeguarded by the home’s policy, procedures and practice. Residents can be assured that staff are being appropriately supported in meeting their needs. The interests of residents are being safeguarded by the home’s record keeping, Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 28 with records being kept secure, up to date and accurate. The health, safety and welfare of residents and staff are being appropriately promoted and protected. EVIDENCE: The home’s registered provider is also the registered home manager; the deputy manager, Debbie Barrett exercises day-to-day responsibility for managing the home. She has had extensive experience in her present role and has obtained the NVQ Level 4 and Registered Manager’s Award. To help facilitate communication, a daily communications log is being maintained; this itemises issues and matters arising during each day. The deputy manager receives periodic supervision from the home’s manager; this has assisted communication and has enabled more effective management of the home. There is evidence of good communication and consultation between management and staff, with regular staff meetings taking place. Staff present as being well supported, and as having generally good relationships with management. Inspection of the staff meetings book indicates that staff meetings are being held on a regular monthly basis. Full minutes of meetings are being recorded. The home has quality assurance processes in place. Questionnaires have been completed with residents, relatives/friends, professionals, care managers and others visiting the home. The inspector was advised that the home is currently preparing a Development Plan for 2007-08. In line with a requirement from the last inspection, this needs to be developed so as to identify service user outcomes, and highlight those areas where survey and other feedback indicates that the home is doing well, less well or poorly. Or where newly identified needs exist. Objectives and priorities for the year ahead must also be identified. The inspector is satisfied that residents’ financial interests are being appropriately protected. These are being safeguarded with records being kept of any expenditure on their behalf. Wherever possible, residents are being encouraged to manage their own monies but, where not possible, relatives or external agencies such as social services or independent advocacy are invited to act on the individual’s behalf. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 29 The home no longer handles residents’ personal monies but keeps records of personal expenditure. These are billed monthly to the responsible relative or representative. The deputy manager has advised that any valuables entrusted for safekeeping are securely kept in the office within a lockable container. Receipts for any such item are issued in accordance with existing procedures, with a signed record being kept. The inspector examined a sample of staff supervision records and evidenced that staff have been receiving regular two-monthly supervision. The home aims to ensure that any new staff members receive initial supervision within two weeks of their start date at the home, and thereafter, on at least a monthly basis, throughout the first three months of their employment. The deputy manager advised that there was currently no sharing of the supervisory workload as the senior care worker who had been delegated this responsibility had now left the home’s employment. Whilst the home’s manager and deputy manager are managing to maintain the regular supervision of staff, some delegation of this task is advisable if this is to be sustained. All staff are appraised as to their performance and development over each 12 month period. Each staff member completes a pre-appraisal self-evaluation form. Generally, the interests of residents are being safeguarded by the home’s record keeping, with records being up to date, accurate and securely stored. All records that are required for regulation are in place and are maintained to a high standard. The records that were inspected included staff and service user files, medication charts, accident and incident records, complaints records, and staff rotas. The inspector examined a wide range of documentation and was generally satisfied with the home’s upkeep of its records, these being maintained in reasonably good order. Residents’ files have been structured so as to include a front index, and separate sections for service user information, assessments, care plans, health, medication, record of accidents and incidents, activity charts, and daily care notes. Staff files were also well structured and maintained. The Home’s policies and procedures are reviewed on an annual basis, with amendment and updating as required. The Home has declared (in the AQAA) that all of its policies and procedures were last reviewed in October 2007. Staff are familiarised with key policies and procedures during their induction, in supervision and at staff meetings. The health, safety and welfare of residents and staff are evidenced as being appropriately promoted and protected. The inspector completed checks on Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 30 documentation relating to health and safety and carried out an inspection of the premises. The premises presented as being generally well maintained, with no particular concerns being identified. Health and safety risk assessments for the home have been updated (on 5/2/08), and the Fire Risk assessment updated (on 24/5/07). Fire safety training is held for all staff. All checks completed for the inspection of gas, electricity, portable appliances, lift maintenance, stair lifts and hoists, fire alarms, emergency call equipment, fire safety, food hygiene, infection control and water supply (legionella), were found to be satisfactory, with the necessary inspections and certification having been completed within the required time-scales. The inspector also evidenced the completion by the home of regular health and safety checks including weekly water temperature checks, and daily fridge/ freezer checks. Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 2 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 4 4 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 2 X 3 4 3 3 Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 5(c) Requirement To denote the involvement and agreement of the service user, all residents must be provided with a placement agreement. This must be signed by the service user (or by his/her nearest relative or representative) and by the home. 2 OP7 14(1) (c) To denote the involvement and agreement of the service user, all assessments and care plans must be signed and dated by the service user (or by his/her nearest relative or representative) and by the home (7.1, 7.6) To ensure the health and safety of residents, all staff appointments must include a signed health declaration. The registered manager must ensure that the Home’s Development Plan is revised so as to highlight the key outcomes DS0000025794.V361808.R01.S.doc Timescale for action 31/05/08 31/05/08 3 OP29 19(1) a&b Schedule 2, No 6 24(1-3) 31/05/08 4 OP33 31/05/08 Hollybank Version 5.2 Page 33 for service users as evidenced from surveys and other feedback. The Plan must also provide an assessment of the Home’s performance in meeting service user needs, and in fulfilling its stated aims and objectives. Objectives and priorities for the year ahead must also be identified. This requirement has still to be met. The Development Plan for 2007-08 is currently being prepared. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hollybank DS0000025794.V361808.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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