Care Home: Hollystead

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What the care home does well The home keeps good records of the care needs of the people who live there. Staff have access to care plans and make a detailed daily report of how the care plan is being carried out. The home is well staffed and the staff are properly qualified and well trained. Everyone who lives at Hollystead has their own bedroom and there are suitable aids and adaptations around the home including supported baths. People are encouraged to keep in touch with their families and relatives who visit the home whenever they choose. People who live at Hollystead and their families told us that they enjoy living there, like the staff and feel that it is homely and comfortable What has improved since the last inspection? The manager ensures that people are properly assessed before they move into Hollystead. The service user guide has been reviewed and made easier for the people who live in the home to understand. There have been no new admissions in the last year but some new people have come in for temporary respite care. Care plans are now reviewed regularly and residents and their relatives are invited and encouraged to attend. There is a format for a detailed daily report by staff on how the care plan is being put into action. Medication was being dealt with properly when we visited. All staff have been trained in how to move and handle people and most staff now have the appropriate qualification. Fire safety systems are regularly checked to ensure the safety of the residents. What the care home could do better: Hollystead is not able to provide the sort of care that most people with learning disabilities choose when given a free choice. Given that choice most people prefer to live in small groups in domestic style housing with care tailored to their specific needs. Hollystead is too large to be readily adapted for such a model. The expert by experience felt that Hollystead was `awful` and that he `wouldn`t live there`. The owners have been saying for some time that the service needs to be fundamentally reviewed and their own Performance Management Unit recently stated that "it is not ideal for people with learning disabilities to live in a large group setting and Nugent Care is currently reviewing the service". That review should be brought forward as quickly as possible. People living at Hollystead do take part in a range of activities but for some people this is limited. More emphasis needs to be put on providing activities that are tailored to the preferences of the individuals concerned. Recruiting more volunteers may help to make this possible. Hollystead is generally reasonably maintained but it would be helpful if someone was on hand on the premises to deal with minor repairs and maintenance issues as they arise. Some of the furniture needs to be replaced, especially in the lounges. Key inspection report Care homes for adults (18-65 years) Name: Address: Hollystead 14 Old Mill Lane Liverpool Merseyside L15 8LN     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: Peter Cresswell     Date: 0 2 0 3 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 Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Hollystead 14 Old Mill Lane Liverpool Merseyside L15 8LN 01517227874 01517227824 Hollystead@nugentcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nugent Care Name of registered manager (if applicable) Mrs Sylvia Youds Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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: Learning disability - Code LD. The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Hollystead is owned and operated by Nugent Care, a voluntary organisation that provides a number of services in the area for people with different support and care needs. The service provides both a permanent home and two short stay (respite) beds for people who need care and support for a short time. All of the people who live at Hollystead require support as they have a learning disability. Some also have a physical disability. The house is a spacious detached Victorian house situated in its own grounds. Parking is available within the grounds. Internally the house has been adapted to meet the Care Homes for Adults (18-65 years) Page 4 of 28 1 3 0 2 2 0 0 9 16 Over 65 0 Brief description of the care home needs of people who also have physical disabilities. This includes ramps, a lift and adapted bathing and shower facilities. Everyone living at Hollystead has their own bedroom. Of the sixteen bedrooms one is en-suite and the others provide washbasins. There are four bath or shower rooms with specialist facilities around the house for people to use. Shared space includes a light and sound room, an activity room, two lounge areas and a dining room. The large grounds provide plenty of space for people to sit in warmer months or go for a short walk. Staff are available at Hollystead twenty four hours a day to support the people living there Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: As part of this inspection we visited the home without telling anyone we were going. We spent eight hours there over two days. An expert by experience was part of the inspection team and spent three hours at the home together with a supporter. He also had lunch with the residents. We spoke to the manager and most of the staff who were on duty. The expert by experience spent some time with the residents who were in the lounge. We looked at documentation including care plans, staff files (including training records) and safety records. We toured the home and looked at all of the rooms. Before we visited the manager sent us an Annual Quality Assurance Assessment (a self assessment) which describes how well the service feels it is meeting the needs of its service users. Four of the eleven people who live at the home, with the support of their families, returned survey forms to us with their views on the service. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 7 of 28 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering staying at Hollystead have enough information to enable them to make an informed decision. Evidence: Those people who responded to our surveys told us that they had enough information about the home before they decided to move in. The service user guide has been reviewed to make it easier to understand. There were still some minor errors and omissions in it so it should be updated further. It says, for instance that the home has its own handyman but this is no longer the case. We looked at the file for one person who has just started to stay for respite care. There was a full, detailed assessment from the local authority social worker that gave the home all of the information they needed to care for a person with complex needs. This person had stayed one night for a trial and it had been successful so further, longer stays were planned. No permanent residents had been admitted in the last year. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans clearly set out the support that people living at the home need. People are encouraged to take part in making decisions about their lives to the best of their ability. Evidence: The manager has changed the care plan format since we last visited and we looked at the plans for two of the residents. They were detailed and clear, setting out the persons needs and what the staff needed to do to support them. There is a daily report sheet with space for staff to make detailed entries. Each month has a separate booklet of daily reports which makes it easy to keep them up to date. It would be helpful if care plan summaries were attached to each booklet of daily report sheets thereby encouraging staff to focus their entries on how the agreed care plans are being implemented on a day to day basis. The existing reports tend to deal with routine matters about food and sleeping rather than how other elements of the care plan are being met. The basis of care plan summaries exist in the form of a file of basic details. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: Reviews are documented and in one case a day centre worker had attended, which is good practice to ensure that the review has a rounded picture of the persons activities and interests. There is no central record of review dates and it would be good practice to keep such a record to make sure that all reviews are held on time. People who live at Hollystead have limited capacity to make their own decisions but the manager told us that all of them are supported by their families in making key decisions about their lives. The activities organiser does hold residents meetings but it was not clear how people participated in these, as in general they are more suited to communicating on a one to one basis. A senior officer of Nugent Care, the owners, has carried out Mental Health Act assessments to assess peoples capacity to make their own decisions. The notes of the reviews state that family members act as advocates. There was information in the home about independent advocacy services should they be needed. In one room there was a notice on the wall about one element of care for the resident. This is an unsuitable, undignified institutional practice and staff should be aware of what is required from the care plan. Care Homes for Adults (18-65 years) Page 12 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in some activities but this should be extended to include more of the things that they enjoy. Evidence: Most of the people who live at Hollystead go to day centres, either in the homes bus or by taxi. The home employs a part time activities organiser who holds some residents meetings and does individual activities such as jigsaws, music and shopping trips. There was an activities schedule on the wall but it was out of date and not used so should be removed. Whilst we were there one resident was doing a jigsaw with a member of staff but the others who were not at a day centre did not appear to be doing much. The expert by experience and his supporter joined the few residents in the home in the main lounge. The expert felt that the staff were not communicating with the residents. The jigsaw one was doing was broken and the pencils another person was using were broken. When we returned the following day a member of staff Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: was leading a musical activity in the main lounge. There is a light and sound room in the basement which is very popular with many residents. The owners, Nugent Care, recruit some volunteers who play a valuable role but there does not seem to be more than one at the home at any time. If more volunteers were recruited there would be more scope to take people out. On one of the files we looked at it was evident that the person in question liked going out, and this was confirmed by staff but there was no evidence that he had been out for some time. One reason for this was a problem with his wheelchair that had not been dealt with by the relevant agency but there was no activity plan and daily schedule to arrange for him to do things he enjoys. Some residents help to prepare some food and snacks. The people we saw seemed to be at ease in the home, moving about freely and having a relaxed relationship with the staff who were on duty. All of the residents have contact with their family and the home encourages family and friends to visit any time. Several relatives responded to our survey and one commented that Hollystead is a good place. The expert by experience had lunch with the residents. It was a cold meal as there was a problem in the kitchen. The expert felt that the meal was tasteless and boring. He did say however that the cook was the friendliest staff there and she told him that she tried to cook healthy meals. The menu is varied and healthy. There is usually a cooked meal twice a day, with the main meal being in the evening. The chef told us that she finds out what people enjoy and the menu is changed to meet their needs. Many people like spicy foods and the menu includes some curries. Meals for the week of our visit included savoury mince cobbler, lasagne and roast pork. There is always a choice available and if someone does not like the main options something else will be prepared for them. Breakfast is usually cereals or toast and supper includes biscuits, toast and jam. The chef works five days a week but a qualified cook is also on duty at weekends. One resident told us in a survey (with the help of a relative) that the food is fabulous . Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hollystead receive appropriate support for their health care. Evidence: People who live at Hollystead have a range of personal support needs and these are clearly set out in their care plans. They are given as much choice and independence as they need and personal support is provided discreetly and in complete privacy. Peoples care plans contain details of their medical conditions, which can be very complex. The plans have been revised to make them easier for staff to follow. Each person has a health screening file that contains the essential details of their conditions. Visits and correspondence from doctors and hospitals are kept on the individuals file. Medication is usually supplied in a monitored dosage system with tablets in individualised blister packs. We checked the medication for two residents and found that it was accurately recorded, though there was one blank entry. Staff must always make an entry for each episode. When medication is to be given as required (PRN) there should be written guidance on file setting out the circumstances in which it is to Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: be given. Medication that has to kept at a fixed temperature is kept in a dedicated, lockable refrigerator. Creams were not dated when they were opened; this is important to make sure as many have to be used within a certain period of time after opening. There were no controlled drugs in the home and if any were to be prescribed the home would need to obtain an approved controlled drugs cabinet. Details of how staff should deal with death and dying are not recorded in any detail on peoples files. The manager and senior staff have recently been on a training course on this issue and this difficult issue should be addressed so that appropriate action can be taken should it become necessary. Care Homes for Adults (18-65 years) Page 16 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Hollystead feel safe and any concerns they have are listened to and treated seriously. Evidence: Staff have been trained in how to deal with safeguarding allegations though they may need reminding that the appropriate action includes reporting any allegations to the manager as soon as possible. There have been no safeguarding referrals since we last visited. Some complaints had been received in the last year and all had been properly dealt with through the owners well established complaints procedure. Care Homes for Adults (18-65 years) Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hollystead is clean and generally reasonably maintained, providing a safe, comfortable home for the people who live there. It is not however suited to provide small, family style group living and would be difficult to adapt for such a purpose. Evidence: Hollystead is a Victorian mansion set in its own large and attractive gardens. The expert by experience felt that the outside looked run down. There is a large decking patio overlooking the lower gardens plus a summerhouse. The staff told us that people use the gardens a lot in warmer weather for barbecues and other outdoor activities, though they always need to be accompanied by staff. There are ramps to make most of the the gardens accessible to people with mobility restrictions. There are sixteen single bedrooms two of which are used solely for respite care. The rooms vary enormously in size; some are very big and bright, others are darker due to the nature of the building. One bedroom has a small sitting area and another has ensuite facilities. The radiator covers in two of the bedrooms were very hot and could have been dangerous if someone had fallen against them. The covers or thermostats need to be checked and adjusted to remove any possible risk. There are overhead electric hoists in two of the bedrooms enabling people to be moved with maximum dignity. The decor in some of the rooms was a little worn - torn wallpaper and minor damage to walls. These need to be attended to and in the past may have been dealt with by Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: the on-site handyman. Some screws had been left in one bedroom wall following removal of a shelf but were removed before we finished our site visit. The expert by experience felt that most bedrooms were cramped, with few personal touches, the nicest bedrooms were the ones the relatives visited regularly. The passenger lift provides access to nearly all areas of the building. It was out of order when we visited but the engineers attended promptly to repair it. The dining room is light and spacious but some of the wallpaper needs to be repaired. The plain blue vinyl floor, whilst still practical is unattractive and old fashioned. It would be more homely if it was replaced by a more modern surface, such as laminate. There are two lounges on the ground floor. Some of the chairs in the main TV lounge need to be replaced. The lounges are bright and overlook the garden but look a bit institutional, with chairs round the edge. It may be difficult to re-arrange these but staff could vary the seating arrangements in the smaller lounge at least (the green room). The expert by experience felt that the two lounges were bare, had institutionalised furniture and were bare of personal touches. There are a number of bathrooms around the home and they are clean and well equipped. There is a laundry, a light and sound room and an activities room in the basement. Although Hollystead is an attractive and imposing building it is frankly ill suited to modern concepts of care and living arrangements for people with learning disabilities. The expert by experience said that it was horrible and old fashioned and he wouldnt live there.The owners own quality assurance assessment comments that it is not ideal for people with learning disabilities to live in a large group setting and Nugent Care is currently reviewing the service. It would be to everyones benefit if this process was moved on as quickly as possible. One resident told us in a survey form On the whole I am very happy at Hollystead. It is comfortable, warm and homely. My room is lovely and I have lots of friends. Care Homes for Adults (18-65 years) Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and most are qualified so people are supported for by competent, appropriately trained care staff. The high level of agency and relief staff may affect the continuity of care. Evidence: People who live at Hollystead and some of their relatives told us in our survey forms that they valued the staff at the home. One said the staff at Hollystead are very caring and hardworking. Another said They do all that I want, they do their best. A relative told us that all of the staff are very supportive to my son. Over the past year the manager has reduced the number of agency staff working at the home. However, they do still use agency workers and a number of relief staff employed directly by Nugent Care. In fact nearly 300 shifts had been covered by such staff in the past three months and when we visited all of the basic grade care staff on duty were relief staff. They were all well known to the residents as the manager does all she can to ensure the same people are employed. Even so, every effort should be made to avoid regular use of agency and relief staff in order to guarantee consistency for the residents. In the daytime there are usually three care staff, a team leader and the manager on duty as well as various ancillary staff such as domestics and kitchen staff. At nights, as well as waking care staff, a senior is always available on the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: premises. The staff we talked to knew the residents well and appeared to have good relationships with them. They were able to tell us about the individuals they support and were familiar with their needs. Most of the support workers have NVQ2 (the appropriate qualification for their work) and any who dont have it are either on a course or about to start one. All of the team leaders have NVQ3. We looked at the training files and found that staff have access to Nugent Cares extensive training programme. Recent training includes developing yourself as a leader, safe handling of medication and PRICE (coping with aggression). Staff get refresher training each year in key areas such as Safeguarding Adults, Moving and Handling and Health and Safety. Everyone had done training in moving and handling and refresher training was due in April 2010. Staff receive regular one to one supervision and training and development needs are identified in these sessions. The expert by experience said that the staff needed some strong guidance in how to support people in person centred ways. We looked at the file for a newly recruited member of staff and found that the appropriate checks (such as criminal records checks) had been carried out as part of the normal recruitment process. This helps to prevent the employment of people who are not be suitable for work with people who may be vulnerable. Care Homes for Adults (18-65 years) Page 21 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owners have quality assurance procedures in place to maintain the level of service provided at Hollystead. Evidence: The manager is qualified and experienced. She has recently gained NVQ4, the relevant qualification for managers. She supervises the team leaders who in turn hold supervision sessions with the rest of the staff. The head of the owners Performance Management Unit carries out a quality assessment of the home every six months and other Nugent Care managers visit each month to carry out assessments of the home. This has included assessments under the Mental Capacity Act. Reports are completed for all of these visits and together they form the basis of the homes quality assurance system which is intended to maintain the quality of the service provided. The manager and staff have constant contact with the residents and their relatives and conducted surveys of relatives and service users. It was not clear that these were systematically analysed and acted on. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Staff carry out regular checks of fire safety systems and these were recorded and up to date. The appropriate safety certificates, such as for gas and electricity, were in place. The environmental health officer visited last year and was happy with the homes hygiene procedures including the way in which staff use the food safety programme Safer Food, Better Business. Care Homes for Adults (18-65 years) Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 16 The owner must provide facilities for recreation and must make sure that games and equipment used for this purpose are in good condition. It is degrading for people to have to use sub standard equipment for leisure activities. 30/04/2010 2 24 13 Radiator covers must be kept at a safe temperature. If radiators and/or their covers are too hot people are at risk of harm. 31/03/2010 3 24 16 The registered person 31/05/2010 (owner) must provide adequate furniture and must therefore review the furniture provided in lounges with a view to providing more homely and comfortable furniture, Care Homes for Adults (18-65 years) Page 25 of 28 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 the building needs to be made as homely as possible. 4 42 13 Unnecessary risks to the 05/04/2010 safety of residents must be eliminated so when cotsides or bedrails are used the manager must carry out and record detailed risk assessments based on Medical Devices Agency guidance. Cotsides or bedrails can be dangerous if used incorrectly. 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 3 10 14 16 Information about the care of individuals should not be displayed on walls, even in bedrooms. The recruitment of more volunteers would help to extend the range of activities available. Staff should, as part of the care plan, devise daily schedules for each resident to make sure that the care plan meets their likes and needs. Where medication is to be given as required there should be written guidance as to what this means in each case. Creams and ointments that need to be used within a fixed period after opening should be marked and dated when they are opened. The manager and senior staff should address the issue of any issues that are to be addressed in the event of a resident dying. 4 20 5 21 Care Homes for Adults (18-65 years) Page 26 of 28 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 6 7 8 24 28 33 Small repair jobs such as damaged wallpaper should be attended to as soon as possible. The blue vinyl flooring in the dining room is not homely or domestic in style and should be replaced if possible. The manager and owner should make every effort to reduce the need for agency and relief staff in order to improve the consistency of the care and support people receive. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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