Care Home: Hollywood Rest Home

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What the care home does well Prospective people wishing to live at Hollywood Rest Home, are assessed prior to admission so that they are able to meet the individual`s needs. Staff working at the home, have a good rapport with individual people and demonstrated a good knowledge and understanding of peoples care needs. Visitors to the home are made to feel welcome and staff morale at the home is good. Many members of staff have been employed at Hollywood Rest Home for some considerable time, providing stability and continuity of care to the people who live there. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. Staffing levels remain appropriate for the numbers and needs of people who currently live at the home. Recruitment procedures within the home are robust so as to protect people and staff are provided with appropriate training in both core and specialist subject areas so as to ensure they are able to meet people`s care needs. There is a quality assurance system in place so as to seek the views of residents and their representatives and other stakeholders about the services and facilities provided at the home. Where comments have been made these have been incorporated into the main body of the report. What has improved since the last inspection? Medication practices and procedures in the home have improved so as to ensure people`s safety and wellbeing. Regular audits are now being undertaken by the deputy manager so as to ensure that any shortfalls and/or deficits are highlighted and dealt with swiftly. Records now show that there are sufficient staff on duty each day and the staff roster accurately reflects staff working on any given day. What the care home could do better: A better system needs to be implemented to ensure that all staff working within the care home receive regular formal supervision, as currently this is not undertaken as frequently as it should. As stated previously, the care planning system within the home would benefit from further detail and from ensuring there are support plans and risk assessments in place for all of the identified needs of the person concerned. Specific examples are detailed within the main text of the report. Where there is an allegation of abuse, ensure that safeguarding procedures are instigated and followed so as to ensure people`s safety and wellbeing. Key inspection report Care homes for older people Name: Address: Hollywood Rest Home 34 Cresthill Avenue Grays Essex RM17 5UJ     The quality rating for this care home is:   one star adequate 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: Michelle Love     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Hollywood Rest Home 34 Cresthill Avenue Grays Essex RM17 5UJ 01375382200 01375381611 hrh@hollywoodresthome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Gurmit Singh Dhillon,Mr Rajpaul Singh Dhillon care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hollywood Rest Home is situated in a quiet residential area on the outskirts of Grays. It is registered to provide care and accommodation for up to 27 older people who may have a formal diagnosis of dementia. Accommodation is provided on two floors with a passenger lift to the first floor. There is a choice of two large communal lounges and one dining room. Hollywood Rest Home has an attractive garden to the rear of the property, which is well maintained and accessible to residents. Limited parking is available to the front of the property. The monthly fees range from 1,713.37 to 3,720.31. Additional charges/costs are incurred by residents relating to hairdressing, purchase of personal toiletries, newspapers/magazines and sweets etc. Care Homes for Older People Page 4 of 30 Over 65 15 27 0 0 0 5 0 2 2 0 0 9 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for Care Homes for Older People Page 5 of 30 people who live at the home, staff and healthcare professionals were requested to be sent to the home. We received 3 completed surveys from staff and 1 from a healthcare professional. Where comments have been recorded these have been incorporated into the main body of the report. The registered manager/provider, deputy manager and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the registered provider, registered manager/provider and deputy manager. The opportunity for discussion and/or clarification was given. Care Homes for Older People Page 6 of 30 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 Older People Page 7 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are assessed and assured that their needs will be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Staff spoken with confirmed they are advised about a prospective resident and their care needs by the deputy manager. Two out of three staff surveys returned to us confirmed they are given up to date information about the needs of the people they support. On inspection of the care files for the two newest people admitted to Hollywood Rest Home, records showed that a pre admission assessment had been completed for each person by the deputy manager and prior to their admission to the home. There was Care Homes for Older People Page 10 of 30 Evidence: evidence to show that the information recorded was informative and detailed. In addition there was a general information sheet detailing the persons personal information and the rationale for their admission. Records showed that following the pre admission assessment, the deputy manager had written to each person confirming that the home could meet their needs. One person spoken with confirmed that the admission process for them had been smooth and both staff and other people who live at the home had made them feel welcome however they wished that they were still living in the comfort of their own home. The home does not provide intermediate care. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are set out in an individual plan of care. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care and behaviours. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and from other associated information provided by other stakeholders. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs). The majority of peoples individual care needs are recorded and in most cases provide a reasonable level of detail of the actions and interventions required by care staff to ensure that all aspects of their health, personal, emotional and social care needs are met. Each care plan was seen to be written in plain language and was easy to Care Homes for Older People Page 12 of 30 Evidence: understand. The care file for one person recorded them as having poor mobility and having appropriate equipment in place at the home to assist them to mobilise safely. A manual handling assessment was in place and there was evidence to show that following a recent admission to hospital, they were reassessed by the deputy manager prior to returning to Hollywood Rest Home. The reassessment of the manual handling care needs of the person was detailed and person centred and showed that their needs had changed however the home were able to meet these. The care records for the same person recorded them as being discharged from hospital with a pressure sore. Records showed that the deputy manager was proactive in ensuring that an appropriate healthcare professional was contacted and that action was taken to meet the persons healthcare needs. However care must be taken to ensure that all of the persons care needs are clearly recorded, that risk assessments are completed for all areas of assessed risk, that where the needs of the individual change the plan of care is reviewed and updated, there is evidence to show that the person and/or their representative is involved in the development of their plan and the plan of care includes peoples strengths, abilities and potential. The pre admission assessment and commissioning assessment from one persons placing authority made reference to them experiencing mental health difficulties, being prone to relapse and providing detail as to how this impacts on the person concerned. In addition the persons placing authority assessment made reference to them lacking motivation resulting in them being reluctant to get out of bed on occasions, having a disturbed sleeping pattern, poor awareness and understanding of how to maintain their personal safety, isolating themselves and having a history of mis-using their prescribed medications including overdosing which has resulted in them being admitted to hospital. No plan of care or risk assessment was completed in relation to their mental health and how this should be proactively managed by the home to ensure stability on a day-to-day basis or provide appropriate support should this deteriorate. It was of concern that on a tour of the premises with a member of staff we found a total of 36 paracetamol tablets in their drawer, an inhaler for asthma, a bottle of cough mixture and indigestion tablets and liquid. The member of staff confirmed that they were unaware that these items were held by the resident. Apart from the potential dangers to the individual as a result of their previous history with medication misuse, this also places others at potential risk of harm as the medication was not stored safely and could mean that others who the medication is not intended for can easily access this. The registered manager, deputy manager and responsible person were told about the latter during feedback. The care file for the same person also made reference to them being a smoker and there being concerns that the person had been found to have smoked in their room on Care Homes for Older People Page 13 of 30 Evidence: several occasions and/or the room to smell of smoke. A risk assessment was in place and this made reference to this. The risk assessment recorded that one of the measures to be taken was that their cigarette lighter would be taken away from them prior to them retiring to bed however on occasions they had been found to be uncooperative and to hide their lighters from staff. We acknowledge the rationale as to why the restriction has been imposed however no evidence was available to show that this had been formally agreed by the resident. We spoke with the resident about this and they confirmed that as far as they remembered the agreement for the above had not been written down. The pre admission assessment and commissioning assessment from anothers persons placing authority made reference to them being non-compliant with some aspects of their care provision and displaying challenging behaviour towards others. While this was highlighted as part of their care plan, the information recorded as to how specifically staff would provide support and/or deal with the person so as to ensure their and others safety and wellbeing was seen to be basic. No risk assessment was in place as to how the above should be minimised. Daily report records evidenced on several occaions that the person could be unco-operative and that they could be confrontational towards others. The deputy manager advised us of concerns in relation to someone who was admitted to hospital and their continuing deterioration in their condition. This information has been passed to a healthcare assessor colleague. Records continue to show that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services as and when required. The deputy manager confirmed there is a good relationship with the local GP surgery and other healthcare professional services. Of those peoples care records case tracked, there was evidence to show in most cases that there is an audit trail detailing healthcare interventions provided and outcomes. A survey returned to us from a healthcare professional recorded I have several service users in the home and am aware they are all seen as indivduals with differing needs that are respected. Interaction between care staff and people who live in the home was observed throughout the day and seen to be provided in a respectful and dignified manner. However it was observed that staff presence in the main lounge areas was more prevalent in the afternoon than the morning. It was evident from discussions with 3 members of staff and the deputy manager, that staff are knowledgeable about individual peoples care needs. Staff interactions and rapport with people who live at Care Homes for Older People Page 14 of 30 Evidence: the home was seen to be positive and not solely based around tasks and/or routines. Comments within the homes quality assurance survey recorded The home looks after my relative very well and staff are always caring. Residents spoken with confirmed they receive the care they require in a timely manner and always with a smile. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. A random sample of 13 peoples Medication Administration Records (MAR) were examined. At the time of the last key inspection to the service on 5th February 2009 we issued an Immediate Requirement Notice as a result of concerns relating to some aspects of the homes medication practices and procedures. Records examined at this inspection showed these were now in good order with no discrepancies noted, therefore the Immediate Requirement Notice has been met. However where a variable dose e.g. 1 or 2 tablets to be administered are recorded, the MAR record for some people did not always identify the actual amount of medication administered. Medicines are stored securely for the protection of people in the home. However the temperature of the room where medication is stored is not monitored so as to ensure medication is of a suitable quality and remains effective for peoples use. We discussed this with the deputy manager at the time of the inspection and were also aware that they did not know the temperature that medication must be stored at. It is positive that since the last key inspection to the service in February 2009 and following concerns related to the homes medication practices and procedures, the deputy manager has initiated monthly staff observations of practice for staff who administer medication. This includes accurate completion of the MAR records, staffs knowledge of medication, administration of medication to people in the home and checking that MAR records are completed accurately. The deputy manager advised that 3 out of 4 members of staff have found the regular monitoring of their practice to be beneficial. In addition records showed the deputy manager is undertaking regular weekly medication audits so as to deal with any issues as they arise. The deputy manager confirmed that there has been a vast improvement in the quality of record keeping and actual administration of medication by the majority of staff. The staff training matrix provided to us showed that all staff who administer medication have up to date training. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have their social care needs met and to receive a varied diet. Evidence: An activities co-ordinator is employed at Hollywood Rest Home for 4 hours per day Monday to Friday. We were advised that they are hoping in the future to undertake an activities course provided by Thurrock County Council. Information relating to possible activities to be undertaken at the home can be found in a folder and there is also information related specifically for activities centred around the needs of people who have dementia. We were advised by the activities co-ordinator that there is a monthly budget of £30.00 so as to purchase art and craft materials and other items required. When discussed with the registered manager/provider they advised this was inaccurate and there is no specific budget and stated what we need we spend. A copy of the activity roster for the week was displayed by the dining room which is where the majority of activities are undertaken. On the day of the site visit several people were observed to be making christmas table decorations (crackers or serviette holders) and some people were noted to be drawing and colouring. The atmosphere in the dining room was relaxed, happy and jovial and people were observed to enjoy the Care Homes for Older People Page 16 of 30 Evidence: activities being undertaken. From discussions with the activity co-ordinator she stated that her role brought about several challenges, especially providing activities for people who have poor cognitive ability, poor communication and trying to provide activities to a range of people with varying abilities. Despite the challenges that their role brings, they remained cheerful and committed to ensuring that an activity programme was provided each day for people. Of those care files case tracked, there was limited evidence to show that their social care needs were recorded and that information relating to past hobbies and interests had been taken into account and/or explored. A record of social activities undertaken each day was recorded detailing the name of the resident, date and activity undertaken. Records showed that people regularly participate in art and craft activities, manicures, listening to music and chatting to people. There was limited evidence to show how people with acute dementia and/or poor cognitive ability are stimulated with meaningful activities. In addition there was little evidence to show that external entertainers had visited the home or that people had regularly accessed the local community. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed they can visit the home at any time and are always made to feel welcome when they visit. Relatives visiting the home were observed to have a good relationship with staff and members of the management team. People spoken with who live at the home confirmed they are enabled to maintain friendships with others and to see members of their family when they choose. The menu for the day was written on a white board in the dining room and this showed 2 choices of main meal at lunchtime with vegetables and a choice of 2 desserts. At the time of the site visit the main kitchen in the home was close to completion of being refurbished and redecorated. The management team of the home had made satisfactory alternative arrangements to ensure that the delivery of meals was not disrupted for people in the home. Meals provided to people were observed to be plentiful and looked appetising. Where people require assistance from staff to eat their meal this was undertaken with due care, however one member of staff was observed to stand up while assisting one resident in the dining room. Comments from people in the home about the quality of meals provided were positive and included Michelle the food is great, yes its fine and I have no complaints. Care Homes for Older People Page 17 of 30 Evidence: We observed during the afternoon staff, asking people about the teatime choice that day as well as the next days choice of main meal. As stated previously consideration should be given to devise a pictorial menu/menu cards so as to aid people who have dementia and/or poor cognitive ability to make an informed choice. In addition some people may find it too confusing being asked in quick succession about two meal choices. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people who live at the home know how to make a complaint and/or raise concerns and people are not protected from abuse by the homes procedures so as to ensure their safety and wellbeing. Evidence: A copy of the homes complaints procedure was displayed in a prominent area for people to see. However a more user friendly version is required so as to ensure that people who live in the home know how to make a complaint and/or raise a concern. In each of the care files case tracked there was a Quality Policy Statement pertaining to Comments, Suggestions and Complaints. Our address needs to be amended to reflect the Care Quality Commissions current address as this still makes reference to the Southend on Sea office address and makes reference to the Commission for Social Care Inspection. We checked the complaints procedure as recorded within the Statement of Purpose and Service Users Guide and this too made reference to the same address and requires amending. Three out of six people spoken with who live at the home confirmed that if they had an issue or a complaint, they would discuss this with a member of staff or the manager. The remaining three people were not sure what to do and one person stated I havent a clue. On inspection of the complaint log this recorded 2 complaints within the last 11 months. Records showed that these related to poor care practices. A record of the Care Homes for Older People Page 19 of 30 Evidence: specific complaint, investigation and outcome was recorded for one complaint. The outcome of this complaint was unsubstantiated. However the second complaint which was made by someone who lives at the home also included an allegation of abuse. Records detailed that a witness statement had been taken by the registered provider/manager from the resident, however initially this was not on file and was only presented at the time of feedback. It was of concern that the registered provider/manager had not followed local safeguarding procedures and a safeguarding alert had not been raised. From discussions with the registered provider/manager it was unclear as to why no safeguarding alert had been made. We advised him that this should be undertaken as a matter of priority and following the site visit a referral was made and a copy of this forwarded to us. The staff training matrix provided to us showed that not all members of staff have up to date SOVA (Safeguarding of Vulnerable Adults) training. However records showed that where there are gaps this has been highlighted and is planned to take place two days after this site visit. Staff spoken with were able to demonstrate an understanding and awareness of safeguarding procedures and confirmed that they would notify the deputy manager or manager. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable, safe and homely which meets their needs. Evidence: A partial tour of the premises was undertaken during the site visit with a member of care staff. The home environment is well maintained and appropriate to meet the needs of the people who live there. Communal areas within the home consist of one large dining room and two lounge areas which are furnished and decorated to a very good standard. Out of 23 bedrooms, 16 are equipped with en-suite facilities. The home has 4 assisted bathrooms and there are additional communal toilet facilities available for people to access. On inspection of a random sample of peoples bedrooms, all were observed to be personalised and individualised to peoples personal taste and preference. All areas of the home were observed to be clean, tidy and odour free. The AQAA details that within the past 11 months carpets in a number of bedrooms have been replaced and where these have not been replaced these have been extensively cleaned. No health and safety issues were highlighted at the time of the site visit. The AQAA details that within the next 12 months the laundry room will be newly extended and the main kitchen to be linked to the food store. In addition a separate hairdressing salon, additional bathrooms/toilets and a treatment room are to be newly Care Homes for Older People Page 21 of 30 Evidence: created. Maintenance at the home is undertaken by Mr G Dhillon, who visits the home most days. A random sample of maintenance records and certificates were examined and these showed that fire drills are undertaken regularly, fire alarms, emergency lighting and fire extinguishers are tested once weekly or once a month. Other certificates were examined in relation to the passenger lift, hoists and employers liability and all were noted to be in date. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be supported by caring staff that are safely recruited and who have the skills and competence to meet peoples specific care needs. Evidence: The deputy manager confirmed that staffing levels at the home are 4 care staff between 07.00 a.m. and 22.00 p.m. (including a person in charge of the shift) and 2 waking members of care staff and 1 person sleeping-in between 22.00 p.m. and 07.00 a.m. each day. We were advised that in addition to this 1-1 support is provided for one named resident for a total of 63 hours per week (5 care hours and 4 housekeeping hours per day). Additional staff are employed to undertake cooking, housekeeping and laundry tasks. The registered manager/provider is supernumerary to the above figures but is rostered Monday to Friday 10.00 a.m. to 18.00 p.m. At the time of the site visit 25 people were living at the home. We were advised that currently there are no staff vacancies. On inspection of 4 weeks staff rosters, staffing levels as detailed above were being maintained. On the day of inspection the staff roster was observed to be accurate and reflected staff working within the home. Several members of the staff team have been employed at Hollywood Rest Home for some considerable time. This is seen as positive as it provides stability and continuity of care to people living at the home. We observed people throughout the day being provided with care and support by staff in a Care Homes for Older People Page 23 of 30 Evidence: timely manner and to interact positively with people. Staff spoken with during the site visit stated that there is good staff morale and that the staff team work cohesively together. One member of staff advised I love coming to work and really enjoy coming here. Everyone supports one another and helps out. However two out of three staff surveys returned to us recorded that communication is not always good and staff are not always listened to. One comment stated I could not even say what they do well, because they need to improve in a lot of areas in the standard of care. The recruitment files for 4 people newly employed since the previous key inspection to the home were examined. Records showed that in general terms there is a robust recruitment procedure in place so as to safeguard people who live in the home. However records showed for one person that an ISA check had been completed prior to them commencing employment at the home but there was no evidence to support them being shadowed until their Criminal Record Bureau (CRB) was received. In addition the previous employment reference for one person was dated March 2007 however their application form detailed that they had been employed at this place of employment until 2009. It was unclear as to why no recent reference had been sought. No health questionnaire was completed for one person. A record of induction was available for each person that meets Skills for Care Common Induction Standards. The AQAA provided to us recorded that out of 27 members of care staff, 14 have attained an NVQ qualification. The registered manager/provider advised that currently 5 people are undertaking NVQ Level 2 and 1 person is completing NVQ Level 3. The staff training matrix provided to us by the registered manager/provider showed that the majority of staff working at the home have up to date training in core subject areas e.g. food hygiene, health and safety, fire awareness, basic first aid, manual handling, SOVA and infection control. There was no evidence of core training for 2 members of staff. Records also showed that staff are provided with training relating to the specialist needs of older people and these include dementia awareness, dealing with challenging behaviour, epilepsy awareness, Parkinsons, Diabetes, incontinence and sensory impairment. The training matrix also showed future planned training relating to palliative care, personal care, stoma care, catheter care, dealing with complaints, deprivation of liberty safeguards and mental capacity act, care planning and stroke awareness. Three members of staff spoken with at the time of the site visit confirmed that they had received a varied programme of training over recent months. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well run and provides positive outcomes for people. Evidence: The registered manager is also the registered provider. The registered manager has attained the City and Guild 325-03 Advanced Management qualification and with the deputy manager they have both been studying to complete the Registered Managers Award. As a result of the organisation who were providing the Registered Managers Award training going into receivership, the course was abandoned. Both the registered manager and deputy manager are looking to commence this as soon as possible. However training records showed that both undertake training in core and specialist subjcet areas as required. Evidence showed that on a day-to-day basis the home is well run and provides positive outcomes for the people who live at Hollywood Rest Home. The management team of the home continue to strive to meet previous identified shortfalls by implementing new systems so as to monitor progress, to examine what works well Care Homes for Older People Page 25 of 30 Evidence: and what requires further improvement. It is positive that since the last key inspection to the service in February 2009, concerns about some aspects of the homes medication practices and procedures have been addressed so as to ensure positive outcomes for people in the home. Emphasis of the management team is ensuring that new staff employed at Hollywood Rest Home are recruited robustly, that staffing levels and staff deployment are appropriate in meeting peoples specific care needs and ensuring that staff are appropriately trained in both core and specialist subject areas. As detailed within the main text of the report, further development is required to ensure that all aspects of a persons care is recorded within a care plan, that risk assessments are compiled for all areas of assessed risk, that where an allegation of abuse is made appropriate safeguarding procedures are instigated and all staff who work at the home receive regular formal supervision. A random sample of 3 peoples supervision records were inspected and these showed that regular formal supervision is not being undertaken in line with regulatory requirements and National Minimum Standards recommendations. Of those records examined these showed that staff are receiving formal supervision however this is not as frequent as it should be. The management team have a quality assurance programme in place that includes obtaining views from residents, relatives and healthcare professionals. The majority of comments recorded were seen to be positive and give an indication that people are satisfied with the care provision provided at Hollywood Rest Home. Comments included staff are all really helpful and there is a good atmosphere in the home and staff are excellent, all very caring and know the service users really well. The registered manager/provider should consider a way of collating the results of the quality assurance surveys and ensuring that any actions are acted upon and monitored. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was seen to be informative and detailed. Health and safety policies and procedures are readily available for staff to access. The AQAA provides a list of policies and procedures currently available within the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 Where a variable dose of medication is administered, the specific dose given is recorded. Previous timescale of 13/3/2009 not met. This is to ensure that people do not inadvertently exceed the specified dose of medication. 01/02/2010 2 9 13 Medication must be stored 08/02/2010 under suitable environmental conditions and records of the temperatures of the storage areas must be kept to show this. Previous timescale for action 13/3/2009 not met. This will ensure that residents receive medicines that are effective. 3 36 18 Ensure that staff receive regular supervision. Previous timescale of 31/3/2009 not met. So that staff feel supported and residents know that staff are appropriately managed. 01/04/2010 Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Ensure that where there are restrictions placed on an individual, there is evidence recorded to show this has been agreed. So as to evidence the persons agreement. 15/02/2010 2 18 13 Ensure that where an allegation of abuse is made, appropriate safeguarding procedures are instigated and followed. So as to ensure peoples safety and wellbeing. 21/12/2009 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 12 12 Ensure that information relating to peoples social activities are clearly recorded within their plan of care. Ensure that people who have dementia and/or poor cognitive ability receive a varied programme of activities Page 28 of 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations which meet their social care needs. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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 Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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