Care Home: Holway House

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What the care home does well Holway House provides a comfortable homely environment for people. Standards of cleanliness are excellent. Due to the size of the home care is very person centred and the person living at the home is able to make choices about all aspects of their day to day life. The home encourages people to maintain contact with family and friends and visitors are always welcome at the home. There are opportunities for social stimulation at the home and people have access to community facilities. What has improved since the last inspection? The home has complied with all recommendations and requirements made at the last inspection. Care plans are now on computer and give clear information about how needs will be met by the home. To ensure that all information about people is recorded the home now keeps daily records. Risk assessments have been put in place where required and records are kept of all health and safety checks. The home has obtained a copy of the local safeguarding vulnerable people policy and there is ongoing training for staff in this area. The member of staff has registered to undertake a National Vocational Qualification (NVQ) in care. What the care home could do better: The person living at the home felt that there was nothing that they could do better. Returned questionnaires from people who have used the service also showed a high level of satisfaction with the care that they had received. During the tour of the premises it was noted that one free standing wardrobe was not secure and posed a risk of toppling forward and causing injury to someone. Currently only the registered manager administers medication. It is strongly recommended that the member of staff undertakes training in the administration of medication to ensure that this role can be safely performed if the manager is away from the home. Key inspection report Care homes for older people Name: Address: Holway House 130 Station Road Ilminster Somerset TA19 9PW     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: Jane Poole     Date: 1 6 0 6 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 23 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 23 Information about the care home Name of care home: Address: Holway House 130 Station Road Ilminster Somerset TA19 9PW 0146053781 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: holwayhouse@btconnect.com Crown Nursing & Residential Homes Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 7. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the follwing category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Holway House is large property situated in the outskirts of Ilminster. The home has been decorated and furnished to a good standard, and is close to local amenities. Holway House has been registered as a care home since 1990. Mrs Jane Ngorima has been the proprietor and registered manager since December 2007. Holway House is registered with the Care Quality Commission to provide accommodation for up to seven people who require assistance with personal care. Holway House has been adapted to provide a comfortable and homely environment for people with low to medium dependency needs. Care Homes for Older People Page 4 of 23 Over 65 7 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 2 star. This means that people who use the service experience GOOD quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. This inspection was carried out by two inspectors over a three hour period. During this time we, the Commission, were able to speak with people living and working at the home, tour the building and view records. The registered manager was available throughout the inspection. We were given unrestricted access to all areas of the home and all records requested Care Homes for Older People Page 5 of 23 were made available. Before the inspection the manager completed an Annual Quality Assurance Assessment (AQAA) This gave information about the home, their achievements in the past year and their plans for the future. Care Homes for Older People Page 6 of 23 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. 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 7 of 23 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 8 of 23 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 thinking of moving in receive adequate information and are able to visit to see if it meets their needs and expectations. Anyone wishing to move in has their needs assessed to ensure that Holway House has the skills and facilities to meet their needs. Intermediate care is not provided. Evidence: The home has an up to date statement of purpose and service user guide. In addition to this there is a brochure about the home with colour photos. This ensures that people receive adequate information about the home before they decide to move in. The manager/provider stated that people wishing to move in, and their representatives, are able to visit the home before deciding if it is the right place for them. Care Homes for Older People Page 9 of 23 Evidence: No new people have moved to the home since the last inspection. The manager is in the process of assessing one person who has shown an interest in becoming a resident. The home has also acquired a copy of a full assessment of need undertaken by professionals outside the home. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans give adequate information considering the size and nature of the home. People have access to health and social care professionals according to their individual needs. Evidence: There is currently only one person living at the home. The care plan is available on a password protected computer. The care plan was seen and it gave clear details of how the persons needs will be met by the home. There are also risk assessments in place to ensure risks to people are minimised. Daily records are written and these give details of how the person has spent their day and any significant events. Due to the size of the home staff are able to demonstrate a good understanding of the persons needs and preferred routines. Daily records show that healthcare is monitored and people have access to healthcare professionals according to individual need. The person living at the home said that they have access to a GP and dentist. Records seen showed that the home assist people to attend appointments. Currently all appointments are recorded in the daily records. To give a clearer picture of how Care Homes for Older People Page 11 of 23 Evidence: healthcare is monitored and what support is provided it is recommended that all medical appointments are held together. People living at the home are able to spend time in the communal areas or the privacy of their rooms. All bedrooms have keys and can be locked by the occupant to protect privacy. The person living at the home said that staff were kind and polite. All medication is administered by the manager in the home who is a registered nurse. The home uses a Monitored Dosage System with printed Medication Administration Records. Records were seen and found to be adequately completed although one medication had not been signed as given for five days. The manager gave assurances that this medication had been administered to the person living at the home. The manager is currently investigating training courses in medication administration to ensure that another member of staff is able to safely administer medication if she is away from the home. Care Homes for Older People Page 12 of 23 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 are able to make choices about their day to day lives. Visitors are welcome at the home at anytime. Evidence: The person living at the home has an activity programme that includes attending a local day centre and an adult education class. In addition to full residential care the home also offers day care to a small group of people and on these days there are in house activities arranged. The person living at the home said that on days when people came for day care they enjoyed socialising and board games. The home also arranges trips out and recently they have had a day trip to Lyme Regis. The home has contacts with local church representatives to ensure that peoples spiritual needs can be met. There are also opportunities for people to attend local churches if they wish. The person living at the home said that they are able to make choices about their every day life. They said that they are able to go out and have visitors at anytime. Care Homes for Older People Page 13 of 23 Evidence: People living at the home are able to choose what time they get up and when they go to bed. Mealtimes can be flexible in line with peoples wishes. Currently the main meal of the day is at mid day with a lighter meal in the evening. There is a two week menu in place but the manager stated that this can be adjusted in line with the wishes of the person who lives at the home. The person living at the home said that the food was excellent. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the last inspection the home has improved the information available about the protection of vulnerable people. People living at the home are able to share worries or concerns with the manager. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Since the last inspection the home has obtained a copy of the local policy for safeguarding vulnerable adults. Staff have received training in safeguarding and further training in abuse awareness is planned for next month. One concern has been raised with the Commission since the last inspection. This was investigated in partnership with the local authority under the safeguarding vulnerable adults procedure. The concern was unsubstantiated. The person living at the home said Very pleased with the way that I am treated. Everyone is very polite. They also said that they would be comfortable to raise any worries or concerns with the manager of the home. Information about independent advocates is available in the home. Care Homes for Older People Page 15 of 23 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. Holway House provides a comfortable homely environment. Standards of cleanliness throughout the home are excellent. Evidence: The home is located on the outskirts of Ilminster, all areas are fitted with a fire detection and call bell system. There are two communal lounge/dining rooms located on the ground floor which are accessible to people with all levels of mobility. Outside there is a garden to the front of the house that can be used by people living at the home. All 6 bedrooms are located on the first floor which can be accessed by a stair-lift. All bedrooms have wash hand basins and 3 have en suite facilities. There is a bathroom and shower room giving people a choice of where they carry out personal care. Some areas of the home appeared tired and the provider stated that there are plans to redecorate many areas. One wardrobe seen had not been secured to the wall and posed a risk of toppling forward causing injury to someone living or working at the home. Care Homes for Older People Page 16 of 23 Evidence: There is a large laundry which is suitable for the home. On the day of this inspection all areas seen were immaculately clean and fresh. Care Homes for Older People Page 17 of 23 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. The home is adequately staffed to meet the current needs of the home. Evidence: The home is currently staffed by the manager, her husband and one other member of staff. Duty rotas seen show that there are two people on duty each morning, one person in the afternoon and one person sleeping in at night. The manager gave evidence that these staffing levels will be reviewed if more people are admitted to the home. Staff complete an induction programme and further training opportunities are available. The staff member said that training had included; fire safety, food hygiene, moving and handling and infection control. They are about to undertake a first aid course and have registered to begin a National Vocational Qualification in care at level 2. No new staff have been appointed since the last inspection. Care Homes for Older People Page 18 of 23 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. The home is being effectively managed. Procedures are in place to ensure the health and safety of people who use the service and staff. Evidence: The registered manager of the home is Jane Ngorima who is a registered psychiatric nurse and is currently completing the Registered Managers Award at NVQ level 4. She was able to demonstrate that she keeps her knowledge up to date by attending training courses and reading relevant information. Prior to the inspection the manager completed an Annual Quality Assurance Assessment (AQAA) as requested by the Commission. The AQAA was completed to a good standard giving information about the home, their improvements and plans for the future. It demonstrated a commitment to ongoing improvements in care and facilities. Care Homes for Older People Page 19 of 23 Evidence: The person living at the home and staff member said that the manager was open and approachable. The home does not act as a financial appointee or power of attorney for anyone. To monitor the health and safety in the home there are regular audits which are documented. The home sends out 6 monthly anonymous questionnaires to people who have used the service. Returned questionnaires were viewed and these showed a high level of satisfaction with the service received. Comments about the home were positive. Informal feedback is sought from the one person who currently lives at the home. The building is maintained to a good standard to ensure the health and safety of people. The gas and electrical installations have been checked by outside contractors and certificates of safety issued. Hot water temperatures are tested and these tests are now recorded in line with a recommendation made at the last inspection. A fire detection system is fitted throughout the home and this is tested on a weekly basis. Up to date certificates of insurance and registration are displayed in the home. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 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 19 12 (1) The manager must ensure that large freestanding furniture is stable and secure. To minimise the risk of injury to people living and working at the home. 16/07/2009 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 9 Staff should receive training in the administration of medication to ensure that they can safely administer medication in the absence of the registered manager. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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