Care Home: The Hollies

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What the care home does well The registered manager has been in post for approximately 20 years, and the majority of staff are also long-serving. The atmosphere in the home is relaxed. Staff were seen to carry out their duties in an unhurried, pleasant and considerate manner. Visiting professionals were complimentary of the care provided. Staff assist residents to participate in the local community and to maintain social contacts. Many residents are local, as are the staff, and this helps to build up the links between the home and the community, and also helps to maintain the perception of the residents as individuals. What has improved since the last inspection? The registered manager has introduced a National Training Organisation compliant induction programme for new staff. What the care home could do better: The home could do more to ensure that the Statement of Purpose and Service User Guide contain the information people need. The registered manager can do more to ensure that the resident`s lifestyle is better recorded in the care notes, including participation in any activities. CARE HOMES FOR OLDER PEOPLE The Hollies 1 Tremodrett Road Roche St Austell Cornwall PL26 8JA Lead Inspector Alan Pitts Unannounced Inspection 15th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hollies Address 1 Tremodrett Road Roche St Austell Cornwall PL26 8JA 01726 890247 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Peter Dye Mrs Maryel Dye Mrs Linda Jones Care Home 20 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (20) The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 20 adults of old age (OP) Service users to include up to 10 adults aged over 65 with dementia (DE{E}) Service users to include up to 10 adults aged over 65 with a mental disorder (MD{E}) Service users to include one named person out of age category Total number of service users not to exceed a maximum of 20 Date of last inspection 14th February 2007 Brief Description of the Service: The Hollies is a period property situated in the heart of the village of Roche. The home provides residential care for up to 20 elderly people, including up to ten that have dementia (DE (E) or a Mental Disorder (MD (E). There is a garden and car parking space to the front of the home, with a lawn and patio easily accessed by service users. A conservatory has been built onto the front of the home, which also provides staff with a new office. Accommodation is provided on two floors accessed by a stair lift. There is a large lounge for non-smokers with an adjacent smaller lounge for those wishing to smoke. Meals are prepared in a spacious kitchen and served in the dining room, this adjoins the lounge. Assisted bathing facilities are provided and all rooms have call bells. Suitably qualified care staff provide personal care within a relaxed, friendly atmosphere. The Registered Providers are committed to training their staff and over 50 have achieved the NVQ level 2 or above in care. The General Practitioner’s surgery is close by and the home maintains a very good rapport with the local Doctors, District Nurses and Community Psychiatric Nurses. There are opportunities for service users to socialise and visitors are actively encouraged. The home’s fees range from £300 - £389 per week. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection that took place on the 15th January 2008, between 08.300 and 14.00 hours. The inspector met with the registered manager, staff, and residents. The inspector recognises the individual care provided to residents, and the benefits afforded to residents by the hard-working, stable and established staff team and the registered manager. Residents were relaxed and comfortable in their interactions with each other and staff. Staff were observed to interact with residents in a manner that respected their dignity and rights as an individual. The Hollies predominantly serves people from the local area, and the staff are also from the local area, this in itself informing people of quality of care offered and also providing another quality assurance tool (word of mouth). What the service does well: What has improved since the last inspection? The registered manager has introduced a National Training Organisation compliant induction programme for new staff. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The staff team are qualified and experienced to work with the needs of the resident. The home employs staff who understand the cultural expectations of the residents, most of which are from the local area. EVIDENCE: The care documentation of the most recent admission to the home shows that a care needs assessment was carried out prior to admission. Each resident has a plan of care. A skilled and experienced member of staff always undertakes the assessment. The registered manager confirms that assessments involve the resident and/or their representative wherever possible. There is a high value on responding to individual needs for information, reassurance and support, as evidenced by the inspector’s observations of staff interactions with The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 9 residents during the course of the inspection. The home has a fax and email facility to assist with assessments provided from outside of the local area. The home has a Statement of Purpose and Service User Guide, but these should be reviewed to ensure they provide the information specified in the regulations and any other information that may be useful to residents and prospective residents. The registered manager may consider combining the two documents. The home states that a trial period is offered in the Statement of Purpose. This was discussed at the previous inspection and the registered manager intends reviewing the Statement of Purpose and Service User Guide, expanding on this statement to better describe the options available to prospective residents (e.g. visit for meals). The home does not provide intermediate care. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a strong ethos of involving residents in all aspects of their life. The health needs of residents are met. All residents have a robust care plan. Residents are protected by the safe storage, administration, and disposal of medicine. Residents are treat with respect, their dignity and rights acknowledged. EVIDENCE: Each resident has a plan of care that is written in plain language, is easy to understand, and considers all areas of the individual’s life including health, personal and social care needs. The plan also includes a risk assessment. Areas have been identified where staff are willing to support residents to take some risks which may have an impact on their rights (e.g. access to the local community, helping out around the home. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan and make the process interesting, and worthwhile using a variety of The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 11 ways (e.g. appointing key workers who build up special relationships with residents and work on a one to one basis). Care plans are reviewed regularly, and the registered manager is implementing a formal annual review of care to ensure the involvement of the resident and/or their representative in this process. The health care needs of the residents are managed and met by visits from local health care services. Two visiting Community Psychiatric Nurses were very complimentary of the care, one saying “they’re the best”. Residents’ personal aids are well maintained and the home provides the necessary aids and equipment to support both staff and residents in daily living. The home works to a medication policy supported by procedures and practice guidance. All the staff have undertaken ‘Safe Handling of Medicines’ training. The medicine administration records were seen to be in good order. The home has an agreement with their supplying pharmacist who inspects the medicines. Resident’s prescription sheets are kept. Medicines were observed to be administered properly. Attention is given to ensuring privacy and dignity when delivering personal care. Staff were observed to make every effort to enable residents to choose who delivers their care and respect their preferences. Interactions between staff and residents were ‘adult’ in nature, recognising the residents’ rights and worth and this was observed during the inspection. Induction training covers privacy and dignity. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. More could be done to demonstrate that the residents’ lifestyle meets their expectations and preferences. Residents are able to maintain contact with family and friends. Residents are encouraged to exercise choice and control over their lives. A wholesome appealing diet is provided. EVIDENCE: Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. There is a monthly activity plan, and a record of activities carried out with one carer who is paid for two hours per week as an activity coordinator. Entries in the care notes have improved, providing more information about how the resident spent their day. The records available reflect one or two residents engaging in activities, or making use of the local community and area. The registered manager can still do more to ensure that the resident’s lifestyle is better recorded in the care notes, including participation in any activities, and demonstrating the regularity and frequency of activities that the inspector was told occurs at the home. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 13 There is a visitors’ book. The home has open visiting arrangements, and there are visits from members of the community including the local church. The design of the home provides seating areas within the communal areas of the home where residents can entertain their visitors, in addition to the privacy of their own room. Staff will support those residents who need help in financial matters, they work to a clear robust policy that protects the residents from financial abuse and clearly directs staff in their practice. The home has effectively worked with the adult protection system in Cornwall to protect one resident recently. The home is able to offer residents information and telephone numbers for contacting independent people who will act as advocates on the residents’ behalf where the resident prefers the help of an independent person. Residents have the choice to bring a limited amount of small goods with them on admission to the home and are encouraged to keep personal items, which are important to them in their own room. The food in the home is of good quality, well presented and meets the dietary needs of residents. The cook is experienced, and staff are trained to help those residents who need help when eating and are sensitive in their approach. Residents are able to choose to eat in their own room if they wish. The menu shows a choice available, as does the blackboard in the dining room. Menus were recently amended to reflect residents’ wishes for pasties from a specific butcher and ‘shop bought’ fish and chips on a more regular basis. The registered manager undertook to ensure that there is a record of food provided kept, which also shows choices made. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a proactive approach to the welfare and best interests of residents. Residents receive the information they need and their legal rights are protected. Residents are protected from abuse. EVIDENCE: There have not been any complaints received either by the home or the Commission for Social Care Inspection since the last inspection. The complaints procedure shows the contact details for the local Adult Social Care office. The home maintains close links with the local community from which most of the residents and staff originate. The policies and procedures regarding the protection of residents are regularly reviewed and updated. The service is clear when incidents need external input and who to refer the incident to. Training of staff in the area of protection is regularly arranged by the home. The home has actively engaged the adult protection unit in order to protect one resident. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides safe, comfortable accommodation that is personalised, wherever possible, to reflect individual resident preferences. The layout and location of the home is suitable for its stated purpose. The home was seen to be clean throughout on the day of the inspection. EVIDENCE: Records and the fabric of the building support the assertion that the building is well maintained. The registered provider is planning to convert the unused bathroom opposite room 12 to a laundry room; simultaneously converting the existing small laundry area for additional storage, and; replacing the existing domestic-type washing machines with an industrial-type machines (with a sluice facility). The registered provider also plans to replace the dining room furniture. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 16 There are in places some steps to negotiate, but access is generally good, aided by good size corridors. There is a stair lift to assist with access between floors. There is sufficient communal space. The home provides aids and equipment to meet the care needs of the residents. It is a pleasant, safe place to live in the community that the majority of residents lived in prior to admission. Where rooms are shared it is only by agreement, and screens are provided for privacy. Residents are given the choice to move into a single room when one becomes vacant. They have the choice to bring small personal items of furniture into the home. All the homes fixtures and fittings meet the needs of the residents and can be changed if their needs change. The kitchen is clean, organised and functional, though the registered provider was reminded to action some areas of work identified at the last inspection by the environmental health officer. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A skilled and committed staff team, in sufficient numbers, meets residents’ needs. Residents are protected by the home’s adherence to a robust employment procedure. EVIDENCE: There were 19 residents living at The Hollies on the day of the inspection, with the registered manager, deputy manager, and 3 care staff, supported by a cook and two housekeepers on duty. Approximately 75 of care staff have achieved NVQ Level 2 or higher. The registered manager maintains an annual staff training file, which includes copies of certificates, where provided. The registered manager showed the inspector the interview records relating to a recent applicant for a care position at the home. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is highly selective, with the recruitment of the right person for the job being more important than the filling of a vacancy. The appropriate records are kept, though as discussed the information provided would be more useful if supported by comments rather than just ticked boxes. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 18 Staff are encouraged to undertake external qualifications beyond the basic requirements. New staff undertake an in-house induction and an National Training Organisation compliant induction, and the most recent employee is doing this. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Hollies is a well managed home that benefits from an established and stable staff team. The home should do more to demonstrate that it is run in the best interests of the residents. Residents’ financial interests are safeguarded. Records show the health, safety and welfare of residents and staff is protected. EVIDENCE: The registered manager has worked within the home for approximately 20 years. The registered manager has achieved the NVQ Levels 2,3 and 4 in care, and has also completed the Registered Manager’s Award. She has the A1 and A2 Assessors qualification and is the Moving and Handling trainer for the home. There are clear lines of accountability within the home and with the The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 20 registered providers who are involved with the home on a day-to-day basis. An experienced deputy manager supports the registered manager. The manager ensures that staff follows the policies and procedures. Staff have practice handbooks and easy access to all documents, which are discussed during supervision, staff training and team meetings. The home has distributed and received back some quality assurance questionnaires. One of the responses from a visiting professional said, “this is a lovely caring home and I would be happy to have a member of my family living there”. The registered manager undertook to summarise the results and publish the anonymous findings, probably in the home’s Service User Guide. The home encourages residents who wish and are capable, to manage their own money and valuables. Residents’ finances are stored securely, recorded, and supported by receipts. Only small amounts are held on the premises. Records relating to the maintenance and safety of the residents and staff (e.g. boiler service, fire equipment maintenance) were available for inspection and show that the premises, fittings and equipment are properly maintained. The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP15 Regulation 16 Requirement The registered manager must ensure there is a record of food provided kept, which also shows choices made. Timescale for action 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP12 Good Practice Recommendations The registered manager should review the Statement of Purpose and Service User Guide to ensure the document(s) contain the required information. The registered manager should ensure that the resident’s lifestyle is better recorded in the care notes, including participation in any activities (or declining to do so). The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Hollies DS0000009041.V349761.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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