Care Home: The Hollies

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What the care home does well Feedback from the questionnaire survey is positive. One relative said that `the staff have a wonderful attitude to the residents. They always take time to listen and talk with them. They react quickly to any health problems. In fact, the service they provide is excellent`. Another stated `my mother is unable to walk. At her age, she requires `peace and quiet` and the home provide this in a comfortable room`. Information about the home is provided to prospective residents and their families. They are also invited to visit and view the home so that they are able to make an informed choice whether to use the home or not. Individual`s needs are assessed to ensure that the home is able to meet the identified needs prior to admission. New care plans have been devised and implemented that are comprehensive and detailed, showing how identified needs were being met. A programme of weekly activities is planned, displayed in the dinning room and residents are reminded of activities taking place on a daily basis. Residents said that they are able to chose whether to participate in the activities provided on the day or not. The environment is homely, comfortable, airy and bright. The home is reasonable well maintained. Residents spoken to said that the food was good. There is a good professional relationship between the staff and the residents and relatives and other professionals. In relation to equality and diversity, the manager has stated in the AQAA that there is an equal opportunity policy which includes race, gender, disability, sexual orientation, age, religion, that are firmly adhered to and staff receive training to ensure that these policies are followed. What has improved since the last inspection? New care plans have been devised and implement so that the identified needs are being met and risk assessments are carried out and the identified risks are minimised and managed. All mandatory and relevant training are being planned and provided for all care staff so that residents receive care and support by a trained and competent staff team. Health and safety issues are being addressed and monitored on a regular basis. What the care home could do better: Carpets that are worn and badly stained in some of the bedrooms should be replaced so that residents` dignity is maintained. Privacy and dignity issues raised in this report should be addressed and respected. Fire drills for the night staff team should be carried out on a regular basis so that they are kept up to date with fire safety practices. Access for wheelchair users should be assessed and levelled so that wheelchairs can be operated with ease. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hollies 11 St Catharines Road Broxbourne Hertfordshire EN10 7LG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bijayraj Ramkhelawon     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: The Hollies 11 St Catharines Road Broxbourne Hertfordshire EN10 7LG 01992445044 01992446911 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shawlmist Ltd care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Hollies is a large Tudor-style Grade II listed building that is located in a quiet residential area of Broxbourne. It was converted to its present use as a care home in 1984. It offers residential accommodation to a maximum of twenty-seven elder people and there are bedrooms on each of the three floors, served by a passenger lift. There are local shops, a Post Office, bank and pharmacy nearby. Public transport is available a short distance away and the home is equidistant from the town centres of Hoddesdon and Broxbourne. Accommodation is provided in nineteen single occupancy bedrooms and four double bedrooms. There are two lounges, a dining room and a conservatory, which leads on to a mature garden. A copy of the homes Statement of Purpose, Service Users Guide and the last inspection report can be obtained from the care home on request. Currently fees for the home range from £429 to £531 per week. Care Homes for Older People Page 4 of 28 Brief description of the care home Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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: We carried out the last key inspection on 11 April 2007. An annual service review was conducted in April 2008. This unannounced key inspection was carried out on the 28th May 2009 and took one whole day. It included talking to people using the service and staff, examining care plans, staff files, staff training records, fire safety procedures, maintenance records, all other records and documents and a tour of the premises. We used an Expert by Experience to assist with this inspection who spoke to 18 of the 19 residents and staff on duty. An expert by experience is a person who has had experience of using services and help us get a a picture of what it is like to live at the home. They observed the lunch as well looked at activities planned for the residents. The home has completed an Annual Quality Assurance Assessment (AQAA) which is a Care Homes for Older People Page 6 of 28 self assessment that is completed by the service. This provides us with information from the service on how they are meeting outcomes for the people who use their service. Information from this assessment has been reflected in this report. 12 completed survey questionnaires were received from residents and their relatives and 5 from staff. Feedback from these questionnaires is also reflected in this report. What the care home does well: What has improved since the last inspection? What they could do better: Carpets that are worn and badly stained in some of the bedrooms should be replaced so that residents dignity is maintained. Privacy and dignity issues raised in this report should be addressed and respected. Fire drills for the night staff team should be carried out on a regular basis so that they are kept up to date with fire safety practices. Access for wheelchair users should be assessed and levelled so that wheelchairs can be operated with ease. Care Homes for Older People Page 8 of 28 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 set out 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 9 of 28 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 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them 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 are provided with information about the home to assist them in making a decision whether to use the care home or not. They know that their needs would be assessed before moving into the home. Evidence: Information about the home including the Statement of Purpose and Service Users Guide was available to prospective residents. Current residents and their relatives were given a copy of both documents on admission. A copy of each document is displayed on the notice board at the front entrance of the care home. An assessment of needs for each individual was carried out prior to admission and residents spoken to said that they were able to visit the home before making a decision to move in. Care Homes for Older People Page 11 of 28 Care Homes for Older People Page 12 of 28 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. People using the service can be assured that their identified needs would be met appropriately Evidence: The manager said that new care plans have been devised and implemented. Three of these were examined and found to be comprehensive, person centred and detailing how the identified needs of individuals were being met. A wide variety of risk assessments including manual handling, Waterlow chart and skin care, psychological well being, personal and health care, continence, sleep patterns, mobility, nutritional assessment had been completed and reviewed on a regular basis. Care plans were also reviewed by care managers. Residents were well dressed and groomed. On the day of the inspection the hairdresser was doing the residents hair. Residents said they always looked forward to having their hair done. Residents and relatives spoken to said that staff were caring, dedicated, supportive and helpful. Residents said that they were being well looked after and that they felt that their needs were being met in a professional way. However, it was noted that commodes were left next to the beds Care Homes for Older People Page 13 of 28 Evidence: during the day despite residents concerned were able to use the toilet. One resident said that although her bedroom door is kept open staff do not always knock before entering. The records for the administration and management of medicines were kept in good order. The medicine record charts showed that medicines were given as prescribed and unused medication was returned to the supplying pharmacy. A monthly audit of the system including the ordering, storage, administration and disposal of medicines was carried out. Care Homes for Older People Page 14 of 28 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 using the service can benefit from the opportunities to participate in activities provided for them that are appropriate to their needs Evidence: Staff arrange a weekly programme of activities for the residents. This weeks programme included games galore, knitting/quiz and bingo, arts and crafts, chair aerobics, hairdressing and pamper day, sing along song and film matinee. Pat dog visits the home on a regular basis. Residents spoken to said that there was usually a weekly activity plan displayed, so they knew what was arranged. Residents confirmed that they have newspapers delivered and have regular visits from the hairdresser. Feedback from the expert by experience was positive and noted that there was a book of suitable quiz questions that was well used and a good supply of videos and books was provided by the local library. Residents said that they enjoyed the singsong sessions. There was some good-natured banter between couple of the residents over this. The expert by experience spoke to nearly all the residents and one person said its all very good here and the food is too, but some dont like it (of the food) and another resident said I am very happy here and the food is good. Care Homes for Older People Page 15 of 28 Evidence: All residents managed their own money except for one person for whom the proprietor is an appointee. People using the service said that they usually enjoyed the food provided and that there is a choice of food available for each meal. Feedback from the expert by experience who observed the lunch, tasted the lunch and spoke to the residents said that food was heaped on the plates which could put people off their food and that the lunch served was quite salty. Some residents ate well but others did not. There was a great deal of fresh fruits on offer in the lounges as well as in the dining room. Drinks were available to the residents throughout the day, in the communal rooms and in the bedrooms. Care Homes for Older People Page 16 of 28 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. People using the service can be assured that their concerns would be listened to and acted upon and that they would be safeguarded from abuse, neglect and harm. Evidence: The home has written policies on Complaints, Safeguarding Adults and Whistle Blowing which staff said they were aware of. The complaints procedure is also included in the Service Users Guide. No complaint has been received in the last twelve months. However, there has been a serious concerns meeting with Adult Care Services that is being concluded. Residents spoken to said they would not hesitate to raise their concern should they have any. All staff members have training in Safeguarding Adults, and the home follows the Hertfordshire County Council Procedure for Safeguarding Adults. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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 using the service are cared for in an environment that is homely, comfortable and safe. Evidence: The home was kept clean, fresh and pleasant. Bedrooms were bright and airy. Residents spoken to said that the home was always kept clean and bedrooms were well furnished, comfortable and homely. They also said that they were happy with their bedrooms and that they are able to bring their personal possessions and belongings. Training records examined showed that infection control has not been provided to staff. But staff spoken to said that they were aware of infection control and it was noted that alcohol gel was available in the staff room. Protective clothes and gloves and hand washing facilities were provided. However, it was noted that the carpet in several bedrooms were worn and badly stained. The pedestals of the dining tables were dirty with dust and dried food. It was also noted that access for wheelchairs at the rear of the building was not levelled and difficult to manoeuvre. The expert by experience noted that there is a small lintel step between the conservatory and the ramp to the garden which is an obstacle for anyone wishing to access the garden in a wheelchair or even a frame on wheels and on their own. Care Homes for Older People Page 18 of 28 Evidence: The home has a macerator for dealing with waste products. Staff said that there were always supplies of disposable gloves available and the manager said that training in infection control is being planned for all staff. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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 using the service do benefit from the care and support they receive from a competent and qualified staff team and that they feel protected by the homes recruitment policies and procedures. Evidence: Residents and staff spoken to felt that, generally, there were always enough staff on duty and praised the care they received. The interaction between staff, residents and visitors was professional and staff knew individuals needs well and that there were very good relationship between them. The expert by experience observed staff moving and handling residents from chairs into a wheelchair both without and with a hoist and these were done very carefully and patiently. One resident said that I have no complaints but the staff do hurt my wrist sometimes so I shout at them. Another said I have no complaints and the staff are lovely and they always come when you call them. Staff did not appear rushed and there seemed to be enough on duty. In talking to them they all seemed delightful and caring people well liked by the residents and interaction between themselves and between them and the residents is good. Six staff files were examined and these were found to have all the necessary Care Homes for Older People Page 20 of 28 Evidence: documents including two written references for each employee and the Criminal Records Bureau (CRB) checks were carried out before an offer of employment was made so that residents would be safe and protected. New staff undergo a programme of induction and staff are provided with training relevant to their work. Staff spoken to confirmed that that they received formal supervision on a regular basis. They also said that they received support from senior members of staff and the management team was approachable and helpful. Staff were knowledgeable about the needs of residents and provided support in a sensitive and professional manner. The manager has devised a training matrix and training are arranged for staff on a rolling programme. Medication awareness training and Health and Safety has been arranged in June of this year followed by First Aid training and personal development training in July. Residents and relatives spoken to said that there was a good staff team working in the home. Residents also said that call alarms were answered in good time and that care staff did not rush their personal care. All staff have completed basic training courses and more updates have been planned by the manager. Staff are encouraged to undertake NVQ training and at present, there are 21 care staff in post of whom 8 have completed the NVQ Level 2, 4 have completed the Level 3. In the AQAA the manager has stated that training for staff would be ongoing and kept up to date. Care Homes for Older People Page 21 of 28 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. People using the service can be assured that their health, safety and welfare are protected by the safe practices in place and the support they receive from an experienced staff team. Evidence: People using the service spoken to have commented positively on the good practices and quality of care and support they received. Staff, residents and relatives spoken to praised the manager and said on how efficiently the home was run. They also said that the manager was approachable and supportive. The home carries out its quality assurance on the service provision by seeking the views of people using the service, their relatives and other interested parties. Records of fire alarm checks and fire drills were maintained on a regular basis. However, it was noted that a fire drill has not been carried for night staff. There are a variety of risk assessments completed for the building and grounds and these are Care Homes for Older People Page 22 of 28 Evidence: regularly reviewed. Records were available for inspection and maintained in accordance with legislation to ensure that the safety of people in the home is promoted. Records examined were up to date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures to ensure that the health, safety and welfare of residents and staff are promoted and protected. A valid insurance certificate was displayed and expires in November 2009. Care Homes for Older People Page 23 of 28 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 7 15 Care plans must be person centred and each specific identified need must be planned and reviewed on a regular basis. This is to ensure that staff are aware of the identified needs of individuals and are able to deliver care and support appropriately. 15/05/2009 2 18 13 Training in Safeguarding Adults must be provided to all staff. This is to ensure that staff are aware of what action to take should they observe or are informed of any abuse or malpractice so that residents are not put at risk. 15/05/2009 3 25 13 The bath hot water 14/04/2009 temperature was recorded at 49.3C and rising. This must be reduced to the safe required level close to 43C so that residents are not put at risk. 4 30 18 All mandatory and other relevant training for safe work practices must be undertaken by all staff. This is to ensure that 15/05/2009 Care Homes for Older People Page 24 of 28 residents receive care and support by a trained and competent staff team. 5 38 23 The large bedroom occupied by a resident must not be used for storage. This is to ensure that the dignity of the resident is respected and both the resident and staff are not put at risk. 30/04/2009 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 10 Staff should ensure that residents privacy and dignity are maintained at all times by knocking on the door prior to entering their bedrooms. Meals should be presented in a manner which is attractive and appealing in terms of texture, flavour and appearance in order to maintain appetite and nutrition. The lintel step between the conservatory and the garden should be levelled and made safe so that residents can access the garden with ease. Access for wheelchairs at the rear of the building was not levelled and difficult to manouvre. This access should be assessed and repaired so that wheelchairs can be used with ease. Carpets in the residents bedroom that are worn and badly stained should be replaced so that residents dignity are maintained. The pedestals of the dining tables were dirty with dust and dried food. These should be kept clean so that residents have their meals in a clean environment. Training in infection control should be provided for all staff so that staff are aware of the procedures for controlling the Page 26 of 28 2 15 3 19 4 19 5 24 6 26 7 26 Care Homes for Older People spread of infection. 8 38 Fire drills should include the night staff team so that they are kept up to date with fire safety practices. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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 © (2010) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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