Care Home: The Hollies

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What the care home does well The informal atmosphere and relaxed approach at The Hollies ensures that the staff team and individuals work together to achieve the common aim of an optimum lifestyle for the person. The home ensures that people living in the home have meaningful activities and works closely with other professionals. Good networks have been built with the local community and relationships maintained with family and friends.The HolliesDS0000020231.V376006.R01.S.docVersion 5.2Individuals have opportunities to have one to one support from staff enabling them to choose how they want to spend their time. Good levels of choice are given to the individuals in their day-to-day lives. What has improved since the last inspection? Individuals now benefit from having sufficient information to enable them to make a decision on whether to move to the home in the form of a statement of purpose and a contract of care. The contract of care has been made more accessible. One individual can now be assured their safety when personal care is being delivered and have benefited from grab rails being installed in the bathroom. Individual`s finances are better protected as now two staff sign for all expenditure and where able individuals are encouraged to sign for their own expenditure. Where restraint is used this is now being clearly recorded in the plan of care and a record maintained in respect of the restraint method used in accordance with the Department Of Health`s guidance ensuring the protection of the individuals living in the home. Individuals have benefited from areas in the home being made more homely namely the hallway and the windowsill in the small sitting room. Clear documentation is now in place detailing the staffing arrangements for the home taking into consideration the needs and the numbers of people living in the home ensuring that there is adequate numbers of staff to support the people and their safety. The home ensures that the registered nurses continue with their registration and that this is checked appropriately. What the care home could do better: Individuals must be assured that information about the service is kept up to date. Individuals would benefit from the care documentation being reviewed ensuring it is accessible to them with information that is out of date being archived. Risk assessments must be reviewed at periodic intervals.The HolliesDS0000020231.V376006.R01.S.docVersion 5.2Individuals must be assured that the menu is healthy and balanced and caters for special dietary needs. Key inspection report CARE HOME ADULTS 18-65 The Hollies 81 High Street Yatton North Somerset BS49 4DW Lead Inspector Paula Cordell Key Unannounced Inspection 17th June 2009 10:00 The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 2 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 The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hollies Address 81 High Street Yatton North Somerset BS49 4DW 01934 876773 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) janet.wheeler@brandontrust.org www.brandontrust.org The Brandon Trust To be appointed Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5 Patients with Learning Difficulties excluding those detained under the Mental Health Act 1983 Staffing Notice dated 10/03/2000 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate one named service user who is over 65 years of age. 8th July 2008 Date of last inspection Brief Description of the Service: The Hollies is owned by the Brandon Trust and is registered to provide nursing care for up to five people with learning difficulties excluding those detained under the Mental Health Act. The home is going through a management change and an application is being forwarded to the Care Quality Commission for a Mr David Rogers to become the registered manager of this service and another Brandon Trust Home. The individuals have complex needs and may challenge the service. The aim of the home is to support the individuals to live in a homely environment and to participate in every day activities of their choice. The home is set in attractive gardens, close to shops and other local amenities. There are five single bedrooms. The home has transport to enable the individuals to access places further a field. The fee level for the home is £1550 per week at the time of publishing this report. The Hollies DS0000020231.V376006.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 two stars – good service. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of the key inspection process. The last full (key) inspection was conducted in July 2008. The purpose of this visit was to review progress to the requirements and recommendations of the visit in July 2008 and to monitor the quality of the care provided to the individuals living at The Hollies. There have been no visits between this and the visit completed in July 2008. The Care Quality Commission has not received any complaints since the last visit. The visit consisted of gathering documentary evidence from care files and records, discussing the service with the staff who were on duty, and observing and chatting to the individuals living in the home. The visit was planned using information received since the last visit including notifications in respect of incidents that affect the wellbeing of individuals living in the home. The home was in the process of completing the annual quality assurance assessment. As yet this has not been received but the home was within the agreed timescales. The local authority’s contracts and compliance officers visited the home in November 2008 and some of the findings of their visit are included in this report. The reason they visited was due to the service having a previous rating of adequate. The visit was conducted over 6.5 hours and ended with structured feedback being delivered to the newly appointed manager. What the service does well: The informal atmosphere and relaxed approach at The Hollies ensures that the staff team and individuals work together to achieve the common aim of an optimum lifestyle for the person. The home ensures that people living in the home have meaningful activities and works closely with other professionals. Good networks have been built with the local community and relationships maintained with family and friends. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 6 Individuals have opportunities to have one to one support from staff enabling them to choose how they want to spend their time. Good levels of choice are given to the individuals in their day-to-day lives. What has improved since the last inspection? What they could do better: Individuals must be assured that information about the service is kept up to date. Individuals would benefit from the care documentation being reviewed ensuring it is accessible to them with information that is out of date being archived. Risk assessments must be reviewed at periodic intervals. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 7 Individuals must be assured that the menu is healthy and balanced and caters for special dietary needs. 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. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is in place to describe the service to individuals. However, it lacks detail on who the home can support which could mean that people are referred to the home inappropriately. Individuals have benefited from having a contract of care that is accessible. EVIDENCE: The home has expanded the information in the statement of purpose and has developed a service user guide. The newly appointed manager said that this was being updated in relation to the change of management structure. It was noted that the range of needs the home can cater for lacks detail in respect of the people they can support and fails to mention learning disability and challenging behaviour. The newly appointed manager said that the home is exploring options in relation to how the service can move forward in meeting the needs of the people living in the home and the long term viability of the service. Brandon Trust are considering whether the Hollies could move to Supported Living which would mean that the home would deregister with the Care Quality Commission. This process has commenced with discussions with relatives, The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 10 commissioners and social workers. As yet the individuals have not been consulted and the manager along with senior management are deciding how this can be done effectively. The manager said that they were planning to involve independent advocates. It was evident from the conversations that the individuals would be assessed to ensure that they have capacity to make the decisions in respect of choice of care for the future. The Care Quality Commission has not received an application for voluntary closure and were not informed of this prior to the visit. It was discussed during the last visit whether the home could change from a care home with nursing to a care home. Again no application was forwarded to the Care Quality Commission. Care reviews had been completed and it was evident for two people that this could be a possibility. All three individuals require support with personal care and if the home moves towards a supported living model then Brandon Trust will need to plan how this will be provided in the future. Brandon Trust own the building and this will need to be discussed as the social landlord should not provide personal care as this could mean that it is operating as a care home. The home presently has two vacancies and the manager said that it has been difficult to fill these, due to the changes in the way Local authorities purchase services and the reluctance to place in residential homes. From talking with the manager it was evident that if a person was referred to the home that the individual would be fully assessed and have an opportunity to visit the home. Contracts were viewed for two of the individuals. This has recently been reviewed and the information is more accessible and includes photographs. Individuals where possible have signed the contract of care. Whilst there is a breakdown of the fee it does not mention that individuals are contributing to the cost of transport. This area remains outstanding. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst it is evident that the care provided to the individuals is person centred this is not captured in the care documentation which is a muddle of person centred planning and a clinical nursing model. The information is not accessible to the individuals. EVIDENCE: Two care plans were looked at as a means of determining the processes the home goes through to support the individuals living at the Hollies. The Home uses the Brandon Trust’s Planning for Life Pack in supporting people with the care planning process. This person centred approach demonstrates that individuals are supported in identifying what their needs are, ensuring The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 12 their care is ‘individual’ and based on their active involvement and participation. The newly appointed manager and the team leader stated that further work is being completed on the plans of care to make them more accessible to the individuals living in the home. Consideration should be taken to ensure that the more traditional care planning processes that presently guide staff link with the person centred plan that has been developed with the individual. Again it was noted that the person centred plan was to the back of the care file and not as accessible as the plans drawn up by the staff. There were numerous care plans that covered all aspects of daily living and were quite difficult to read or capture the individuality of the person. A discussion took place with staff about how this could be improved and whether some of the information could be captured in a pen picture rather than individual care plans. The team leader showed the inspector a new format that is being introduced for each individual as yet this process has only commenced for one person and was still incomplete. Each person had two files, one containing the care planning documentation and the other the day to day recording. Some of the information would benefit from being archived with a general review of all the documentation to ensure that it has been completed or kept in the correct place. The newly appointed manager said that all the individuals would be supported by an external person centred facilitator as part of the move to supported living. From reading the information and talking to staff it was evident that each person’s plan of care was tailored to the person. Information was being reviewed on a six monthly basis. It was noted that the care staff complete monthly reviews for individuals however it was noted that for one person this stopped in January 2009 and the other in April 2009. It was evident from talking with staff clarification was required whether this should continue. The local placing authority was conducting annual reviews with the individual and the care staff and where relevant relatives. It was noted during the last visit that two areas were not clearly documented in the home’s care planning processes. One area related to bathing and the other related to an individual being supported to go on trips further a field. Both of these have been rectified since the last visit. Safe handling guidelines are in place and handrails have been fitted in the bathroom. Evidence was provided in respect of the person going on trips further a field. Staff had a good awareness of the needs of the individuals living in the home and how they were supported. There was a general improvement in the staff’s knowledge of the individuals which clearly linked with the information recorded in the plan of care. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 13 However, one person had a plan of care around weight loss and an exercise plan. There was no evidence that this was being followed although staff were aware of the need to encourage healthy eating for this particular individual. It was noted that this plan had been in place for a number of years and there has not been any significant weight loss. Staff said that the individual refuses to participate in the exercise regime but this was not clearly documented in the daily diary notes and it was difficult to assess whether the person was having a healthy diet from the way the home records the menu planning. Four days a week individuals have puddings but it was not clear whether there was a healthier option. This will be discussed further in this report. The home has consultation processes in place in order to seek the views of the individuals. House meetings take place at three monthly intervals to discuss holidays, menu planning and the routines of the home. The contract and compliance visit conducted in November 2008 highlighted that the agenda was limited and did not fully involve the individuals about the running of the home and focused on the feelings of the individuals, menu planning and festive seasons. The agenda or the minutes were not accessible and was very much led by the staff. There were detailed written risk assessments, which helped to demonstrate actions are taken to ensure the home is safe for individuals and staff. Risk assessments also demonstrated individuals are encouraged to live an independent and fulfilling life and take part in activities both in and away from the home. It was evident that the risk assessments in place did not restrict individuals but encouraged people to be as independent as possible. The risk assessments had not been reviewed for a period of twelve months for both the individuals seen. Staff said all the individuals at The Hollies are able to self-advocate to some extent, and speak up and express their wishes. It was evident that the three individuals have close family that support them and are actively involved in their care. As already discussed in this report the staff are exploring how advocates can support the individuals with the choice of care they would like in the future. Observations of the people living in the home were that they had the freedom to move around their home accessing the private space of their bedroom, the communal areas and the garden. Risk assessments are in place in respect of the access to the kitchen area. The kitchen is locked when staff are not in close proximity. Although individuals can access this area to make drinks and snacks with staff support. From talking with staff this is continually assessed on a day to day basis for any signs of changes of mood that may put the individual or others at risk. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have access to the activities both in the home and the local community. The lack of transport can at times mean that trips further afield are difficult to organise. Whilst individuals have a varied diet there is a lack of evidence that a healthy alternative is being offered which could put individuals at risk if they are prone to weight gain or other health related matters. EVIDENCE: Two of the individuals were home during the visit the third was on holiday with care staff. Both individuals were keen to talk about their recent holiday to Torquay. It was evident from talking with them and the staff it had been an enjoyable holiday. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 15 Care plans and talking with staff evidenced that the individuals have meaningful activities both during the day, evening and at weekends. Presently the three people have a four-day week placement at a local day centre run by the Brandon Trust. It was evident that the activities were tailored to the individual. Both individuals said they liked going to the Day Centre. One person is supported by the care staff to attend their day care service with guidelines in place. This has assisted in the person maintaining this placement and with inclusion. One person said they have paid employment working as a cleaner. Contracts were seen confirming this. During the week there are varying days when there is one person in the home which enables the person to have one to two staff support. It is evident that this “house” day is tailored to the individual and combines household chores with going out to a place of the individual’s choice. This was documented in the daily notes and linked to the plan of care. Individuals confirmed they were supported to go to the shops, out for lunch and recently a trip to Bristol to the SS Great Britain. Staff said that the individuals enjoy going out but prefer places they know. The Contracts and Compliance visit conducted by the local placing authority highlighted that there was no evidence of personal development or that the individuals take part in age and peer activities or that new opportunities are offered to use their community or wider. However, it was evident from talking with staff that activities are organised both in the home and the community some of this was captured in daily diaries. A member of staff said that the home historically is not been good at recording some of the activities that are completed in house like cooking, sewing and arts and crafts that happen in the home. Staff said that the individuals are supported to attend the day centre and activities in house and the local community on a regular basis. Staff said it can be difficult to go further a field due to the lack of transport. One of the individuals has a motability car and the other two individuals can only use the vehicle if the owner is in the car and with their consent. One of the individuals is unable to use public transport. Staff said that a trip may be planned and then the owner of the vehicle will decline which means that alternative transport arrangements have to be made which can cause disappointment and raise anxieties for the individuals. Two of the individuals have had a holiday to Torquay and one person last year planned a trip to Disneyland which was successful. It was evident that the holidays were planned and tailored to the individual. One person was on holiday during the visit with two members of staff. All the individuals have contact with family and it was evident from records and conversations that they were supported to visit and keep in touch by telephone. Relatives where relevant were invited to care reviews. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 16 The day-to-day running of the home is dependent on the needs of the people living in the home and it is evident that staff are continually monitoring the wellbeing of the people living in The Hollies. The routines of the home are very flexible and the people can make choices about how to spend their time, when to get up and go to bed, what to wear and to some extent choice over food. This was confirmed in conversations with staff and care planning documentation. However, it was clear that there were some boundaries to ensure that the individuals are safe and to assist with their anxieties. It was evident that these were drawn up with other professionals. Care plans included how staff in relation to the challenges that may be exhibited should support the person. This included the triggers and positive steps that staff should take to reduce the person’s anxieties. Staff have received training on supporting people who can challenge the service. Menus were viewed on this occasion. The home has developed a pictorial menu for the individuals. Each person has an opportunity to choose an evening meal. One person said they liked the food and could help themselves when they wanted. Individuals were observed making teas and coffees. A concern was discussed earlier in the report in that one person is on a healthy eating plan and another on a high fibre. However there was no written evidence that this was being followed or alternatives being given to the planned menu. There was no weight loss in a period of twelve months so this would indicate that this is not being consistently followed. Good practice would be for the staff to liaise with a dietician and the GP and review the menus to ensure that a healthier diet is provided. The menu included crisps on a daily basis, puddings and lots of carbohydrates (pasta and potatoes). It was not clear other than with the Sunday roast what vegetables were being provided so therefore poorly evidenced how individuals were getting their five a day. However, from conversations with staff meals are fresh and consideration is taken to provide a healthy balanced diet. There was a fruit bowl available for individuals to help themselves. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s safe practices in the administration of medication. EVIDENCE: Individuals said they were happy with the care support they were given. There is always a registered nurse on duty in the home. The two individuals that were home during the visit said they had a key worker a named member of staff who assists the individual. One person said “my key worker” helps me clean my room and takes me shopping”. Care plans included how the individuals like to be supported and by whom. All the individuals need some support with their personal care however from talking with staff people were encouraged to be as independent as possible. Individuals are registered with the local GP and attend routine appointments with a dentist, opticians and chiropodist. Records confirmed individuals were The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 18 supported to attend appointments including the outcome. To support the individuals with their needs the home liaises with other relevant professionals in the planning of care that is provided including the consultant psychiatrist. The home is keeping the Care Quality Commission informed of incidents that affect the wellbeing of the individuals living in the home in respect of regulation 37. The medication system was viewed. There were clear records of medication entering, administration and disposal. The registered nurses are responsible for administering the medication. Most of the staff have attended training with the local pharmacy on the system in place including some of the care staff. There is a medication policy in place that clearly describes the role of staff and procedures to follow if there is an error. Each person had a current list of medication, what it was prescribed for and the side effects. Medication records included a current photograph. Again it was noted that in the planning for life pack that the wishes in the event of my death had not been completed for one of the individuals. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are listened to and good systems are in place to afford their protection. Individuals can be confident that staff are aware of the procedures to follow in the event of an allegation of abuse. A review of the transport is required with better documentation and consultation with the individuals this would ensure an open and transparent service is being provided. EVIDENCE: The Brandon Trust has an accessible complaints procedure, which is given to people who use the service with an explanation of how it can be used. Copies were seen in care files. Individuals spoken with said they would tell staff if they were not happy. The two individuals spoken with during this visit said they were happy living in the home and the staff support they were given. The home maintains a record of complaints. There has been one complaint received since the last visit and this had been addressed with the complainant. The staff at the home receive training in adult abuse awareness as part of their induction. This ensures that all the staff understand what constitutes abuse and how to report incidents of abuse. A requirement was made at the last visit for all staff to complete further training as many had not attended or it had been six years previously. All staff have now attended this training in January The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 20 2009. Staff spoken with during this visit had a good understanding of the reporting processes and the role of the local councils (adult care). Care plans detail how to support individuals with challenging behaviour. It was noted at the visit in June 2007 and again in July 2008 that the home failed to maintain a record of restraint in accordance with the guidelines from the Department of Health. This has now been rectified and a record is maintained of all incidents of restraint. Staff said that restraint is only used as a last resort. The home has sought the advice of the intensive interaction team in respect of one person’s challenging behaviour. The home uses the term “Off baseline” to describe incidents of challenging behaviour. This term does not lend itself to person centred planning and will make it hard to review the different behaviours that are exhibited or any changes. Staff should clearly record what is happening. It is evident that the new support plan in place has had a significant impact on the person in reducing the episodes of challenging behaviour. From talking with staff it is evident that this person now has a consistent staff team supporting them. Finances were checked in respect of the two people living in the Hollies. Records were maintained of all financial transactions along with receipts. The home has responded to a recommendation to ensure that there are two staff signatures and where possible the individuals signs the record. Staff said that the individuals often refuse to sign. The individuals have access to a motability vehicle, which is funded by one of the people living in the home. Two of the individuals contribute towards the petrol which is based on usage, whilst the other pays for the lease and other costs related to the running of a vehicle. Records are maintained of the expenditure of the petrol, detailing all journeys. There was no consent form in relation to the individual granting permission for the others access to use the vehicle or in the contract of care in relation to the contributions made. There was no signed agreement for the other two agreeing to contribute to the cost of the vehicle. The newly appointed manager and two members of staff said that the owner of the vehicle must be in the vehicle otherwise this affects the insurance. From talking with staff this can be restrictive for the other two individuals if the person does not want to go out. There has been no consultation with relatives or the funding authorities in relation to the additional cost or whether the individuals had capacity to agree to such a long-term decision in respect of taking out a motability vehicle. This additional cost was not detailed in the home’s contract. The manager should consult with the placing authorities to ensure that they are following the Local The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 21 Authority contract and that this does not already form part of the fees paid in respect of the service. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 Hollies provides a safe, comfortable and clean environment for the individuals living there who have benefited from the ongoing refurbishment plan. EVIDENCE: The Hollies is situated in the centre of Yatton Village close to amenities and in keeping with the local neighbourhood. There are good transport links to neighbouring towns including Bristol, Weston Super Mare and Clevedon. There are shops, a church and local pubs within close walking distance. Each person has his or her own bedroom, which is decorated to reflect the taste of the individual. One person’s bedroom is minimalist; risk assessments were in place to demonstrate the reasons and with evidence from staff that The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 23 this had been in consultation with the individual. This person said that they have access to a key which they prefer to keep in the office for safekeeping. Staff said all individuals can have a key however these are often lost. Consideration should be taken to whether the keys can be fitted with a large handle which may assist in individuals keeping them safe. The communal area was bright and homely. The corridors have recently been redecorated along with the smaller sitting room. This has enhanced the overall feeling of the home. The home maintains a record of maintenance and it was noted that repairs are responded to in a timely manner. The staff complete audits on the environment and annually this is completed by the Brandon Trust. In addition a monthly audit is completed by the provider in respect of the regulation 26 monitoring visits. The home was clean and free from odour. Cleaning schedules are in place and the individuals are encouraged to assist with the household chores with staff support. Chemicals are stored in accordance with the home’s risk assessment. The home has separate laundry facilities sited away from the kitchen. There is a sluice on the first floor. There is a pleasant garden area that is fully enclosed. It is evident that this is used by the people who live at the Hollies giving them an additional area to relax. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient and competent staff support the people living in The Hollies. EVIDENCE: The home is staffed with a registered nurse at all times. The newly appointed manager said that a review of the staffing is being completed as there are times when they could be two staff in the home and all the individuals are at their day care. A letter was forwarded to the Care Quality Commission stating that the home would not be staffed on a Tuesday and Thursday as there were no individuals in the home. Staff said that this has not happened and the home is always staffed. The rota provided evidence that there are usually three staff on duty during the day and two staff providing sleep in cover at night. One of the individual requires two staff when out in the community and at times in the home. However, there is a protocol where the individual can go to the local shops The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 25 with one member of staff and this is assessed on each occasion. Staffing is reduced when one individual goes away for the weekend. Staff confirmed that the staffing was adequate to meet the needs of the individuals. All information relating to recruitment is held at the offices of Brandon Trust and is subject to a separate inspection to ensure that a thorough and robust recruitment is undertaken. The newly appointed manager described the recruitment process and it was evident that he was aware of the legislation. Staff complete the Learning Disability Qualification as part of their induction and attend a five day corporate induction which covers statutory training, values and policies and procedures. The newly appointed manager was in the process of reviewing the training completed for all staff. It was evident that staff have attended statutory training including manual handling, first aid, food hygiene, fire and health and safety. Where staff were due this training courses had been arranged. In response to a requirement from the last visit staff have now attended training in mental health and safeguarding. Other training included epilepsy, autism and person centred planning. Care staff have an opportunity to complete a National Vocational Qualification in care. Presently four staff have an NVQ and 2 are in the process of enrolling. Both the team leader and the newly appointed manager are assessors. It is evident that the home is working towards the government target of 50 of the workforce having an NVQ in care. Staff meetings and supervisions are held regularly with records maintained. Staff described good systems of support and communication ensuring the home runs smoothly. The newly appointed manager said that they will complete annual appraisals with staff in line with the Brandon Trust Policy. The home maintains a staff register which includes qualifications, experience and their role. The home has responded to a requirement to ensure that appropriate checks are completed for the registered nurses in respect of their registration with the Nursing Midwifery Council ensuring they are still fit to practice. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that the home is managed well, with good systems in place to measure the quality of the service. Individuals are assured their safety with good systems in place in respect of health and safety. EVIDENCE: The organisation has reviewed the management structure both in the head office and in the homes. This has meant that there has been a review of the registered home manager’s role. This has led to registered managers managing more than one service, as is the case for The Hollies. There new title is locality manager. The newly appointed manager is Mr David Rogers. He has been registered with the Commission for Social Care Inspection in respect of The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 27 another service for approximately eight years. He is in the process of submitting an application to become the registered manager for The Hollies and the other service he has management responsibility for. Both services are care homes with nursing and approximately six miles apart. Mr Rogers does not have a nursing qualification so therefore both homes will have a clinical lead called team managers. Mr Rogers said that he plans to spend half his working week in The Hollies and the other half at the other home. A rota must be in place demonstrating the hours that he works. Mr Rogers said that the role is relatively new and has only been in operation since April 2009 and is continually evolving. Staff said that the new manager is contactable and responds quickly to telephone calls. The home has systems for measuring the quality of the service including routine health and safety audits, medication, finances, staff supervisions, training audits to name a few. Individuals and relatives where relevant were involved in care reviews where their views were sought. Consideration should be taken for individuals and other stakeholder views to be sought through questionnaires. The provider completes a monthly audit on the home in respect of Regulation 26 of the Care Homes Regulations. The newly appointed manager said that these are being completed by other home managers and new links are being built to ensure that these continue. Copies of the documentation of the visits were seen. These have recently been reviewed and cover all areas of running the home and the care support and appear much more informative about the service rather than the one page document that was in place previously. It was noted that a recent visit in May 2009 had highlighted that the care documentation would benefit from being reviewed including risk assessments and that the environment was the best it has looked for many years. Health and safety in the home was monitored both by the manager and a member of staff with this particular designated role. Health and safety training for staff was in place to ensure that individuals are protected and supported by competent staff. Fire records were viewed and found to be satisfactory including the fire risk assessment, fire training, staff participation in fire drills and checks on the equipment. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 28 The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 3 3 X X 3 x Version 5.2 Page 30 The Hollies DS0000020231.V376006.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 5 Requirement To amend the statement of purpose to reflect the change in management and clearly detail who the home can support. Contracts to include any additional charges made including contributions towards the transport. Timescale for action 17/08/09 2. YA5 5A 17/08/09 3. YA17 13 4. 5. YA9 YA37 13 (4) 15(2) 17 (2) Sch 4.7 To review the menu to ensure it 17/08/09 is balanced and meeting the needs of the individuals including how information is recorded. To keep risk assessments under 17/08/09 review. Maintain a record of the hours 17/07/09 the manager works in the home. 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. Refer to Standard YA6 Good Practice Recommendations Review the term baseline to ensure that it captures the DS0000020231.V376006.R01.S.doc Version 5.2 Page 31 The Hollies 2. YA23 individual’s behaviour traits. Review the transport arrangements to ensure meets the needs of the individual and as a group ensuring it is equitable and transparent. Document in the individual’s contract, the statement of purpose how transport is provided and funded ensuring that individuals have consented to the arrangements. Where individuals are unable to consent consultation must taken place with their representatives and in all cases the local placing authority. The Hollies DS0000020231.V376006.R01.S.doc Version 5.2 Page 32 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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