Inspection on 30/07/08 for East Hill House Residential Care Home

This is the latest available inspection report for this service, carried out on 30th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

East Hill House Residential Care... 13/12/05

East Hill House Residential Care... 08/07/05

East Hill House Residential Care... 31/01/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE East Hill House Residential Care Home East Hill Drive Hillbrow Road Liss Hampshire GU33 7RR Lead Inspector Christine Bowman Unannounced Inspection 30th July 2008 10:30 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 East Hill House Residential Care Home DS0000061353.V367421.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. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service East Hill House Residential Care Home Address East Hill Drive Hillbrow Road Liss Hampshire GU33 7RR 01730 895170 01730 895377 easthill@caringhomes.org 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) East Hill (Liss) Limited Mrs Priscilla Le Pla Care Home 45 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE) - Maximum number of 24 in the main house only The maximum number of service users to be accommodated is 45. Date of last inspection 23rd August 2006 Brief Description of the Service: East Hill House is a large old house just on the outskirts of the village of Liss. It has been modernised to meet the requirements of the National Minimum Standards but still retains much of the old character and charm of the original house. Caring Homes Limited owns the house and employs a manager. The home is set in three acres of landscaped gardens on a site that also includes seven cottages and a number of apartments that also house older people (referred to as The Cottages). These dwellings now form part of the homes registration. The provider makes information available about the service, including a statement of purpose and service user guide and the commission’s report to prospective residents on request. Copies of these documents are available at the home and may be sent out by post on request. Fees range from £415 to £850 per week for residential care. There are no additional charges but service users make their own private arrangement for hairdressing, chiropody, newspapers, magazines and toiletries. East Hill House Residential Care Home DS0000061353.V367421.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 the service experience good quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six and a half hours. The Registered Manager had resigned since the previous site visit and a peripatetic manager was managing the home. The manager assisted with the inspection process and the responsible individual also made herself available for consultation throughout the day. A tour of the premises was undertaken and some of the residents’ bedrooms, bathrooms and communal areas were viewed. A number of staff and residents were spoken with throughout the day and residents were observed as they relaxed in the living areas and in their bedrooms. The key inspection standards for care homes for older people were assessed with regard to the outcomes for the residents living at the home. The service user guide was viewed and residents’ files including assessments, care plans, medication administration records and risk assessments were sampled. Staff personnel files, including recruitment, induction and training records were also sampled. The home’s quality assurance system, complaints and compliments, some policies and procedures and maintenance certificates were also viewed. The registered manager had completed the Annual Quality Assurance Assessment (AQAA) prior to resigning and information recorded in this, and on the inspection record since the previous site visit, has been taken into consideration in the writing of this report. A site visit had been carried out on 7th March 2008 by a registration inspector to assess the environment with respect to a variation in the conditions of registration of the home. This was to increase the number of residents from twenty-four to thirty-four by adding the independent living accommodation to the registration and by including the category of dementia for twenty-four residents in the house only. The report highlighted matters to be considered during this inspection. Four residents completed service user surveys and four staff members returned four completed surveys. Comments from these sources have been included in this report. Thanks are offered to the management and the staff of East Hill House for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Medication continued to be stored in the cellar, as was the case at the previous site visit. However, a cooling system had been installed to stabilise the temperature, so that medication, which had been stored in the refrigerator because of the high temperatures reached in this area, could now be safely stored at room temperature. The new menu was a la carte and included many different foods for the residents to sample. Improvements had been made to the percentage of staff accessing mandatory training for the safety and protection of the residents East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 8 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. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 9 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 East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 10 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): Standards 1,3, 6 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. More information is required to inform prospective clients to help them to make a decision about the suitability of the home to meet their needs and expectations. Prospective residents’ individual needs are assessed prior to the offer of a placement to ensure the home is able to meet them. The home does not provide intermediate care, so Standard 6 does not apply. EVIDENCE: There was a good process in place for introducing prospective residents, who were invited, in the home’s brochure, to take a short break at the home and sample the lifestyle. The glossy Statement of Purpose was illustrated with colour photographs of the exterior and interior of the home and gave a good description of the accommodation and the social environment. The Service East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 11 User Guide contained more detailed information about the service, but did not contain details of the fees payable. The four residents, who completed surveys, confirmed they had received sufficient information about the home before moving in, to decide if it was the right place for them. One resident commented, ‘it was the right place then, but has gone down hill since then.’ Residents spoken with on the day of the site visit stated they were happy with their choice, two stated they had moved to be close to their families and that relatives had visited homes in the area on their behalf and made the choice for them.’ The Statement of Purpose did not state that residents with dementia would be admitted to the house only, state admission criteria or clarify the good practice model being followed with respect to dementia, as had been agreed as part of the registration. A number of other details were not included in the Statement of Purpose including the relevant experience and qualifications of the registered persons, the organisational structure, and the number, relevant experience and qualifications of the staff working in the home. The assessment documentation of two residents, admitted since the previous site visit, was viewed. Information with regard to the prospective resident’s communication, mobility, personal care needs, nutrition, medication, medical history, recreational and spiritual needs were included in the pre-admission assessment, which had been signed to confirm agreement. Resident’s files also contained a biography which included information with respect to equality and diversity including their country of origin, religious and cultural needs and preferences, dietary and any other likes and dislikes so that care plans produced from this information could be written to reflect the individuality of the resident. The AQAA recorded that unlimited time is offered to prospective residents to support decision-making prior to moving into the home, and that planned improvements included involving a named care worker in the initial process to provide continuity and to assist with settling in. The home also plans to publish information with respect to fees and benefits to help residents to make betterinformed decisions. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9,10 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are recorded to inform the staff of how to support them and access to health and social care professionals is promoted. Medication is handled safely, the residents are treated with respect and their right to privacy is upheld. EVIDENCE: Residents’ files sampled, contained comprehensive care plans, identifying individuals’ health, personal and social care needs. Goals were set, and support plans, giving clear instructions (entitled care interventions) to the staff were set out. Special requirements with respect to residents’ personal requirements and wishes were recorded to inform the staff. Two of the four staff, who completed surveys, confirmed that they were always given up-to-date East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 13 information about the people they support, one that they usually were and the fourth that they never were. Care plans sampled had been signed and dated monthly and changes had been made, keeping them up-to-date and, where appropriate, risk assessments had been carried out to safeguard the residents and the staff. It was noted, however that the information written in the care plans was not presented in an accessible format for the residents and particularly for those with dementia. The manager stated that the care plans were in the process of being improved and all the staff were undertaking retraining to use them. There was a notice on the notice board in the managers office advertising ‘Annie’s Care Plan Workshop.’ The peripatetic manager had informed the Commission for Social Care Inspection (CSCI), after she had been working at the home for a week, that some of the residents were in need of nursing care. She stated that they were too dependent to be living in a care home and that she was in the process of referring them to care management for re-assessment. She also stated she had completed a clinical audit to identify equipment required and that the organisation were supporting her in ensuring that the right equipment was available for the individual needs of the residents. In the meantime, district nurses were providing nursing care. One resident’s records confirmed that the district nurse had regularly attended to promote the healing of their pressure sores by dressing the wounds when needed. This resident had been provided with a profiling bed, which can be adjusted to enable the staff to turn them regularly to prevent more pressure areas from developing. Records were also kept of all appointments with healthcare professional including General Practitioners, dentists, optician with outcomes recorded to inform the staff. Three of the four residents, who completed surveys, stated they usually received the care and support needed and one that they sometimes did. One resident commented, ‘ sometimes it is necessary to remind the staff and sometimes more than once,’ another resident added, ‘the staff have on the whole not got time, because they are short-staffed –so one gets around to finding someone to help, and the staff are all very kind and helpful’. Medication continued to be stored in the cellar, as was the case at the previous site visit. However, a cooling system had been installed to stabilise the temperature, so that medication, which had been stored in the refrigerator because of the high temperatures reached in this area, could now be safely stored at room temperature. The home held controlled drugs, which were stored appropriately in a metal cupboard, which was secured to the wall to prevent misappropriation. The controlled drugs record had been signed and witnessed, and balances checked agreed with the drugs stored in the cupboard and confirmed that a regular supply was available for the residents. Signatures of the staff administering medication were kept for identification and a senior staff member confirmed that only staff, who had been trained, carried out this task. Medication administration records contained a photograph of the resident East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 14 for identification and to ensure that residents received their own medication and individual resident’s medication was clearly labelled with their name. The Skills for Care Common Induction Standards, which promote residents’ rights, individuality, choice, privacy, independence, dignity and respect and also promote the understanding of their equality and diversity issues, were used by the home to introduce new staff to the caring role. The staff-training matrix confirmed that a high percentage of the staff had received this training and plans were in place to reach the target of 100 . The AQAA recorded that, ‘residents are supported to maintain contact with family, friends and significant others in privacy.’ It was observed on the day of the site visit that residents were treated with respect and that staff knocked on doors and waited to be invited into residents’ bedrooms. The AQAA also recorded that all the resident’s bedrooms have access to a private telephone line, should they require this service, and that a cordless phone is available for private use. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14,15 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Social and recreational activities are limited and do not always match the expectations and preferences of the residents or promote choice and empowerment. Contact with family and friends is promoted, but access to the local community is minimal. Congenial dining areas are provided for the residents to eat their meals in and some residents expressed satisfaction with the diet whilst others thought improvements could be made. EVIDENCE: An activities co-ordinator had been employed to arrange a programme of recreational and social activities, but had left the employment of the company. A replacement for this position had been recruited, but failed to start work, the manger stated. There was some evidence of planned events and activities on the residents’ notice boards. Holy Communion, a talk with photographs about a naval ship, a clothes show, a wine and cheese party, mobile library visiting times, a Garden Fete, and information about the new reminiscence room in the East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 16 main house. The manager stated that some of the organised entertainment took place on a regular basis including musical entertainment, exercise programmes, a visiting hairdresser, quizzes and art and craft. Records of one to one time with residents had been kept by the activities coordinator, showing that efforts had been made to identify individual preferences and that support had been given to enable some residents to continue to attend community groups and continue their hobbies. Three of the four residents, who completed surveys, thought there were sometimes activities arranged for them to take part in and one did not complete. One resident commented, ‘I enjoy the musical side but not whist etc. We have not had any outings for a year because staff are needed for the wheelchairs,’ another wrote, ‘there are activities provided but I do not make use of them,’ and a third mentioned having been taken on a trip to see the bluebells.’ On the day of the site visit, the manager pointed out that some of the residents in the cottages maintained their own transport. The home did not provide dedicated transport adapted for the use of wheelchair users, but some staff were willing to insure their cars for business use, and would transport residents for local appointments and visits to the shops. Residents spoken with stated they didn’t go out and that they thought the reason was to do with the limited numbers of staff available and the rise of petrol prices. Musical entertainment was popular with the residents spoken with, and they stated they had enjoyed listening to a harpist and a violinist and that there had been a talk about ‘Parkinson’s disease.’ The manager stated that one resident enjoyed gardening and had helped the home’s gardener to arrange the plants in the flowerbeds and pots. A greenhouse had been erected and the possibility of a gardening club was being considered. Residents spoken with confirmed that their relatives and friends were made welcome at the home and some residents spoke of being taken out by their relatives. The Service User Guide informed residents that they were welcome to invite guests to enjoy a meal with them, in one of the dining rooms or in their own room, for which a charge was made. Well-behaved pets were also welcomed provided they were suitably restrained and facilities in the home could be made available for special occasions such as birthdays and family parties. Consideration had been given to creating an ambiance of elegance in the dining rooms with table cloths, fresh flowers, formal place settings with wine glasses, table napkins and good quality furniture. Both dining rooms were tastefully decorated and one provided views through the large bay windows over the gardens to the rear of the main house, and the other benefited form views over the flowerbeds to the front of the house. One of the four residents who completed surveys always liked the meals provided by the home, two sometimes did and commented, ‘they are too bland for me –on the whole- too many sponge puddings and tinned fruit with custard or cream- These are very East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 17 unimaginative.’ One resident never liked the meals and commented, ‘poor quality food. Too stodgy for people sitting around – so I go out as much as possible. Boring food to eat with no flavour.’ A staff member also commented under the heading of what they thought the home could do better that, ‘the kitchen budget is too low.’ The manager stated that the home’s food budget had improved and the organisation had agreed that adhering to it should not be to the detriment of the residents. She also stated that a resident’s meeting had been held with the new chef to set new objectives. Residents had been encouraged to put forward their choices and the chef had started to do his rounds of the dining rooms to gain direct feedback. The new menu was a la carte and included many different foods for the residents to sample. Snacks and drinks were provided throughout the day and two residents, who had just had lunch commented that they had enjoyed their lunch and that the chef had consulted with them about their preferences. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 18 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): Standards 16,18 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents were not always confident that their concerns/complaints would be taken seriously and acted upon, but measures had been put in place to regain their confidence. Policies, procedures and training ensure the staff are informed and the residents are confident that they will be protected from abuse. EVIDENCE: Two of the four residents who completed surveys usually knew who to speak to if they were not happy and two sometimes did. One resident commented, ‘I speak at residents meetings but not much notice is taken,’ another wrote, ‘I would like some advice on this, I have no real idea of the hierarchy which means messages tend to pass from one to another’. Two confirmed they knew how to make a complaint, one left the response blank and one stated they didn’t but commented, ‘but I do speak out.’ The four staff, who completed surveys knew what to do if a resident, their relatives or representatives had concerns about the home and one commented, ‘but they don’t take any notice. The complaints procedure was included in the service user guide and provided a variety of options for residents to take their initial concern or complaint to but also included the registered manager, who had left the company. The East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 19 procedure was also prominently displayed in the home. The manager stated that there had been a rise in complaints before she started working at the home and a wine and cheese party had been held for residents, their relatives, representatives and friends to offer the opportunity for concerns to be raised and for the management to listen and offer assurances that action would be taken. The complaints log was viewed. Complaint forms had been completed, letters of acknowledgement had been sent, and copies of letters of response had been retained on file indicating to complainants the outcomes of investigations. The AQAA recorded that four complaints had been received, two of which had been upheld, and all had been responded to within twenty-eight days. The AQAA had been completed several months previously and the manager stated there had been an increase in the number of complaints in the interim period. Two anonymous complaints had been received by the CSCI within this period. Areas covered by the complaints included insufficient staff to meet the care needs of the residents and that some residents’ nursing care needs could not be met at the care home. The manager, who updated the progress at the site visit, had already reported these issues to the CSCI. It was clear that everything was being done to ensure the residents with nursing care needs were receiving sufficient care from district nurses (records confirmed this), and that the manager was working with care management to ensure that clinical reassessments were undertaken and that residents with nursing needs would be placed in nursing homes. Two bath chairs had been out of order and the replacements arrived on the day of the site visit. The manager had completed the residential forum with respect to staffing levels and included the dependency levels of the residents as evidence of the need for higher staffing levels, which had been acknowledged by the organisation. The home had an up to date copy of the local authority safeguarding procedures and a local procedure based on this to clarify referral details for the staff. The staff-training matrix confirmed that the majority of the staff had accessed the Protection of Vulnerable Adults training and the AQAA recorded that,’ residents are assisted to exercise their rights and to access advocacy services as required by them.’ No safeguarding referrals had been made since the previous site visit. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 20 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): Standards 19,23,24,26 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a pleasant and comfortable environment, which meets their needs, and has an extensive maintenance and improvement programme in place to ensure its suitability for the specialist dementia needs of residents in the main house and for the residential care of up to ten people in self-contained accommodation adjoining the home. The home is clean and hygienic. EVIDENCE: The home is located at the end of a drive and is close to the village of Liss. Parking is provided at the front of the house and in a second car park to the side of the house. East Hill House is an elegant and imposing period home, which had been adapted for use as a care home, whist retaining many of its East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 21 attractive original features. The cottages and apartments, which are adjacent to the house, were originally purpose built for independent living and were not registered. After the site visit in August 2006, a domiciliary care agency had been set up with an office in the grounds, to support the people living there. Since that time, a decision had been made to include them in the care home registration, which had been completed in April 2008, providing an additional ten places for older people. Lights had been supplied along the drive for the protection of the staff on dark evenings when moving between the buildings. The flowerbeds at the entrance to the home and around the cottages were well tended and the displays of plants in pots and hanging baskets created a welcoming ambiance. The home was set in mature grounds of several acres with trees and shrubs, lawns and areas of decking providing a pleasant environment for the residents to enjoy from their windows and to sit out in clement weather. Communal areas, available to the residents for socialisation, consisted of an entrance hall, a large lounge, a reminiscence room and dining room in the house and a dining room in the courtyard. A tour of the premises confirmed the home was suitable for its stated purpose and that it was a homely and pleasant place for the residents to live in. There were fresh flowers displayed in some of the rooms, framed pictures on the walls, plants, pleasant domestic lighting, and comfortable and appropriate furnishings for the enjoyment and comfort of the residents. A registration inspector had carried out a site visit on 7th March 2008 to assess the fitness of the unregistered accommodation for registration as part of the care home and to assess the house with respect to adding the category of dementia for the twenty-four residents in the main house. The home had completed risk-assessments with action plans to improve facilities in line with good practice for this client group, and the report had concluded that the environment was conducive to caring for people with complex, physical and behavioural needs. Patterned carpets had been replaced to reduce confusion, a keypad exit system had been added to the front door to protect vulnerable residents and other exit doors had been fitted with alarms linked to the nurse call system, the rear garden provided a secure external space, radiators had been thermostatically controlled to prevent burning, mixer valves had been added to regulate the hot water and reduce the risk of scalding and external windows had been restricted. A major re-decoration programme was in hand to bring in new colour schemes as recommended by current dementia care models and to include signage. Resident’s personal accommodation, viewed with their permission, was of a high standard. Many of the bedrooms were large and most of the accommodation in the cottages included a lounge and small kitchenette. One also included a dressing room. All the bedrooms sampled had en-suite facilities, and the Statement of Purpose recorded that only two bedrooms did East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 22 not have this facility, but shared a bathroom. The total number of bedrooms in the house, however, was not recorded so it was not possible to ascertain if any of the bedrooms were shared. A lift provided access to the two upper floors in the house and the original mahogany staircase had been retained. The manager confirmed this had been risk assessed as part of the recent registration for residents with dementia. Bedrooms viewed were personalised and it was clear that residents had been encouraged to bring items of their own furniture, pictures, photographs, decorative items such as ornaments and lamps. Residents spoken with were very happy with the accommodation, commenting that, ‘the bedrooms are comfortable’, ‘my bedroom has nice big windows and a nice bed’, and ‘I was able to bring some of my things.’ The laundry was equipped with industrial washing machines and hand-washing facilities were available to promote infection control. The staff training matrix showed that 60 of the staff had received infection control training and plans were in place for future training. Two of the four residents, who completed surveys thought the home was always clean and fresh, one thought it usually was and one that it sometimes was. The home was fresh, clean and free from offensive odours on the day of the site visit. One resident commented, ‘I should complain if it was not.’ East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 23 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): Standards 27,28,29,30 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Recent increases in staffing ratios promote the ability of the home to meet the resident’s needs, but continued dissatisfaction expressed by some staff and residents, indicates further improvements may be required. Satisfactory recruitment procedures and good induction training prepare the staff to meet the residents care needs but further improvements in foundation and specialist training are needed to promote the competence of the staff to fully meet all the residents’ needs. EVIDENCE: The staff training matrix recorded a total of thirty seven staff and that three had left and four had been recruited since the AQQA was completed in January. Ancillary staff for cleaning, laundry, kitchen and maintenance were included and an administrator was also employed by the home. The AQAA recorded that twenty-nine staff were employed at the care home at that time, and nine full time and three part-time staff had left the employment of the home in the twelve months prior to that time. The registration report completed in April 2008, noted that the domiciliary care staff would be absorbed by the care home and indicated that staffing levels would remain the East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 24 same in this area during the day but increase to two waking night staff. There would continue to be two waking night staff in the main house and there would be an increase of one carer each day shift to assist with increased dementia care needs. It was recorded in the registration report that, ‘the staffing would be needs led, flexible and led by demand and that the manager and the deputy manager would be supernumerary’. Of the four residents who returned surveys, one thought the staff listened and acted on what they say, two declined to comment, and a fourth thought the staff did not listen and act on what they said, but commented, ‘they have, on the whole not got time, because they are short-staffed.’ Three thought the staff were usually available when they needed them and one that they sometimes were. One resident commented, ‘they are too busy owing to there being so few of them.’ Two of the four staff, who completed surveys stated there were never enough staff to meet the individual needs of all the people who use the service and one wrote, ‘carers can only cope with the basic needs of the residents. They do not have time to take residents to activities most of the time and certainly cannot stop to chat as they are too busy.’ They also commented that, ‘the staff are hard-working and try to deliver as good a service as possible.’ A requirement had been made at the previous site visit that, ‘staffing arrangements for the main house must be kept separate from staffing support for ‘The Cottages’. This had been made because, at the time, those services were specifically for residents, who were independent and did not need to be registered. Since that time a registered domiciliary care agency had been set up to cater for the needs of the people living in the cottages. More recently a decision had been made to register the cottages as part of the residential home and a major variation in the registration criteria for the home had been undertaken. When the peripatetic manager started working at the home in June she confirmed that, ‘staffing levels are not high enough. Agency staff will be used in meantime and advertising/ recruitment is in hand’. The AQAA recorded that, ‘staff are encouraged and supported to undertake National Vocational Qualifications and other vocational training according to their role and experience’ and that one of the senior staff had achieved an NVQ Assessor Award. However, the numbers of staff having achieved or involved in working towards this qualification was recorded as less than 50 . The staff personnel files of two newly recruited carers, sampled, confirmed that recruitment checks had been carried out prior to the offer of a post. Full employment histories, with gaps explained and reasons for leaving had been completed, to ensure that only those suitable to work with vulnerable people would be considered for employment, to safeguard the residents. Interview records showed that recruitment was carried out fairly and in line with equal East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 25 opportunities. 100 of the staff, who completed surveys, confirmed they had checks carried out before they started work such as Criminal Record Bureau checks and references. The staff training matrix confirmed that a high percentage had received induction training in line with ‘The Skills for Care Common Induction Standards’, which is an excellent introduction to care staff to the caring role and promotes the residents’ rights to be treated as an individual and have their equality and diversity needs respected. The manager stated that, staff recruited from abroad, are tested on their understanding of the English language and spend the first induction day confirming this. If there is a need for further support, they are referred to local colleges courses. Staff training and development logs sampled, contained training certificates including induction, health and safety, the Control of Substances Hazardous to Health, fire safety, the Protection of Vulnerable Adults, moving and handling, NVQ level 2, infection control, food safety, general medication management, pressure area care, dementia training (Yesterday/today/tomorrow) and care planning. One member of staff commented in the survey they completed, ‘the training I have received has been of excellent quality and this is obviously good for the residents.’ East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35,38 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Excellent leadership and systems in place ensure the home is run safely and in the best interests of the residents. A prompt decision about the future management of the home should be made to promote consistency and continuity for the residents and staff. EVIDENCE: Since the previous site visit, the registered manager had resigned. Comments received from staff indicated that they thought the manager had not received sufficient support from the organisation to enable her to carry out her role. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 27 Comments received included, ‘the manager left the company as they wouldn’t give her more staff’, ‘staff have asked for more staff and manager did not provide – on going’, ‘more management input is needed to support the staff,’ ‘there are never enough staff to meet the individual needs of all the people who use the service,’ ‘staffing levels always meets the criteria for the home occupancy but never their dependency levels – this is frustrating for the care staff’. The peripatetic manager had collated evidence to support the need for more staff and had been allocated an extra staff member. She stated that the organisation were very supportive. The peripatetic manager was a Registered General Nurse and was experienced and competent with respect to the management of the home. The Responsible Individual confirmed that the peripatetic manager would be applying to be considered for the role of registered manager for the home, should an appointment not be made in the near future. In the relatively short time the manger had been working at the home, quality assurance questionnaires had been completed. These had been collated and the results used to enable plans for the improvement of the service to be completed. The manager had arranged for residents, their relatives, representatives and friends to attend a cheese and wine party, to provide an open forum for concerns to be discussed and to give assurances of prompt action should any concerns be raised in the future. Arrangement had also been made for the chef to meet with individuals, who had expressed dissatisfaction with the meals, to discuss their specific requirements. The manager had also devised a system of self-audit to ensure the home’s policies and procedures were being adhered to and that all residents were receiving individual care in line with their care plans. The AQAA recorded that there were robust financial procedures, which included handling the residents’ money held for safekeeping, and that residents were encouraged and supported to manage their own financial affairs where appropriate and according to their choice. When this was not possible, their family or a financial appointee took this responsibly rather than the home. A requirement made at the previous site visit that, ‘staffing arrangements for the main house must be kept separate from staffing support for ‘The Cottages’ was no longer appropriate and this has been explained under the ‘staffing’ section of the report. Although some sections of the report have been given scores, which indicate actions are required for improvements to be made, the peripatetic manager confirmed plans already in place for the development of the home. The considerable progress already made in the relatively short time of her leadership, and her enthusiasm for the management task in hand, inspired confidence in her ability to ensure the plans would be completed. East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 28 The staff training matrix showed that health and safety, moving and handling, fire safety, food hygiene and infection control had been given high priority in the training schedule. Targets of 98 and 99 compliance had been achieved for health and safety and first aid over the last three weeks, the manager stated, and plans were in place to achieve similar results in the remaining areas. A staff member stated on the day of the site visit, ‘The ethos of East Hill House is caring, warm and friendly and staff treat their colleagues with respect and go out of their way to help each other in looking after the residents well.’ East Hill House Residential Care Home DS0000061353.V367421.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 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 2 14 2 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 2 28 2 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 East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 East Hill House Residential Care Home DS0000061353.V367421.R01.S.doc Version 5.2 Page 32 - 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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