Inspection on 19/01/09 for Hillcrest House Limited

This is the latest available inspection report for this service, carried out on 19th January 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Hillcrest House Limited 30/10/06

Hillcrest House Limited 28/11/05

Hillcrest House Limited 07/06/05

Hillcrest House Limited 01/12/04

Hillcrest House Limited 15/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Hillcrest House Limited Hillcrest House Barbican Road East Looe Cornwall PL13 1NN Lead Inspector Jane Gurnell Unannounced Inspection 19th January 2009 09:25 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 Hillcrest House Limited DS0000046312.V373742.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. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest House Limited Address Hillcrest House Barbican Road East Looe Cornwall PL13 1NN 01503 263489 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) enquiries@hillcrestlooe.co.uk www.hillcrestlooe.co.uk Hillcrest House Limited Ms Sharon Jane Keast Stephen Phillip Jones Shelley Anne Blyth Care Home 88 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (38), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (38), Old age, not falling within any other category (57), Physical disability (57), Physical disability over 65 years of age (57) Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd October 2007 Brief Description of the Service: Hillcrest House offers care and accommodation to older people in need of care by reason of old age and to those who have may have dementia or mental health needs. The home has two units, the General Nursing Unit that provides nursing care for up to 57 people and Trevena which provides care for up to 31 older people who have mental health problems or dementia. Both units are divided over two floors and in effect the service provides four smaller care homes with one, giving the impression people are living in a much smaller home that the registration of 88 beds would imply. The home is owned by Hillcrest House Ltd, a family run company that has owned the home for over 20 years. Ms Sharon Jane Keast, one of the directors of the company, is registered with the Commission and has overall responsibility for the home. Stephen Jones, is registered with the Commission to manage Trevena, the dementia care unit and Shelley Anne Blyth, is registered to manage the general nursing unit. All are trained nurses. The home is able to offer respite care as well as convalescent care in one of two nursing units depending on the assessed needs of the person being admitted. The two units of the home are staffed separately and both have a nurse in charge at all times. A more secure area is provided in the Trevena unit for the safety and well-being of the people with confusion who may be at risk from leaving the home unsupervised due to their dementia or mental health needs. The home also cares for people who have been diagnosed with terminal illnesses. The home is situated on the outskirts of Looe and has scenic views over the surrounding countryside and sea. There is a small group of shops nearby. Each bedroom offers en suite facilities and a number of bedrooms are more spacious and are suitable to be used by married couples, partners or friends who have made a positive choice to share. Each of the four areas of the home has a spacious lounge room and dining area. The garden is large and pleasantly landscaped. The home is a modern building, purpose built prior to the implementation of the Care Standards Act. There is a large car park to the front of the home. The weekly cost of care ranges from £308.09 to £650.75 dependant upon care needs. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Hillcrest House Nursing Home took place on the 19th and 20th January between the hours of 0925 and 1625 on the first day and 0930 and 1245 on the second day. Prior to the inspection a completed Annual Quality Assurance Assessment (AQAA) was received from the home. The AQAA is a document used by the home to notify us of what the service does well and what has improved over the past 12 months. Also received were written surveys from nine people living in the home and 12 members of staff. Many of the people living in the home were spoken with, as were five visitors, the staff on duty, the registered managers and the owners. The premises were inspected, as were the standard of the meals and the medication arrangements. The care files/records relating to six of people were looked at in detail. Five staff files were also examined as were a number of important policies and procedures. Two periods of observation were undertaken using the Short Observational Framework for Inspection document (SOFI), one in each of the lounge rooms of Trevena, the Dementia Care Unit. This is a document that focuses our attention on the well-being of people in the home as well how staff engage with them. What the service does well: The home is very well managed, having 3 registered managers, one for each unit and Ms Keast the owner registered to have overall responsibility: this exceeds the requirements of the National Minimum Standards for care homes. People living in the home and their relatives confirmed that have an excellent relationship with the managers and staff team and have confidence that concerns will be dealt with promptly. Four of the visitors spoken with said they spend each day at the home and are fully involved with the care of their relative. The home has been commended for recognising the needs of family members in continuing to care for their relative once they have been admitted. The home is commended for the variety of leisure and social activities provided and for employing staff specifically to facilitate these and to support staff with 1:1 and group activities. An aromatherapist and reflexologist is employed twice a week to offer massage for those people who remain in their rooms due to illness. Staff are professional and confident in their duties. They are well trained and motivated to provide a good quality of life to people living at Hillcrest. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 6 Assessments and care plans are thorough and reviewed frequently to ensure people’s needs are identified and fully met. People said they enjoyed the meals and there was a wide variety of choice. All bedrooms provide en suite facilities thus exceeding the National Minimum Standards for care homes for older people. The home is divided into 4 areas giving the impression of living in a much smaller home, this is important for people’s feelings of safety and security as well as providing a more homely environment. Communal rooms are spacious and well decorated and furnished. Infection control practices are effective in reducing the risk of cross infection and the home has been commended for investing in equipment to allow for a more thorough cleaning of room. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough and comprehensive procedures prior to admission ensure that the people and their relatives/representatives can be confident that their needs will be met. People are given sufficient information to make an informed decision over the suitability of the home. EVIDENCE: The service user guide is available to visitors to read in the reception area of the home. The document is regularly updated to ensure that people considering moving to Hillcrest House and their relatives or representatives have the correct information on the services provided. Each person and their representative had been provided with a copy of this document. One relative spoken with confirmed that he had been made very welcome whist he was deciding if the home was suitable for his wife. He said he had been given information in writing and staff had spent time with him describing life in the Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 9 home. On the day of his wife’s admission he was provided with lunch while he waiting for her to be admitted from hospital. New admissions to the home take place following a full assessment undertaken by one of the registered managers of the home. The assessment is undertaken in hospital, the person’s home or on a visit to the home. This information forms the basis of the person’s individual plan of care. Evidence was also available in files of assessment information gathered from health care/social care professionals. The assessment process is thorough to ensure that the home will be able to meet the needs of the person coming to the home. One completed survey from a person in the home whose family had assisted with the choice of home and the completion of the survey said: “we were given ample time to look around and all questions were encouraged and answered satisfactorily. We went away convinced that Hillcrest was a caring environment for our aunt”. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people in the home can be confident that they will be treated with respect and that their personal and health care needs will be met in the manner of their choosing. Families can be assured they will not be excluded from any decisions that need to be made or any involvement they wish to participate in with the care of their relative. Medication practices are safe. EVIDENCE: During the first day of the inspection, time was spent in both units of the home, talking to people and observing staff going about their duties. All those people spoken with were very satisfied with the care and support they receive. The staff were described as “excellent” and one person described living in the home as “first class”. Those relatives spoken with also expressed their satisfaction with the home; “it’s marvellous” and “the staff are absolutely lovely, I can’t thank them enough for what they do for my mum” were amongst the comments received. Of the nine surveys returned by people living in the home, eight said they “always” receive the care and support they require and one said they “usually” do. Comments included “the staff are very Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 11 friendly and helpful. Nothing is too much trouble”. One visitor described how her relative’s health and well-being had improved considerably since moving into the home. She said he had regained his appetite and had put on weight. Four relatives described how they are encouraged to continue to care for their relative and said they are able to assist staff with personal care, leisure activities and meal times. They said they are grateful the staff recognise their need to continue to be carers themselves, and the home is commended for this. One care plan indicated that only male staff would assist a gentleman as he preferred not to be helped a female staff member. In consultation with the person and their relatives a qualified nurse draws up the plan of care for each person in the home. There was evidence of this involvement in the six care plans examined with a signature in place. Two nurses have the main responsibility for care planning in the two separate areas of the home. The care plans incorporate the health, personal and social care needs of the people in the home. In both the nursing unit and the dementia care unit the care plans examined showed evidence of regular monthly reviews and changes where necessary. Daily care notes and staff interaction are recorded on the computer and printed out and placed in the person’s file. Comprehensive information is included in the care plans and include for example dietary requirements, weight monitoring and nutritional assessments, pressure sore prevention, continence assessments, moving and handling assessments and falls risk assessments. For those people at risk of falling from their bed, a risk assessment demonstrated whether it was appropriate to fix bedrails. For one person, it was agreed that the bedrail would present an increased risk of injury and it was decided to lower the person’s bed and place a second mattress on the floor to prevent injury should he try to get up from his bed unaided. For those people where it was identified that a bedrail would be effective, a risk assessment and measurements had been taken with regard to the suitability of the particular rail with the bed type and mattress. All these assessments were reviewed each month. The home has good working relationships with the local Primary Health Care team members. All the people in the home are registered with one of the general practitioners at the local surgery. This does mean for some people they may have to change their general practitioner, but there are three general practitioners who visit the home weekly. A GP specialising in dementia care visits the Trevena unit each week. The medication administration records for the people whose care plans had been looked at were examined. These were found to be completed correctly. Each floor of the home has it’s own medication trolley and the medicines are dispensed from blister packs with bottles and items prescribed in between deliveries being kept separately in the trolleys. A medication fridge is kept in the office of each unit and the temperature of these was recorded each day to ensure medication was kept at the correct temperature. The home did not Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 12 have any controlled medication at the time of the inspection, but had suitable storage should it be needed. The homely remedy list is up to date and kept in the medication file. The findings of the SOFI observations showed the interactions between staff and people who use the service were very good. Genuine signs of affection and humour were seen and heard throughout the inspection. All staff were professional and cooperative. People’s moods were generally positive throughout the observation. All episodes of staff interaction were positive with many examples showing signs of genuineness, warmth, recognition, friendliness and fun. Staff demonstrated understanding and patience with those people who became agitated or upset due to their dementia. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The routines in the home are relaxed, relatives and friends can be confident that they are welcomed and social activities are arranged. The dietary needs of the people in the home are well catered for with a balanced and varied selection of food that meets the peoples’ tastes and choices. EVIDENCE: One of the SOFI sessions was spent observing a mealtime. It was noted that staff assisted those that needed help with eating in a sensitive and unhurried way. Staff interaction was very good and staff were patient with those people who were struggling to eat or who became upset or confused. Staff were seen to anticipate the needs of people and were able to intervene to prevent further upset. Care staff kept records of what people had eaten and were seen to inform the nurse in charge if they were concerned. All those people spoken with said they enjoyed the meals and had plenty to eat and drink. They confirmed that drinks and snacks were available at all times. The lunch-time meal was cottage pie, carrots, peas and gravy, with rice pudding for dessert. Alternatives included baked potatoes with a choice of fillings, omelettes, scrabbled eggs, sandwiches, soup, cheese and biscuits and salad. Ms Keast confirmed the chef leaves sandwiches and snacks should people request Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 14 something to eat during the night. People said the chef meets with them regularly to ensure they are receiving meals they enjoy and to discuss changes to the menu and their preferences. The chef explained that special diets are catered for and supplements are available as required. Pureed/liquidised food was seen being served at lunch-time: each item had been pureed separately so the meals retained the colours of the original food. There was a good supply of fresh vegetables in dry stock in the kitchen. Local services are used for meat. One relative said in a survey from someone living in the home that her relative had previously not been eating but she had “started eating all her meals again….the staff have persevered and gained her confidence”. The chef, who holds the position of catering manager, has line management responsibilities for the catering staff. These staff members receive regular supervision and appraisals. The home is commended for its management of leisure and social activities. Two people are employed to organise leisure and social activities both in and out of the home. The Quality and Training Officer facilitates and participates in activities and the Information Officer arranges transport, visits to local places of interest and writes the monthly newsletter, The Hillcrest Hound. This newsletter is sent, with invitations to participate in the activities, to former respite residents, relatives of former residents, retired staff and anyone else who has expressed an interest in maintaining contact with the home. The Information Officer said 150 newsletters are sent out each month. Photographs are taken of events within the home and the trips out and displayed nicely in a photograph album for all to see. Recent events include a visit from the local animal shelter when people were able to touch animals they would not normally be able to such as snakes, ferret and owls; visits from “Pets as Therapy” organisation; a concert from the local choir and a Christmas party. An external facilitator visits the home each week to provide “music and movement” sessions. Future events include a pantomime on 26th January and a visit to Kernow Mill for a cream tea on 4th February. The home also has a dog and two cats which people were seen to thoroughly enjoy the company of. Those relatives spoken with said they were encouraged to participate in the activities and said they were always welcome. Prior to the Christmas holidays, the local primary school visited the home each Wednesday afternoon for a “Generation Group” where residents and children enjoy arts and crafts, gardening and playing games together. Photographs of these sessions were in the photograph albums and showed real affection between the children and the people living in the home. Ms Keast confirmed that the children will recommence visiting soon. With regard to interaction with people who either through illness or choice remain in their bedrooms, the home employs an aromatherapist and reflexologist twice a week to provide individual touch and massage sessions. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 15 The Quality and Training Liaison Officer and staff said they spend time with people in their rooms. A basic preference form is in each file and a list of “likes and dislikes” to ensure that people have choices about how they are spending their days at the home, including their choice of television and radio programmes, music, hobbies and books. A “Hillcrest Committee” meets every month and includes staff, residents and relatives, who discuss and plan forthcoming events and issues related to the running of the home. Visiting to the home is encouraged and welcomed. The people in the home maintain contact with family/friends as they so wish. All visits are recorded and all visitors to the home are greeted by the reception staff member and asked to sign into the home in the visitors’ book. There are a number of communal areas in the home where visitors can be received as well as private accommodation areas. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people in the home can be confident that any concerns or complaints they may have will be treated seriously and that they will be protected from abuse. EVIDENCE: The home has in place a clear complaints policy and procedure in place. All policies and procedures are kept in accessible files in the two separate areas of the home. All nine of the surveys returned from people living in the home said they know how and whom to complain to if required. Comments included, “have had a good relationship with the home’s manager and staff”, “have had a few complaints, those raised have been addressed” and “I have never had cause to complain”. The home had received 5 complains since the previous inspection in October 2007: one of these was partially upheld. Evidence was available about how these matters had been investigated and the manager had met with families and social services to resolve the issues. In April and July 2008 the Commission visited the home on two occasions to look at the care plans of two people whom social services had raised concerns about. The managers were asked to review practices relating to risk management which, Ms Keast confirmed had been undertaken and which was evident in the care plans examined and people spoken with. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 17 There are clear policies and procedures in the home regarding whistle blowing and adult protection. Staff files evidence that staff have received internal adult protection training and senior members of staff have attended external training (Cornwall County Council) to enable them to cascade adult protection procedures information to the rest of the staff. All 12 staff who returned a survey said they knew what to do should someone raise a concern or make a complaint, including adult protection issues. Those staff spoken with at the home were also confident in what action to take and who to report their concerns to. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Hillcrest House is a spacious, pleasant and well-maintained home. It is comfortable, warm and clean. It provides suitable facilities and equipment to promote people’s privacy and assist with their care needs. EVIDENCE: Hillcrest House is situated on the outskirts of Looe. The home is purpose built prior to the Care Standards Act and provides en suite accommodation in all bedrooms, thus exceeding the National Minimum Standards for care homes. Many rooms have very pleasant views over the valley and of the river. Good car parking is available at the home. The home is divided into two separate units, one for people who have general nursing needs and one for the people who have a dementia/mental health needs. Each of these areas is divided again into two separate areas giving the impression of being a much smaller home than the registration of 88 beds Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 19 would imply, and the home is commended for this. There are lounge and dining areas on each floor of each unit. These rooms were pleasantly decorated and provided a variety of seating positioned in a way that promotes conversation and interaction between people. Bedrooms are on both the ground and first floors with a passenger lift providing access to the first floor. Those bedrooms looked at were clean and tidy and free from offensive odours. All were decorated with personal items. Radiators were covered to reduce the risk of burns should someone fall against them and the window openings were restricted to prevent them from fully opening. The owners were advised to refer to the recommendation of specialist dementia care organisations such as the Alzheimer’s Association and Dementia Voice with regard to best practice with the environment, such as painting doors to the toilets and bathroom different colours to distinguish them from bedrooms. Access is available from each area of the home into the gardens which are pleasant and have been provided with seating in a patio area. A safe external area is provided for people from Trevena, the dementia care unit. Trevena is a locked unit where access is gained by a numbered key pad which ensures people with confusion are free to move about the home without worry of placing themselves at risk by leaving the home unsupervised. In the AQAA, Ms Keast confirmed that bedroom and lounge furniture would continue to be replaced as necessary and those that had been were of good quality. Suitable equipment was in place to meet needs for example, lifting hoists and stand-aids, wheelchairs, beds and mattresses. Three maintenance staff members are employed by the home to undertake daily repairs and redecoration as well as refurbishment. Ms Keast confirmed that all bedroom doors had been replaced to provide added protection to people in the event of a fire. These doors had been fitted with closure devices that allow the door to be held open at any angle for those people who prefer to leave the door open or ajar, and which would close at the sound of the fire alarm. It was noted on the day of the inspection the home was very clean. Domestic and laundry staff are employed with a domestic supervisor in charge. The whole home is vacuumed each day and other jobs are allocated as required such as carpet cleaning and deep cleaning rooms. The domestic supervisor has responsibility for ensuring that the cleaning at the home is of a good standard. Two cats live in the home and cat flaps have been fitted for them on doors to the building. There is a rota for feeding the cats and the litter trays are cleaned out as necessary. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 20 The laundry has two washing machines and driers in place, all laundry is undertaken at the home. When washed the laundry is delivered to the rooms by the carers who sometimes have to put a load of washing on in the evening. In the AQAA, Ms Keast confirmed that the home had invested in a “fogging” machine that completely disinfects a room and it’s furnishings. Alcohol solution is provided at the entrance and throughout the home to reduce the risk of infection and staff were seen to be wearing gloves and aprons where appropriate. Training records indicted all staff had received training in infection control. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at Hillcrest House are cared for by motivated, knowledgeable, capable and caring staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment procedures protect vulnerable people. EVIDENCE: People living in the home and their relatives confirmed that they receive the assistance they need in a manner that suits them. People confirmed that should they call for assistance, staff attend to them promptly indicating there are sufficient staff on duty. Each shift is managed by a qualified nurse and there is always a qualified nurse on duty in each unit 24 hours a day. A number of staff at the home are long standing employees and staff turnover is generally low for a home of this size. During the course of the inspection the staff were observed to be interacting well with the people in the home, they presented as professional during their interactions and looked smart in their uniforms with their name badges. A number of ancillary staff are employed for example laundry, housekeeping, administration, maintenance, catering. A thorough recruitment procedure is in operation and includes completed application forms, two written references and a criminal bureau check to Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 22 ensure as far as possible only suitable people are employed at the home. Five staff files were inspected, including one for a member of staff recently employed, a member of staff who has been employed for a number of years, a Registered Nurse and a Nurse from overseas. These were found to be completed well and held the necessary documentation. All staff are issued with a contract of employment detailing the terms and conditions of their employment. Permission had been received from the Home Office to employ the Nurse from overseas and Ms Keast provided evidence that she had applied to the Home Office for a licence to continue to employ staff from outside the Eurpoean Union: an officer from the Home Office was due to visit the home the week following the inspection. Staff are encouraged and supported to undertake NVQ training. Statutory training including moving and handling, fire safety and first aid was found to be up to date. Two staff are trained to deliver moving and handling training and fire safety training. The home uses a mixture of in-house and external training for its staff team to ensure their training needs can be met promptly, other training subjects include dementia care and nutritional support. The nursing staff undertake regular training to ensure that their skills are kept up to date, for example wound care and catheter care. The Information Liaison Officer has the responsibility for evidencing and organising all the training that is taking place in the home. She has worked hard to organise her systems and collate all the information together for a large number of staff. The home provides training places for student nurses from Plymouth University, although there were no student nurses at the time of the inspection. The McMillan nurses provide training in relation to the care of people who are terminally ill. The staff team presented as motivated and enthusiastic in their work. New staff members employed at the home receive induction training that complies with the Skills for Care Council which provides a recognised standard of care values and principles. One new member of staff confirmed she felt very well supported and was working alongside a more experienced member of staff. All 12 staff who returned a survey said they felt they had the right support, experience and knowledge to meet the different needs of the people use the service. Eleven staff felt they received the training necessary to undertake their job. Comments included, “I can say with confidence that Hillcrest has always been in the forefront of keeping up with the training” and “there are ongoing training sessions covering all aspects of care which are available for all members of staff”. One staff member said “I would like to have more hands-on training in all areas as they so many different areas to cover” and this was passed on to Ms Keast. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people at Hillcrest House live in a very well-managed home. The management and staff team strive to provide a stimulating, safe environment where people are respected and rights are upheld. EVIDENCE: There are three registered managers at Hillcrest House. Ms Keast, one of the owners and a director of the company is registered to have overall management responsibility for the home. Mr Jones is the Registered Manager of Trevena, the dementia care unit, and Ms Blyth is the Registered Manager of the general nursing unit: this exceeds the National Minimum Standards with regard to have a person registered with the Commission to manage the home. Ms Keast and Mr Michael Cotton, have owned and managed the home since 1987 and attend each day: Mr Cotton undertakes the role of the Responsible Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 24 Individual for the company in line with regulation 26 of the Care Homes Regulations 2002. The management team present strong leadership where duties and responsibilities are clearly identified and delegated to appropriate staff members as required. All have defined responsibilities with each person overseeing specific tasks. This ensures the home is well managed and people’s needs do not get overlooked. Weekly meetings ensure each manager is up to date with events throughout the home. The managers meet with the registered nurses regularly to pass on updates in policies and procedures as well as information regarding the welfare of each person living in the home. The Quality and Training Liaison Officer is responsible for offering supervision for care staff, and the catering and domestic managers are responsible for supervision their teams. A record of supervisions was maintained and demonstrated people were offered supervision at least 6 times a year. A yearly annual quality assurance review takes place where surveys are sent out to people living in the home and their relatives: the results are collated and an action plan developed to address service improvements. The results of the most recent review were available and showed a high level of satisfaction with the home. A manager is available every Wednesday evening to meet with relatives who are unable to visit during the day. The name of the available manager for each week is included in the newsletter. Appointments are also available should this not be suitable. The manager and the accounts manager explained that they try not to be involved with the people’s finances. Bills are sent out (newspapers and hairdressing for example) to the relatives or the representatives looking after a person’s finances. Receipts are in place of financial transactions. Secure facilities are available in the home for the safe storage of money and person items of value. The home employs a Health and Safety Consultant once a week advise on best practice and to undertake health and safety audits of the practices within the home. Servicing records for equipment were available and demonstrated equipment is kept in good working order. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 4 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 3 3 Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 26 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. 1 Refer to Standard OP22 Good Practice Recommendations The owners were advised to refer to the recommendation of specialist dementia care organisations such as the Alzheimer’s Association and Dementia Voice with regard to best practice with the environment, such as painting doors to the toilets and bathroom different colours to distinguish them from bedrooms. Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Hillcrest House Limited DS0000046312.V373742.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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