Inspection on 22/05/07 for Hickling House

This inspection was carried out on 22nd May 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hickling House 19/08/09

Hickling House 17/03/09

Hickling House 29/07/08

Hickling House 26/09/06

Hickling House 24/02/06

Hickling House 25/10/05

Hickling House 29/11/04

Hickling House 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hickling House Town Street Hickling Norwich Norfolk NR12 0AY Lead Inspector Ann Catterick Unannounced Inspection 22nd May 2007 09:15 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 Hickling House DS0000027434.V341375.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. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hickling House Address Town Street Hickling Norwich Norfolk NR12 0AY 01692 598372 P/F01692 598372 info@hicklinghouse.fsnet.co.uk info@glendonhouse.fsnet.co.uk Mr Rhoderick Smart Mrs Frances Smart Angela Marlow Care Home 29 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) Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (28) of places Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to twenty-eight (28) service users, over 65 years of age with dementia may be accommodated. One (1) adult with dementia may be accommodated The total number not to exceed twenty-nine (29). Date of last inspection 26th September 2006 Brief Description of the Service: Hickling House is a care home providing personal care and accommodation for 29 older people with dementia. Mr Rhoderick Smart and Mrs Frances Smart own the home and the registered manager is Mrs Angela Marlow. The home is situated on the outskirts of the village of Hickling, close to Hickling Broad and less than 5 miles from the Norfolk Coast. Originally a Victorian Inn, the premises has been extended and modernised to provide residential accommodation on two floors. There are 25 single rooms, 24 of which have en suite facilities, and 2 double rooms, both with en suite facilities. A shaft lift and separate stair lift provide access to the upper floor and there are two outside fire escapes. The weekly fees for care and accommodation are between £404 and £500 a week. Day care is provided to a small group of people and they are accommodated during the day in the general communal areas. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key unannounced inspection and took place on the 22nd May 2007. The site visit lasted for 8 hrs. Following the inspection and Annual Quality Assurance Assessment was completed by the manager and returned to the Commission. On the day of the site visit the inspector was able to speak with residents, a family member, the manager and staff as well as have a tour of the building and look at care plans, staff files and other documents and policies. Generally this is a well managed care home that provides a good quality of care. All of those service users spoken to, who were able to comment, were satisfied with the care they received. Observations were made of residents and the interaction between staff and residents was good. There are some areas where the home could do better and these are identified within the requirements and recommendations. What the service does well: All of those residents seen on the day of inspection appeared to be having their care needs met. Care plans seen were mostly comprehensive and were being reviewed on a regular basis. The home provides at least 40 staff hours a week for dedicated staff to offer meaningful varied activities to residents. The home provides good-sized personal space and varied communal space for residents. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 6 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. Hickling House DS0000027434.V341375.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 Hickling House DS0000027434.V341375.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): 3 and 6 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Documentation suggested that residents have their needs assessed to ensure that the home can meet these prior to admission. Not all assessments seen were signed or dated and therefore confirmation of this was hard to evidence. EVIDENCE: Assessments were seen for three residents who had recently moved into the care home. Assessments were seen on file but not signed or dated. Assessments from health professionals were seen on file. A residents contract was seen but did not state what room they were to occupy Contracts could be made more user friendly and easier to understand. Those residents observed and spoken to on the day of inspection appeared to be having their needs met. Intermediate care is not provided in the home. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 9 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 and 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care plans include most of the information needed to ensure that staff know how to meet their needs. Staff were seen to work with residents in a way that protected their privacy and promoted their dignity. The homes policy and procedure around medication promotes safe practice. EVIDENCE: The format for care plans is good and in some cases care plans were well detailed and complete. Within other care plans there were gaps and not all parts of the care plan were fully completed. For example not all care plans seen had a photograph on the missing person page. Some weight charts were not completed. Social history information and recent social history information was seen in care plans and this area has improved since the last inspection. Running records were sometimes quite brief; ‘fine today’, ‘wandering a lot’ and these could be more detailed. Evidence of regular reviews was seen within care plans. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 10 Evidence was seen on care plans that the home involves the community health services when appropriate and that health needs of residents were being met. A requirement with regard medication made at the last inspection has now been met and the care and administration of medication promotes safe practice. Those service users spoken to appeared to be having their needs met within the home. Staff were seen to have a good understanding of individual needs and the relationship between staff and service users was good. Staff aim to promote the privacy and dignity of service users. For example, residents and/or relatives have been asked whether or not a person likes to be spoken to using endearing terms, for example “my love” or “my dear”. Staff now use these terms with some residents but not with all. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices about their lives and are encouraged to continue with old and develop new interests. Meals are nutritious and are taken in an environment that is pleasing and comfortable. EVIDENCE: The home has two activity staff who offer activities on a daily basis working for at least forty hours a week. This includes quizzes, dancing, cooking, reminiscence, flower arranging and gardening. Care staff have some time to spend on a one to one with residents and one staff member said that they were often able to walk residents around the local area in the fine weather. On the day of inspection staff were seen interacting with residents in a friendly way with lots of banter between them. Some care plans had identified preferences, hobbies and interests and others had limited information in this area. The manager is planning to further develop this area by asking relatives for more information in this area at the time of admission. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 12 The home has a newsletter that informs residents and their families of what is going on in the home. Visitors are made welcome in the home and this was supported by a visitor comments on the day of inspection. Bedrooms are all of a good size and give opportunity for personal items and some furniture to be brought into the home. The midday meal was observed and this looked appetising and nutritious with residents having a choice of what they had. Music was played and some residents and staff were singing along. The dining area is bright and pleasant, offering a comfortable area for residents to have their meals. The home uses a local butcher and greengrocer and the general quality of food provide appears to be good. All of those residents spoken to were satisfied with the meals provided. Staff were seen entering the kitchen without protective clothing and need to ensure that they follow good practice with regard food and hygiene at all times. A recommendation has been made in this area. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 13 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their families have access to the homes complaints procedure and can be assured any concerns will be taken seriously. The home has a policy to safeguard vulnerable adults and when followed this should promote the safety and well being of residents. EVIDENCE: The home has a complaints procedure and this is made available to service users and their families. The home has received no complaints since the last inspection. The home has a copy of the local safeguarding vulnerable adults policy and is planning to create a policy that relates specifically to Hickling House. Staff have received training in this area and should be clear on the policy and procedures to follow. A referral to adult protection regarding a specific situation was made by the home and this matter is still being investigated. There were some concerns as to whether or not staff had fully followed their own procedures with regard safeguarding adults. A requirement has been made in this area. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 14 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 and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are living in a comfortable environment that is clean and well cared for. The manager has begun to address some of the environmental needs of service users with dementia. EVIDENCE: The home provides comfortable accommodation with bedrooms being of good size with ample communal space and attractive gardens. There has been much research completed with regard environments for people with dementia. The manager has begun to address the issue of signage in the home and is putting signage that is appropriate to individuals on bedroom doors. There is opportunity for further work in this area. All bathroom and toilet doors are the same colour and finish as other doors in the home which gives no prompting for residents to encourage them to become more familiar Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 15 with their environment. Some corridors upstairs have poor lighting and would benefit from brighter lighting. A recommendation has been made in this area. Bedroom doors are left open during the day to ensure residents have access to their own rooms. Those residents that wish to lock their bedroom doors are able to do so. Evidence was seen of this on the day of inspection with a gentleman choosing to lock his door to ensure privacy. This was seen as good practice. The garden is well cared for with a variety of shrubs and flowers with raised beds near the conservatory to make gardening easier for service users. It is enclosed and of a good size with garden furniture for residents to use. The garden offers additional communal space to residents in the warmer weather. There are plans for a summer house in the garden. A bathroom near the laundry was also being used to rinse soiled bedding and this practice must stop. The bath is still used by some residents so must not be used as a sluice. A requirement has been made in this area. Since the last inspection all radiators have been covered and all hot water outlets that residents have access to have been fitted with thermostat controls. The home has the potential to offer a good environment to people with dementia. Experts in the field of dementia are now offering advice and guidance in relation to environments factors and dementia care and the manager needs to ensure that the home keeps up to date with modern practice. A recommendation has been made in this area. All areas of the home were clean and well presented, being free from any offensive odours. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 16 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 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by sufficient numbers of staff who receive training and support to enable them to fulfil their role. Staff would benefit from more training relating specifically to the care of people with dementia. EVIDENCE: On the day of inspection there appeared to be enough staff on duty to meet the needs of the residents. The staff group has a good mix of age, gender and experience offering a diverse group of staff to care for the residents. Comment was made that less staff are on duty at weekends and staff have less time for residents at this time. Additional staff are on shift each day to promote activities and social contact with residents. Domestic staff were spoken to on the day of inspection and felt that there were enough domestic staff employed to keep the home clean and tidy. The home was clean and well cared for on the day of inspection. Three staff have completed their NVQ level 2 or above and five staff are in the process of completing this. The home does not yet have 50 of staff with this qualification but should do so within the next twelve months. A recommendation has been made in this area. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 17 Some staff have had some training with regard caring for residents with dementia but further work needs to be done in this area. The manager is aware of this and plans to provide further training in the coming months. A requirement has been made in this area. Staff files were inspected and included all of the information that needs to be collated to ensure that the procedure promotes the safety and well being of residents. Evidence was seen of staff induction and those staff spoken to said they had a comprehensive induction and felt the training and support offered at the time of employment was good. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are living in a home that is well managed by a manager who is open and inclusive. The manager has begun to audit the quality of the service and there is opportunity for this area to develop further. Safe practice is promoted within the home. EVIDENCE: The manager is in the process of completing her Registered Manager’s Award, hoping to complete this by the end of the year. She has significant experience within residential care and staff spoken to felt that she was supportive and approachable. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 19 As part of the quality assurance for the home questionnaires have been sent to relatives and residents. This information has been collated but has yet to be published. The manager plans to develop this area further and to publish the findings. A recommendation has been made in this area. The manager did not believe regular reports as required under Regulation 26 of the Care Homes Regulations 2001 are being completed for the home. A requirement has been made in this area. Staff receive training with regard moving and handling, fire safety, first aid, food hygiene and the control of infection. Other relevant training is offered. There is no staff training profile and this would give the manager a tool that would inform her who had completed what training and when training needed to be completed and/or updated. The manager has had a significant amount of planned sick leave this year and this has meant that formal supervision has not been taking place. The manager is now in good health and has returned to work and intends to commence regular formal supervision as soon as possible. A requirement has been made in this area. Since the last inspection all radiators have been covered and safety valves have been put on hot water outlets that residents have access to. The property is secure and residents have a safe outside area to use. Evidence of the reporting of incidents and accidents was seen and audited against information in care plans. This was accurate, detailed and in good order. Evidence of risk assessments was seen on the day of inspection. All staff receive induction and foundation training and evidence of the use of the new common induction standards was seen. The home does not take responsibility for any residents’ money and any money spent is provided by the home and then invoiced to those responsible for the residents’ finances. Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 20 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 x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x 2 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 2 x 3 2 x 3 Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 13.6 Requirement The manager must ensure that all staff are aware of their responsibilities and duties regarding the safeguarding of residents and that staff follow the home’s policy and procedures at all times. This will ensure that staff help to protect residents. The manager must ensure that the downstairs bathroom, near the laundry is only used as a bathing facility and not a sluicing facility. This will ensure that good practice with regard the spread of infection. The Registered Person must ensure that staff have the appropriate training to meet the needs of service users. This relates to specific training about caring for service users with dementia. This will ensure that all staff have the knowledge and skills to care for people with dementia. Timescale for action 01/07/07 2. OP21 13.3 01/07/07 3. OP27 18 1 a 01/07/07 Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 22 4. OP33 26 The Registered Provider must ensure that they visit the home and complete a report as stated in regulation 26 and make his report available to Commission. This will ensure that the registered provider is up to date with the quality of the service. All staff should be offered formal supervision on a regular basis. This will ensure that the staff received the support, guidance and training to fulfil their role and their competence is formally monitored. 01/07/07 5 OP36 18.2 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP15 OP25 Good Practice Recommendations The manager should ensure that care staff follow the homes procedures with regard food hygiene when entering the kitchen. It would be good practice to ensure that lighting throughout the home enhances the environment and meets the needs of service users. The manager should continue to develop the environment to ensure it meets the needs of people with dementia. The Registered Provider must ensure that at least 50 of staff have NVQ level 2 or above. The manger needs to continue to develop the quality assurance system for the home. 3 4 5. OP19 OP28 OP33 Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Hickling House DS0000027434.V341375.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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