Inspection on 24/02/06 for Hickling House

This inspection was carried out on 24th February 2006.

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 22/05/07

Hickling House 26/09/06

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 24 th Unannounced Inspection February 2006 09:45 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.V277584.R01.S.doc Version 5.1 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.V277584.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hickling House Address Town Street Hickling Norwich Norfolk NR12 0AY 01692 598372 01692 598372 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) Mr Rhoderick Smart Mrs Frances Smart Angela Marlow Care Home 29 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (28) of places Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 25th October 2005 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. 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.V277584.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 22nd of February over a period of 7 hours. The inspector was able to speak with several service users, staff, the manager, relatives and a health professional. The inspector was also able to have a tour of the building and inspect files, care plans and other documents. Comment cards for service users and relatives were sent to the home prior to the inspection and 5 comment cards were returned from relatives. All said that they were satisfied with the overall care provided. Those relatives spoken to on the day of inspection spoke positively about the care provided and service users spoken to were either able to express positive comments about the home or were observed to be relaxed and comfortable within the home. The environment is generally good but some small changes could be made to adapt it to the specific needs of service users with dementia. Overall the quality of care in the home appeared good and service users were well cared for. What the service does well: Several care plans were seen and the new format used provides all of the information required. One care plan was read in detail and the care needs identified within the care plan were seen to take place. An example of this was that within a care plan a service user was described as having a small appetite and preferred her meal to be presented on a small plate. The inspector sat with service users at lunchtime and this service user had her meal on a small plate and ate all that was given to her. A health professional was spoken to and she confirmed that the home worked well with service users health needs and in regard to pressure care their practice was very good. It was felt that the home communicated well with the local health professionals. The relationship between service users and carers was seen to be good. Relatives spoken to were all very positive about the care their loved ones received and said they were always made welcome within the home. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were looked at on this occasion. EVIDENCE: Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 All service users have an individual plan of care that identifies their health, care and social needs with their own individual preferences. Those service users spoken to appeared to be having their health needs met. Nobody in the home is responsible for their own medication and the home has a policy and procedure for the safe storage, recording and administration of medication. The policy needs to be updated. EVIDENCE: The home has started to use a new format for care plans and this is thorough and comprehensive. This includes a general profile and missing person form at the front of the care plan. The care plan includes information about the personal, social and health needs of service users. The care plans also contain daily running records of service users. From the care plans inspected four service users had pressure areas. The home had good documentation relating to this within the care plans. There was opportunity to speak to one of the district nurses who visits the building Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 10 and she confirmed that the home worked well with the health service and had good practice with regard caring of service users with vulnerable skin. Nutritional screening was seen within care plans and the information in this area could be more detailed as this is especially important for service users who have dementia and cannot always be aware of their own well being. Personal risk assessments were seen in care plans. Overall care plans were good and had improved significantly since the last inspection. The home has a policy and procedures for the administration and care of medicines. The policy is outdated and needs to be revised. A requirement has been made in this area. . No service users are able to administer their own medication. All staff who are involved with the administration of medication have had the appropriate training. Good practice was observed on the day of inspection. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 The routines of daily living offer some choice and flexibility to service users. There is opportunity for further developed. Families and friends are welcomed into the home. The home is in a rural area and therefore contact with the local community is limited. Staff aim to enable service users to be as independent as possible and take as much control over their lives as they can. EVIDENCE: The home appoints a member of staff who works specifically with service users to encourage activities. This person has not been at work for some time and the service users are not receiving the same input in this area as previously. There may be opportunity to appoint or train another member of staff in this area to ensure there is always someone available to fulfil this role. A recommendation has been made in this area. Family members were spoken to on the day of inspection and said they were satisfied with the care provided within the home and that they were always made welcome by staff and management. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 12 None of the service users are able to manage their own finances. If a service user needs to purchase anything or to pay for the hairdresser or chiropodist the home pays for this and then bills the person who has responsibility for the service users finances. This could be a family member or a financial advocate. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The homes has a complaints procedure and details of this are made available to service users and/or their families. EVIDENCE: The home has a policy and procedure for complaints and this is made available to service users and there families and is in the Service User Guide. There have been no complaints since the last inspection. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 The service users live in comfortable accommodation that is safe and well maintained. The service users have sufficient bathing and lavatory facilities that are appropriate and accessible. The home is clean pleasant and hygienic. EVIDENCE: The environment is clean, well maintained and furnished offering comfortable surroundings. All service users have dementia and there is opportunity to make the environment meet the specific needs of people with dementia. For example toilet facilities could be made to be more easily identifiable. Bedroom doors could be made to have some particular relevance to the occupant. Menu and information boards could be used in the dining area. The Alzheimer’s Society and other organisations have written guidance in this area. A Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 15 recommendation has been made for the manager to try to make the environment more user friendly for the service users within the home. Since the last inspection there has been improvement in the bathroom and shower areas and now all of these facilities are available to service users. The home has risk assessed radiators and is covering them all starting with those that are of most risk to service users. The majority of radiators have now been covered. It is planned to have all radiators covered in the near future. All communal areas of the home were clean tidy and free from any odours. One bedroom was noted to have an odour and the manager needs to find a way of addressing this issue. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The home continues to aim to have at least 50 of care staff with NVQ level 2 although this had not been achieved at the time of the inspection. The homes recruitment and selection process aims to ensure that all of those staff who work in the home are fit to do so. Staff have mandatory training but have had little or no training with regard the care of people with dementia. EVIDENCE: The home did have 50 of staff with NVQ level two but due to several of the staff leaving the home they not longer meet this standard. The manager has 4 staff with NVQ, some staff completing the course and others awaiting commencement. Staff files were seen and these included all of the information required prior to admission. This included the initial application form and outcomes for CRB checks and details of references. Staff have induction and foundation training but there was little evidence of any specific training relating to the care of service users with dementia. Since the last inspection some books had been purchased and the manager said that she was planning to buy different publications on a regular basis. Some training had been cancelled and some had been planned for a future date. The manager was advised to look at what further training was available as this Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 17 training is essential where a dementia care service is provided. A requirement has been made in this area. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The home is managed by a person who is fit to be in charge and is able to carry out her duties in full. The home needs to improve and develop ways of ensuring the home is run in the best interests of service users. The manager holds no service users’ money or has any other involvement with their finances. The manager works in a way that aims to promote the health and safety of service users and staff. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 19 EVIDENCE: The manager has been managing the home for the past 18 months and is at present completing her Registered Managers Award. The proprietor needs to comply with regulation 26 of the Care Home Regulations 2001. A requirement has been made in this area. The manager has started to collate information from service users and/or relatives. This information now needs to be collated and published with plans for ongoing improvement of the service. The home takes no responsibility for service user finances. Staff have training in moving and handling, fire safety, first aid and food hygiene. The manager needs to ensure that this training is kept up to date for all staff. Some service users choose to have their door open of a night. The manager needs to consult with the fire service to see how residents can choose to do this in a safe way. A requirement has been made in this area. Provision is made for chemicals to be stored safely but the domestic trolley had been left in the bathroom on the day of inspection. A recommendation has been made in this area. All services and appliances are serviced on a regular basis. Water outlets are of the recommended temperature and all radiators have been risk assessed. The inspector does not feel competent to inspect against 38.4, however the manager believes that she is compliant with this registration. All accidents and incidents are recorded. Risk assessments were seen on service user files. Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x 3 x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 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 OP9 Regulation 13 2 Requirement The Registered Provider must ensure that the home has an up to date Policy and Procedure. The policy in the Policy and Procedure folder was out of date with incorrect information for staff. The Registered Provider must ensure that staff receive dementia care training to enable them to have the knowledge, competence and skills to fulfil their role. The Registered Provider must ensure that they visit the home and complete a report as stated in regulation 26 and forward the report to Commission as stated in the regulation. This is a repeated requirement. The previous timescale was 01/12/05 The Registered Provider must ensure that if service users choose to have their bedroom doors open during the night the manager consults with the fire authority to ensure that this is DS0000027434.V277584.R01.S.doc Timescale for action 01/04/06 2 OP30 18 01/06/06 3 OP33 26 01/04/06 4 OP38 23 4 01/04/06 Hickling House Version 5.1 Page 22 done in the safest way. 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 OP12 Good Practice Recommendations It would be good practice to re assess the situation with regard the provision of activities with the view of using other staff to fulfil the role of the activities person who has not been at work for some time. It would be good practice to make the environment as user friendly as possible for the service users. This relates specifically to the environmental needs of service users with dementia care needs. It would be good practice to have at least 50 of NVQ level 2 trained. The manager needs to ensure that staff always return chemicals to the appropriate place when they have finished using them. This relates to the domestic trolley that was stored in a bathroom on the day of inspection. 2. OP19 3. 4. OP27 OP38 Hickling House DS0000027434.V277584.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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. 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