Inspection on 17/09/08 for High Hilden

This inspection was carried out on 17th September 2008.

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

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

Other inspections for this house

High Hilden 10/10/06

High Hilden 09/11/05

High Hilden 22/07/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: High Hilden Limited High Hilden Close Tonbridge Kent TN10 3DB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Montgomery     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: High Hilden Limited High Hilden Close Tonbridge Kent TN10 3DB 01732353070 01732353078 highhilden@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): High Hilden Limited Name of registered manager (if applicable) Mrs Carol Ann Tincombe Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home High Hilden has been a residential care home for the elderly since 1946. It is registered with the Charities Commission. A board of Trustees consisting of a chairman and eight other members governs the home. The Trustees provide their services on a voluntary and unpaid basis. High Hilden is registered for up to 40 older people, but only offers shared accommodation in specific instances, otherwise all clients are offered single rooms over Care Homes for Older People Page 4 of 25 care home 40 Over 65 40 0 Brief description of the care home the ground and first floors. There are office facilities, a meeting room, an activities room, a hairdressing salon, a staff room, storage facilities and a visitors suite on the second floor. All floors are accessible by two shaft lifts as well as staircases. The house is surrounded by extensive grounds and has car parking for visitors to the front, and ambulance bay and staff car parking to the side. High Hilden is about one mile from Tonbridge town centre and the main line train station and there is a bus stop at the end of the Close. Please contact the home for information about weekly care fees. The fees at High Hilden include chiropody care. Additional charges that are not covered by fees include hairdressing, newspapers, toiletries, clothing and some outings. The last inspection report can be located on the hallway table at the main entrance of the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was conducted by Sarah Montgomery, Regulatory Inspector, who was in High Hilden from 11am until 5pm. Judgements about quality of life and choices were taken from direct observation, and by discussion with the residents, staff, and a visitor. Some records and parts of the building were inspected. The manager had previously completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are appropriately assessed by the service before they move in. They are provided with up to date information to assist them with making a choice about using the service. Evidence: Standard 3 was inspected. Standard 6 does not apply as the home does not provide intermediate care. To assess Standard 3 we looked at pre admission assessments of two residents. Inspection of these assessments demonstrated that the home had taken a thorough approach to pre assessment, and had gathered significant information about the individual. This included assessing support needs and personal preferences in the areas of personal care, diet, weight, sight, hearing, communication, oral health, foot care, mobility, history of falls, continence, medication, mental state, and risks. A medical questionnaire is completed by the General Practioner, and the prospective resident and family members complete a resident application form. This form details Care Homes for Older People Page 9 of 25 Evidence: the persons preferred social activities, their aspirations and important relationships. We looked at the care planning documentation which corresponded to the pre assessment documentation assessed. It was clear that the pre assessments had served as an excellent foundation for informing initial care planning and risk assessment. In addition, we spoke with the home manager and members of the staff team about individuals assessed needs. Their responses indicated that staff were aware of assessed support needs of individual residents. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their health and personal care needs appropriately assessed. Residents benefit from having their support needs clearly set out in an individual plan of care. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at care plans of individual residents, and cross referenced these with information gathered at the pre admission assessment stage. We spoke with staff and the manager about how they support people day to day, and had conversations with residents and a relative about how they feel they are being supported by the home. We looked at the homes medication policies and practices, and observed the working practices at the home. The home operates a system which involves two levels of care planning; one for the day, and one for the night. The plans are very detailed, and provide information about each assessed need including details of required levels of support. All care plans include the personal wishes and preferences of the individual. This ensures everyones Care Homes for Older People Page 11 of 25 Evidence: care is person centred, and not only takes into account support needs, but how the person prefers to be supported. For example, what type of soap to use, how many pillows used, what drink is preferred when taking tablets. Risk assessments were equally comprehensive, and contained a detailed description of the assessed risk, with accompanying support guidelines for staff. In discussion with residents many said they felt looked after very well by staff, with all their needs met. The detail of care planning and risk assessment at this home has meant that residents are well cared for and are kept safe by having risks identified and minimised. Each resident has a detailed health care plan. This plan identifies the health care needs, and provides details about what specialist services the individual is recieving. All healthcare appointments are recorded, along with outcomes of the appointment and follow up action for either the home or health care professional. Medication storage, recording and administration was assessed. The home have clear systems and protocols which ensure residents recieve their medication correctly, and residents are kept safe by appropriate storage and record keeping. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident they will be supported to make positive lifestyle choices, and that they will be offered a range of activities in the home. Evidence: Standards 12, 13, and 15 were assessed. To assess these standards we looked at what activities are offered to residents, how the home supports residents to maintain relationships with family and friends, and assessed how the home ensures residents nutritional needs are met. We spent time talking with residents, staff and the manager, and looked at records which told us about activities, dietary needs, and records which told us how residents are supported to make decisions about their daily lifestyle choices. The manager told us about the daily activities. These are arranged by the homes activity coordinator. Activities range from excercise classes to local outings. The programme of activities is displayed in the large entrance area. Residents choose whether to participate. The home keeps a diary of who has participated in activities. Daily notes were inspected. They mainly record what support the resident has recieved during the day. It would be beneficial if the home recorded choices and decisions made by individual residents during the day. This would enhance the homes quality Care Homes for Older People Page 13 of 25 Evidence: monitoring records. Through discussions with residents and the manager it was evident that residents make choices and decisions daily regarding their daily lives, however these are not presently recorded. Many residents were spoken to during the inspection. Without exception all residents spoken with expressed complete satisfaction with all aspects of the home, speaking highly of staff, the environment, meals, activities and of friendships they had developed since moving in. These are some of the comments made; this is a lovely place, you wouldnt find better, I feel very lucky to be here, the staff talk to you like you are human, they are lovely, nothing is ever too much trouble, my family are always made welcome. We also had an opportunity to speak with a relative. They described the home as brilliant. We had been told by several residents that the food at the home is wonderful. Assessment and care planning documentation evidenced that the home not only carefully detail specialist dietary needs, for example diabetes, lactose free, vegetarian, but also ensure that they know what combinations of food individuals like, and what they do not like. Menus are developed with regard to nutrition and balance, and take into account specialist diets and individual preferences. All residents are regularly weighed, and any changes in appetite are recorded and monitored, with support from health professionals if necessary. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 feel valued and listened to, and are protected from harm by the homes adult protection policies and procedures. Evidence: Standards 16 and 18 were assessed. To assess these standards we looked at the homes complaints policy and protocols, spoke with the manager and with residents about how to make complaints, and inspected policies, protocols and staff training with regard to adult protection. Residents told us they feel valued and listened to. They said the staff and manager were always available for a chat, and they were extremely happy with the home and had no complaints. Residents told us they are aware of the complaint forms (with envelopes) in the reception area, and also aware that a member of the board of trustees comes to the home monthly for a complaints surgery. They said that it is nice to go in and talk to the person. Records viewed told us that no complaints had been received. All residents and their representatives are given a copy of the service user guide prior to admission. During the pre assessment process all aspects covered in the statement of purpose and service user guide are explained to prospective residents and their representatives. The manager has an open door policy and welcomes all comments, concerns and suggestions from residents and visitors. Discussion with the manager regarding protecting residents from harm and abuse Care Homes for Older People Page 15 of 25 Evidence: evidenced she has extensive and up to date knowledge on adult protection protocols. The home has relevant policies and procedures which all staff and management follow. Staff receive regular accredited adult protection training. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a homely, safe and well maintained environment. Evidence: Standards 19 and 26 were assessed. To assess these standards we looked at all communal areas of the home, inspected some bedrooms, and spoke with a group of residents regarding their views on the decor, furnishings and cleanliness of the home. We looked at policies and procedures which told us how the cleaning and maintainence is undertaken, and looked at staffing numbers and responsibilities in the domestic team. High Hilden is a large country estate property. It has many original features, most notably the wood panelled entrance hall and staircase, and large picture windows overlooking the extensive grounds. Residents spoken with told us they loved their home, and said it was warm, comfortable and homely. A tour of communal areas and some bedrooms evidenced the home is furnished, decorated and maintained to a very high standard. Bedrooms were comfortable and personalised, and contained equipment necessary to meet individual needs. We looked at maintainence records and records for specialist equipment in the home. These records evidenced that all appliances and equipment are regularly and appropriately maintained, and that the manager has ensured a rolling maintainence programme for the home and gardens. Eleven domestic staff are employed. The tour of the home evidenced a clean, safe and Care Homes for Older People Page 17 of 25 Evidence: hygenic environment, with no offensive odours present. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from being supported by a staff team who are competent and well trained. Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at staffing numbers, qualifications, and training. We also inspected recruitment records and procedures. Throughout the inspection we observed staff interacting with residents and spoke with residents about their experiences with staff, and with staff about their roles, responsibilities and training. We also looked at information contained in the homes annual quality assurance assessment (aqaa) which had been completed by the home manager. The annual quality assurance assessment told us that all care staff have a minimum qualification of national vocational qualification Level 2. The staff training matrix supported this, and also evidenced that staff recieve regular accredited training in adult protection, first aid, infection control, diabetic care and epilepsy. Newly recruited staff benefit from a formal six week induction programme. Residents are supported by a large team of care staff. Day shifts comprise of 4 care workers and two seniors. They are supported by the manager and by domestic and catering staff. We spoke with four members of staff. They all told us they enjoyed working at the home, that morale was great, and the manager fantastic. They feel Care Homes for Older People Page 19 of 25 Evidence: valued and enjoy being with the residents. Throughout the inspection we observed staff working with residents. All interactions observed were positive, with staff being respectful, approachable and professional. Residents told us that staff are lovely, and that nothing is ever too much. Staff recruitment records were inspected. The home operates a thorough recruitment process, which ensures the protection of residents by obtaining information about prospective staff in the form of references and criminal record bereau checks. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well run home. Evidence: Standards 31, 33 and 38 were assessed. To assess these standards we looked at the homes quality assurance systems, policies and procedures concerning the health, safety and welfare of residents, and assessed the managers experience and qualifications. Quality assurance systems at the home are good. Residents are regularly given questionnaires to fill in. We read a selection of these, and it was evident that questions were designed to gather views on all aspects of care and support at the home. It is recommended that these questionnaires are dated. Records pertaining to ensuring the health, safety and welfare of residents were inspected. The records evidenced that the home operates within Regulation, and adhere to safe working practices. The home manager is a registered nurse and is a qualified registered manager. She has several years experience of managing residential services for older people. The staff and residents continue to speak highly of the manager, and Care Homes for Older People Page 21 of 25 Evidence: it is evident that her management style creates an environment in which staff and residents feel valued, and are able to approach the manager with any suggestions and concerns they may have. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 It is recommended that staff record on daily notes the decisions and choices made by individual residents. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!