Inspection on 28/02/06 for Hilbre House

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Hilbre House 02/06/08

Hilbre House 05/12/07

Hilbre House 29/05/07

Hilbre House 12/12/06

Hilbre House 21/06/06

Hilbre House 09/12/05

Hilbre House 18/02/05

Hilbre House 21/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hilbre House St Margarets Road Hoylake Wirral CH47 1HX Lead Inspector Leila Mavropoulou Unannounced Inspection 28th February 2006 11:00 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 Hilbre House DS0000018896.V286393.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. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hilbre House Address St Margarets Road Hoylake Wirral CH47 1HX 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) 0151 632 6781 Mrs Della Haynes-McManus Dr Francis Bernard McManus Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th December 2005 Brief Description of the Service: Hilbre House is a large detached property overlooking the river in the Hoylake area on the Wirral. It provides support and personal care to twenty-seven service users. The accommodation is provided in single bedrooms all with ensuite facility. The home is staffed twenty-four hours and some staff have completed their NVQ level 2 &3 in Care Qualification. The home has a sitting room, large dining room and conservatory on the ground floor. All parts of the home are easily accessible by a passenger lift. The fee level at the home varies depending on the bedroom accommodated. The home has assisted baths to promote the safety and independence of the service users. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted six hours over two days. During the inspection, various records were inspected such as: service users records, fire records and staff files. Also, inspection of the building was carried out and six service users and four staff members were spoken to individually. What the service does well: What has improved since the last inspection? A manager has been appointed and an application is being made to Commission to register the manager. Since the last inspection the service users and staff information have been reviewed and new systems have been implemented to ensure that the relevant information is available and easily accessible. Information on appropriate training for staff is being obtained to enable staff to improve their knowledge and skills. Regular staff meetings are being held to keep staff inform of the changes at Hilbre House and to seek their views on how the service could be improved. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 6 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. Hilbre House DS0000018896.V286393.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 Hilbre House DS0000018896.V286393.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): 1,2,3,4,5 Service users needs are assessed before admission to Hilbre House to ensure that the service is able to meet the assessed needs of service user. EVIDENCE: The service has Statement of Purpose, which gives information to prospective service users regarding the suitability of the service in meeting their needs. The manager should review the Statement of Purpose to ensure that it continues to reflect accurately the information about Hilbre House. Service users records who were admitted to Hilbre House recently showed that a pre-admission assessment was completed and that the service users and/or their representative visited the care the home to assess for themselves the suitability of the home and the opportunity to meet other service users and staff. A record is kept of pre-admission visits and issues discussed. Observation and discussion with staff showed that they had the necessary skills and qualities to meet the needs of service users at Hilbre House. Hilbre House DS0000018896.V286393.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): 7,8,9,10,11 Service users health needs are being met through regular assessment and monitoring of changes in their health by staff. EVIDENCE: The service users plan format at Hilbre House has been revised and the manager has completed some of the service users plans and files fully using the new format. The service user plans and risk are more detailed and easy to understand. The manager must ensure that wherever necessary the service user or their family are involved in the development of the plan. Service users health needs are met by regular visits by the GP, district nurse input, outpatient appointments to various health clinics and six weekly visits by the chiropodist etc. The district nurse provides pressure relief aids after assessment to prevent service users from developing pressure areas. The home maintains a record of service users medication received into the care home, administered and returned to the pharmacist. Some of the service users Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 10 administer some of their own medication such as: creams, laxatives etc. However, this was not identified in the service user plan or any action taken to minimise any identified risks. The registered person must ensure that where service users are self-medicating that a lockable space is provided in their bedroom for the storage of medication as not all bedrooms have a lockable space. Observation throughout the inspection showed that the service users are treated with respect and dignity through the manner in which staff spoke to the service users, by knocking on doors before entering and the way in which service users were assisted with personal care. All the bedrooms at Hilbre House are single rooms even though some are large enough to be a shared room. All of the bedrooms have a toilet en-suite facility. Many of the service users have a direct telephone line in their bedroom to enable them to maintain contact with family and friends in private. The home has a cordless phone to enable service users to make and receive telephone calls in their bedrooms, to promote their privacy. All of the service users were well presented and dressed to reflect their taste and preferences such as the use of make up. The hairdresser visits once a week. Service users spoken to said that they liked to have their hair washed and set by the hairdresser. Hilbre House DS0000018896.V286393.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): 12,13,14,15 The service users make decisions over all aspects of their daily lives with the support of the staff and their family. EVIDENCE: Discussion with service users and observation throughout the inspection show that service users exercise a high degree of choice over their daily lives as service users choose where to have their meals, when they rise and go to bed, where they wish to spend their time either in their bedroom or in the communal areas etc. The revised service users plans are reflecting service users social needs and interests to enable staff to support them to maintain their interests before moving to Hilbre House. Discussion with the manager indicated that she is trying to obtain information of local community activities such as: tea dances, which service users could access to enable them to meet other people. The manager is trying to get an activities person to visit the home regularly to supplement the activities provided by staff and increase the level of stimulation provided to service users. The manager should review the recording of service Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 12 users participation in activities to evidence more clearly the level of participation in activities and types of activities that the service users enjoy. Some of the service users enjoy reading and listening to the “talking books” and a volunteer visit the home regularly to change books and tapes. The service has an unrestricted visiting policy and service user are able to choose where to see their visitors. Many of the service users access various community facilities independently. Discussion with the staff and service users confirmed that they or their family manage their finances. A tour of the building showed that service users are able to bring items of furniture into the home if they wish. The service continues to stress the importance of meals being well presented to promote service users choice, to maintain their independence and appetite. Records are kept of all food provided to service users and fridge and food temperatures are maintained to promote the health and safety of the service users. Currently, none of the service users require assistance at mealtimes. Discussion with the service users and staff confirm that the home would cater for service user that requires a special diet. Currently, two service users have a sugar free diet. At the time of the inspection the kitchen was in the process of being refurbished in stages to ensure that service users dietary needs were met. Details of service users wishes after death is obtained where possible to ensure that the service user and their family wishes are met. Service users would be cared for at Hilbre House as long as the service user needs could be met with the support of other specialist health professionals. Hilbre House DS0000018896.V286393.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): 16,17,18 Service users protection against abuse could be improved through improved staff training and awareness of the home’s procedures. EVIDENCE: The home has a complaints procedure, which is display in a prominent position. The complaints procedure outline to service users or their representatives how to make a complaint and to whom. Staff would assist service users to vote either through using the postal vote or by taking/ arranging for service users to be taken to the polling station. The manager must ensure that details of independent advocacy services are available and accessible to service users and staff. Discussion with the manager indicated that training on Managing Physical Aggression is being sources and that she will be attending a course in May 2006 and information obtained would be shared with staff. The manager must ensure that all senior staff are familiar with the Wirral Adult Protection Procedure to promote service users safety. Hilbre House DS0000018896.V286393.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): 19,20,22, 24,25, Hilbre House provides a homely and comfortable environment for service users to promote their wellbeing. EVIDENCE: The home is well-maintained and regular maintenance and repairs are carried out. The painting of the exterior has not been completed and has been ongoing for sometime. The kitchen was being retiled on the day of the inspection, before installation of new units. It is the policy of the service that wherever possible when a service user leaves Hilbre House that the bedroom is decorated if necessary before another service user occupies the room. The first floor bedrooms are easily accessible by the passenger lift or stairs. There is a call system in every bedroom and en-suite, which service users use to obtain assistance from staff. Various aids are provided at Hilbre House to promote service users safety and independence such as: - grab rails, raised toilet seat etc. The home has a large sitting room, conservatory and dining area on the ground floor, which overlook the river. There is a additional Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 15 seating area by the front door, which is used by service users as they like to see the coming and going of people at the care home. Many bedrooms are furnished to reflect the service users needs, as some service users have brought into Hilbre House some of their furniture to personalise their bedroom. All of the bedrooms are of single occupancy. Inspection of the building showed that not all service user bedrooms had a lockable space. The registered person should ensure that all bedrooms have a lockable space to meet all of the requirements of standard 24 of the National Minimum Standard. The bedrooms in the home have an en-suite toilet facility and toilets are located close to the communal areas. The home has assisted baths to promote the safety and independence of the service users. The home is centrally heated. All of the bedrooms are bright and well ventilated. There is emergency lighting throughout the home, which is tested at regular intervals. At the time of the inspection regular hot water temperature checks were not recorded. The registered person must ensure that the hot water temperature at outlets used by service users is as close as possible to 43 degrees centigrade. Hilbre House DS0000018896.V286393.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): 27,29,30, Hilbre House staff have the necessary skills to meet the day-to-day needs of service users. EVIDENCE: The staffing levels at the time of the inspection meet the needs of service users. However, the manager must be aware that the staffing level of the service must be regularly reviewed to reflect the changing needs of service users. The service was clean and free from malodour throughout, as domestic staff are employed in sufficient numbers to maintain the cleanliness of the building. The staff records were being reviewed at the time of the inspection and staff were requested to provide certificates of training obtained in order that a copy could be kept on their file. Applications for existing staff Criminal Record Bureau checks were applied for and the inspector was shown evidence of this. The registered person must ensure that staff records are maintained in accordance with the requirements of the Care Homes Regulations 2001. That is:- two written references must be obtained, staff are given a job description and a written terms and conditions and Criminal Record Bureau check or a POVA first check are obtained before they commence employment at the care home. The manager must keep a record of all training provided to staff to evidence that they are provided with three paid training days a year. Some of the staff have completed their NVQ level 2 & 3 care qualification. The manager is investigating training for other staff to commence their NVQ level 2. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 17 Staff files seen and discussion with staff showed that they are inducted into their role. However, there is inconsistency in the recording of staff induction as some are recorded and others not. Hilbre House DS0000018896.V286393.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): 31,32,33,34,35,36,37,38 The management of the service is improving which should reflect in improvements in the quality of service provided. EVIDENCE: A manager has been appointed and an application has been made to the Commission to register the manager. There is evidence that the manager is working towards improving the quality of recording of service users information which should result in improve quality and continuity of care to service users. Since her appointment, regular staff meetings are being held to develop the staff team and to exchange information. Minutes are kept of staff meetings. The service has not yet developed its quality assurance system to show continuous improvement in the service and quality of care provided to service users. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 19 A current Public Liability Insurance certificate was displayed and discussion with the registered provider indicated that records are kept of all income and expenditure for accounting purposes and accounts would be made available to the Commission on request. The manager has not started providing individual supervision for staff. However, staff are supervised during their working day to ensure that they are carrying out their roles and responsibilities effectively. The record keeping at Hilbre House has improved and service users records are stored securely. Service users and their family have access to their records in accordance with the service Access to Records policy. The service does promote the health and safety of service users. However, this could be improved by ensuring that all staff training in:- food hygiene, fire awareness, load management and first aid are up to date. The registered person must ensure that the service has a current fire risk assessment and that regular risk assessment of the building is carried out to promote the health and safety of service users such as: regular checks on hot water, ensuring that the service has a current Electrical Wiring Certificate etc. The service maintains a record of all accidents/incidents to service users and a where necessary the Commission is notified. Hilbre House DS0000018896.V286393.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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 2 18 2 2 3 X 3 X 2 2 X STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X X 1 2 2 Hilbre House DS0000018896.V286393.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 OP7 Regulation 15 Requirement The registered person must ensure that service user or their representative is involved in the development of the service user plan. The registered person must review the service medication policy to ensure it promotes the health and safety of service users. The registered person must ensure that where service users are self-medicating that a lockable space is provided in their bedroom for the storage of medication as not all bedrooms have a lockable space. The registered person must ensure that all staff receives training on managing physical and verbal aggression. The registered person must ensure that senior staff are aware of the Wirral Adult Protection Procedures. The registered person must ensure that regular hot water tests are carried out and ensure that hot water at outlets used by DS0000018896.V286393.R01.S.doc Timescale for action 30/04/06 2 OP9 13 30/04/06 3 OP18 13 30/04/06 4 OP25 13 30/04/06 Hilbre House Version 5.1 Page 22 5 OP29 17 6 OP33 24 &26 7 OP37 17 8 OP23 13,18 & 23 service users are as close to 43degrees centigrade. The registered person must ensure that all staff have a Criminal Record Bureau check, job description, two written references and a terms and conditions of employment. The registered person must ensure that a quality assurance system is developed to show the continuous improving in the quality of care provided. The registered provider must forward a copy of their monthly visit report to the Commission. The registered person must ensure that all records are current and in accordance with the Care Homes Regulation 2001. The registered person must ensure that all staff have the necessary skills and knowledge to carry out the roles and responsibilities by ensuring that they have current training in: Food Hygiene, Fire Awareness, First Aid, Load Management etc. The registered person must ensure that the building is free from hazards by carrying out regular risk assessments of the building. The registered person must ensure that the care home has a current fire risk assessment. 30/04/06 30/04/06 30/04/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Hilbre House Refer to Good Practice Recommendations DS0000018896.V286393.R01.S.doc Version 5.1 Page 23 1 2 3 Standard OP1 OP17 OP31 The registered person should review the service Statement of Purpose to ensure that the information is accurate. The registered person must insure that information about local independent advocacy service is available and easily accessible for service users and staff. The manager should start working towards achieving the NVQ level 4 management and care qualification. Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. Extracts may not be used or reproduced without the express permission of CSCI Hilbre House DS0000018896.V286393.R01.S.doc Version 5.1 Page 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!