Inspection on 02/07/09 for Hilcote Hall

This inspection was carried out on 2nd July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilcote Hall 16/07/08

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hilcote Hall Stone Road Eccleshall Stafford Staffordshire ST21 6JX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 0 2 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 36 Information about the care home Name of care home: Address: Hilcote Hall Stone Road Eccleshall Stafford Staffordshire ST21 6JX 01785851296 01785851853 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Select Health Care Limited Name of registered manager (if applicable) Ms Karen Badger Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be registered is 44 The registered person may provide the followng category of service only: Care Home Only (Code PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older People (OP) 44 Dementia (DE) 18 Physical Disabiltiy (PD) 2 Date of last inspection Brief description of the care home Hilcote Hall is a care home registered to provide residential care for 44 older people; there were 37 people in residence on the day of inspection. The needs of the people who may wish to live at Hilcote Hall range from old age to dementia or a physical Care Homes for Older People Page 4 of 36 18 0 2 Over 65 0 44 0 Brief description of the care home disability. The registered Provider is Select Healthcare Ltd. who has overall responsibility for the home; the registered manager is Karen Badger. Fees payable range from GBP373 to GBP430 correct at the time of inspection, those who wish to confirm up to date information about the fees for this service will need to enquire directly to the Homes Care Manager to obtain this information. The Home provides accommodation on three floors in a mixture of single and shared rooms. Communal areas are sited on the ground floor; there is one dining room and a number of lounge areas. Suitable facilities are available for people who use the service to sit outside and enjoy the surrounding countryside. The home lies just over a mile from the local shops and services of the town of Eccleshall. A reduced bus service passes the home, and the nearest railway station is Norton Bridge, about one and a half miles away. Care Homes for Older People Page 5 of 36 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: one star adequate 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: We conducted this unannounced inspection with the Care Manager and senior care staff on duty, with the Area Manager Select Healthcare, whose input contributed to this report. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 39 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with dementia and personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their Care Homes for Older People Page 6 of 36 input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and five survey forms returned from people living in Hilcote Hall and their relatives. We inspected a sample review of administrative procedures, practices and records, confirming consistent practice and effective management. There followed a report feedback with the Care Manager and Area Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? The influence of the new Care Manager has had a highly significant effect on a broad front of care and service. We found an improvement in the assessment process, with relatives, and those people who may be coming to the home, being more actively involved in the planning of care. We examined and confirmed that care files have been re-organised to provide a more focused person centred process of care. Relationships with visiting professionals, local Doctors and District Nurses are much improved. We recognise the principle that activities are a key element in the socialisation approach to care. The Home has recently engaged an activity co-ordinator for 30 hours a week, and was apparent that there is a recognition to enhance the socialisation role to activities, with an aim of providing a programme including art & crafts, light exercise, sing a longs, games, outings and shopping trips. There was some evidence that for people with dementia there is a move towards working with colours, texture and musical instruments, to covering the most popular sensory needs. However much remains to be accomplished to effectively promote the full potential. Various comments through surveying from people in the home: More activity participation, I would like to see residents taken outside for a breath of fresh air. Care Homes for Older People Page 8 of 36 Many people would like to sit outside in sunny weather, the home has a nice garden and outlook. We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home, with the appointment of a full time maintenance man. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through sound management. Information gathered from the AQAA, and discussed during our inspection, found this to be true. We also found that those requirements and recommendations made at the last inspection have been satisfactorily addressed by the Manager and Provider. What they could do better: We recognized that much has been achieved over the past year, although there remains an essential foundation of a service steeped in institutional ways and practices, especially in accommodating the needs of people with dementia. Consideration is to be given on addressing these issue, some of which are identified below. To review the policy of issuing institutional notices and signs throughout the building, which over-structures living style and homeliness. We observed the standard use of blue disposable plastic aprons being given to most people having a meal, and would ask for a review to enhance the ethos of dignity in receiving care. That the Registered Manager reviews the inconsistent night report system, to establish an agreed report for all people, every night, and that people on high dependency care have a two hourly monitoring chart to identify fluids and nutrition intake, oral and personal care given, and attention to pressure areas, to evidence a good standard of care. It is our recommendation that continuing development of creative ways of providing activities, including adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Hilcote Hall. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. It is evident that the demands placed on Hilcote Hall, through increased dependency of people with dementia care needs, that staffing levels will need to be improved to cope with the demands. We advised that an extra member of staff will be needed for each shift That the service ensure that the Home meets the minimum expected standard of staff trained to the National Vocational Qualification (NVQ) at level II or III by April 2010. We also recommend that immediate address is given to staff training in dementia awareness, to meet the needs of people living in the Home. Care Homes for Older People Page 9 of 36 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 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 10 of 36 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 11 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose and found that it provided an informative description of Hilcote Halls aims, objectives, and the way it operated, and was available for general distribution. We acknowledged that the informative Service User Guide is presented to all enquirers, and is produced in large print as and when necessary. We also advised that the Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people Care Homes for Older People Page 12 of 36 Evidence: who may use the service, and their relatives, the opportunity to make an informed choice about where to live. We looked at the case file of a person who recently moved into the home to see if information had been sought regarding this persons needs prior to moving in. Information had been obtained from the previous health care setting, and that the Care Manager had visited this person prior to offering accommodation at the home. We looked at other case files and they included pre admission assessments by the Home in addition to social worker reviews, community care services and other social care settings. The AQAA offered information on the admission process; this was confirmed by the manager explaining the robust pre admission procedures that are in place. This gathering of information ensures that the service can be confident of meeting a persons care needs. Two of the Surveys completed by relatives told us that they both had to make the decision for their relative to move into the home, they stated that they were satisfied with the accommodation and care provided. When we had a look round the manager explained everything we asked of her, and found the home better suited to mums needs than we had expected. We found through our discussions with relatives and people using the service, that their involvement was taken into account, and that they felt included. We saw that each record showed the attention to details of individuality to allow the formulation of a care support plan, based on assessed, individual needs. Relatives we talked to informed us: It provides an appropriate level of care in an entirely clean and safe environment Its good to see inspections take place, but I am satisfied completely with this home. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. We are satisfied that people are informed of those facilities, but have indicated that this process would be greatly enhanced with a more detailed personal and social assessment report, with a closer collaboration with the family. A plan of care based on personal needs and daily living processes is then produced from the assessment information obtained. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and Care Homes for Older People Page 13 of 36 Evidence: management. No intermediate care took place in the home. Care Homes for Older People Page 14 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are addressed through the care planning process, generally meeting principles of respect, dignity and privacy. Medicine administration systems and practice are safe. Evidence: We found that care records, through case tracking, showed that this standard is well met, maintaining a satisfactory quality process of assessment. The pre admission assessment represented the foundation for an organised care planning process, in association with Social Services reports if available. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Through case tracking, our discussions and Care Homes for Older People Page 15 of 36 Evidence: inspection of records, it was recognised that the home arranges for health professionals should special health care needs be identified. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their life style, and the care they were receiving at Hilcote Hall. Comments we received during the course of inspection from people using the service: I feel very safe and well looked after here, all the staff are really kind and caring. If I need anything we are helped. They understand me and my little ways. When I need a doctor or the nurse they get them here very quickly, and I find them all very helpful, and work well together. We noted that people on high dependency care were receiving a good standard of care, although the documentary evidence did not support the observed good standard. We advised that all people on high dependency care have a two hourly monitoring chart to identify fluids and nutrition intake, oral and personal care given and attention to pressure areas. We noted a significant usage of institutional notices throughout the Home, that needs a serious address to make the Home more like a personal living space than an institution. However there was a clear appreciation of the openness and opportunity to contribute. Carers were seen to generally interact with people who use the service with understanding and friendly compassion, people were seen to be supervised in the lounge areas, although several people we spoke with said there were times when there was no supervision. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. The medication we saw was stored safely in locked cupboards and also within a locked medicine trolley. We saw medication stored neatly and tidily, which ensured that peoples medication could be easily located. The majority of the current Medicines Administration Record (MAR) seen were documented with staff signatures to record that medication had been administered to a person, or a code was recorded to explain why medication had not been administered; it was acknowledged that the current charts available were being accurately documented. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Some medication was checked to ensure it had been administered correctly. Self medication and risk assessment policies were seen to be satisfactory with no one in at the time who wished to participate in the scheme. We confirmed that only senior care staff administer medication, all have received training in the Safe Handling of Medications. Care Homes for Older People Page 16 of 36 Evidence: We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. All three people being cases tracked were found to have appropriate medication. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. In our discussions with people who use the service and staff it was recognised that diverse needs were accommodated within the planning of care, with dietary, religious and personal matters identified, along with the diverse physical needs. Generally the arrangements for care planning are satisfactory with fair assessment, wide based risk analysis and care plans regularly reviewed, and good daily reports, although there was an inconsistent night report system. It was agreed that there be a report for all people, every night. Cross referencing accidents and events with care plans showed a connection of appraisal, with regeneration of plans or risks assessments were noted. There were risk assessments in place and seen to be followed up in practice. Care Homes for Older People Page 17 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are central to the homes aims and objectives. People are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be generally flexible and increasingly non institutionalised, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We recommend that a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. We recognise the principle that activities are a key element in the socialisation Care Homes for Older People Page 18 of 36 Evidence: approach to care, with visitors encouraged to be involved in a partnership style with care staff. The Home has recently engaged an activity coordinator for 30 hours a week, and on talking with the Care Manager it was apparent that there is a recognition to enhance the socialization role to activities, with an aim of providing a programme including art & crafts, light exercise, sing a longs, games, outings and shopping trips. There was some evidence that for people with dementia there is a move towards working with colours, texture and musical instruments, to covering the most popular sensory needs. However much remains to be accomplished to effectively promote the full potential. During the course of the inspection we saw staff interact with people in a positive and polite manner at times, although we also observed in the lounge areas limited distraction or entertainment for people using the service. A comment received from a relatives survey indicated; The day room is frequently occupied with people suffering from dementia, and there is no one supervising the room, and frequently left unattended for 30 - 40 minutes when residents are left alone. However, on the day we could find no evidence of this when talking to people using the service, staff, or through our observations. We acknowledge resources are available to provide ad hoc entertainers. We feel that there is insufficient attention drawn to offer a therapeutic service for people with dementia, and for people who have greater dependency needs. It is our recommendation that continuing development of creative ways of providing activities, including adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Hilcote Hall. We also recognised that people would like the opportunity to enjoy outside activities in a potentially attractive garden and patio area, a move already begun through the resiting of the dining area adjacent to the closed patio/garden area. Comments we received from people who use the service, during the inspection: More activity participation, I would like to see residents taken outside for a breath of fresh air. Many people would like to sit outside in sunny weather, the home has a nice garden and outlook. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed an influence of personalisation in the inclusion of belongings, some furniture and general decor, although attention was drawn to addressing the personal needs of people with Care Homes for Older People Page 19 of 36 Evidence: dementia, in the furnishing of bedrooms. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. Communion is arranged on a monthly basis, and with ministers visiting on individual invite. No other religious or spiritual needs were presented at this time. We found that the standards of catering offered a good quality service, to which those people we spoke with were very complimentary of all aspects of quality. We observed a very pleasant lunch served during inspection, with choices available, and that a menu was inspected and seen to offer a wide choice of meals throughout the day, served in a comfortable and clean dining room. We observed the standard use of blue disposable plastic aprons being given to most people having a meal, and would ask for a review to enhance the ethos of dignity in receiving care. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: My sister was in a Southampton Home, in every way this is better. Very clean, residents comfortably seated. But quality of meals fluctuate depending on shortage of staff. Very good standard of cooking and choice available. Its always set out so nice. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people living in the home. We were informed that the cook knew each person using the service, and some of the relatives, and in meeting individual needs. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. Care Homes for Older People Page 20 of 36 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. 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. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We examined the complaints policy and found it appropriate and up to date. There were a few minor concerns, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. All people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been no formal complaints received by us, although eight concerns or complaints had been handled and dealt with by the Care Manager. We examined the responses and found them to have dealt with the issues in a responsible manner, upholding three as Care Homes for Older People Page 21 of 36 Evidence: justified, and actioned upon. There have been no safeguarding issues raised concerning people who are living in the home. Comments we received from people on the day of inspection: Have complained to home previously, not happy altogether with care offered, but would upset mother to move her The response from the Care Manager was examined and found to be appropriate in answering the concerns. If I have a problem, I speak to L (carer) who sorts it out. There is usually some one to speak to. Create better conditions, keep better records, admit when things go wrong . The matron came to see me when I mentioned about the illnesses going about, she explained it nicely. Our discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure We found staff received training on abuse at induction, this includes the right to Whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 22 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, satisfactorily maintained, clean and comfortable environment for the people who live there. Evidence: Hilcote Hall is a large Georgian House overlooking picturesque Staffordshire countryside, approximately half a mile from Eccleshall market town. The Home is registered to provide residential care for 44 older people; the needs of the people who may wish to live at Hilcote Hall range from old age to dementia or a physical disability. Hilcote Hall is situated in its own, extensive grounds, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views all round, although with a good car park. The attractive garden and patio areas are well maintained and secure, and we were informed, increasingly used during the summer months. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. We were informed that the front entrance is to be repositioned to the side of the building, to minimise disruption to the lounge areas adjacent to the front entrance. Care Homes for Older People Page 23 of 36 Evidence: An enclosed patio area was a popular facility on a beautiful day, and the garden area holds potential for people to enjoy the summer. Appropriate risk assessments have been made to ensure full awareness to safety standards. We found that internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. On admission the Care Manager or her deputy assesses each individual peoples needs for equipment and necessary adaptations. We noted the siting of the carers station does not allow for confidential discussion and that the care files were unsecured, openly available in an unmanned area. We have indicated the need to develop the decor of corridors to reflect a growing need to assist people with dementia in pathway location signs, including corridors with themes and easily recognisable colour coordination, linked in with familiar and individualised bedroom doors. Efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of a satisfactory standard. The home provides four lounge areas that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. Bedrooms were generally well maintained to meet peoples personal preferences. On inspection, most bedrooms were personalised, with some displaying personal furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. We noted that there were no curtain tracks to facilitate privacy in double bedrooms, having considered the wheeled curtains an unacceptable risk to accidental injury to staff, and people living in the home. We acknowledge the identification of fire doors and easily recognizable coding for efficient evacuation should a fire occur. However we noted a significant usage of institutional notices throughout the Home, that needs a serious address to make the Home more like a personal living space than an institution. We recognize the welcome engagement of a full time maintenance man, who was seen to be establishing a solid foundation of repair and renewal throughout the Home. We have considered that there is a need to enhance personal space for people with dementia, in identifying bedroom doors, fitting items of easy recognition and usage, and installing a personal ownership to their rooms. An effective call system was tested, and a locked facility and lockable bedroom doors are available in each bedroom on request. The locking mechanism to bedroom doors needs to facilitate Care Homes for Older People Page 24 of 36 Evidence: effective dementia care needs, or allow privacy with easy escape option. However those people we spoke with expressed a sense of belonging and satisfaction in the quality and presentation of their living areas with no one expressing any dissatisfaction. Toilets were located on both floors and were in close proximity to bedrooms and communal areas. We found the central heating and ventilation to be satisfactory, and lighting was domestic in style. Water temperatures are not appropriate, with evidence of uncontrolled high temperature at 54 C. This matter was addressed immediately by the maintenance man would identified a thermostat breakage, which rectified that particular difficulty, and focused attention to the wider issue of maintaining suitable temperatures throughout, at all times. A comment received from a relatives survey said: Keeps the heating on even in hot weather, the home is like a greenhouse at times. The laundry was equipped to a good standard, that red alginate laundry bags were available for handling soiled linen, with appropriate notices regarding chemical handling openly displayed. Peoples belongings were seen to be handled piecemeal, in an organised process, with some evidence of communal usage of certain items of clothing, a practice to cease immediately. Disposable gloves and aprons were seen in use, and liquid soap and paper towels were evident throughout. The home presented a clean and pleasant, mainly odour free atmosphere, much to the credit of staff. Care Homes for Older People Page 25 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further staff training, monitoring and supervision are required to ensure staff have the appropriate skills and knowledge to meet peoples needs. Recruitment processes are inconsistent and need review to ensure protection of the people who use the service from harm and abuse. Evidence: We confirmed that there were 39 people using the service on the day of inspection, with 18 people receiving care for dementia. We examined three weeks of duty rotas, and found that on the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 4 carers (Plus care manager). Evening shift 1 Senior Carer and 3 carers Night duty 1 Senior Carer and 2 carer. We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and Care Homes for Older People Page 26 of 36 Evidence: absence, and we noted that the use of agencies are at minimum. It was considered that the staffing levels are at a basic, barely adequate level for the number of people being cared for at this time. It is evident that the demands placed on Hilcote Hall, through increased dependency of people with dementia care needs, that staffing levels will need to be improved to cope with the demands. We advised that an extra member of care staff will be needed for each shift, to ensure an adequate number of staff are available to secure care quality and supervision. Comments we received from relatives surveyed: More staff, getting up in the morning before 11:45, and more stimulation for residents. Employ more carers, have the residents out of bed for breakfast, sitting at a table. The Providers and Care Manager have established sound procedures for interview, selection and appointment of staff, with a consistency for all employees. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. All new staff goes through a detailed induction process, that will ensure that they are going to be the right person for the home. All staff have the General Social Care Council code of conduct. Discussions with the Registered Care Manager confirmed that only three care staff had receipt of the National Vocational Qualification (NVQ) at level II or III, and that a concentrated effort is under way to ensure the Home meets the minimum expected standard of 50 by April 2010. We recognize this deficiency as an example of previous management policies, and staff turnover over the past 12 months. There was evidence that a thorough training schedule has been established, and that an effective training programme is undertaken to ensure that all staff have up to date portfolios of achievement and qualification to maintain quality of standards. We recognized that few staff had received dementia awareness training, which is being addressed at the time of inspection. All staff advised us that they received a good induction programme on starting work at Hilcote Hall. Discussion with staff demonstrated an improved process of supervised practice, meeting required six sessions a year, although the process should be delegated and cascaded through the staffing structure. Managers and relatives/residents meetings are held on a monthly basis, and staff meetings have an organized structure, held monthly and seen to be meaningful. Staff were seen to be committed to the task although we advised the Care Manager to review the standards of dress and presentation. All the staff spoken with indicated an much improved approachability, Care Homes for Older People Page 27 of 36 Evidence: better organized, and higher staff morale. Care Homes for Older People Page 28 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: The Registered Care Manager Karen Badger has previously been registered under current regulatory legislation, registered with CSCI as a dementia residential care home manager. During the past seven months Mrs Badger has demonstrated an experienced capability in managing a care home that provided specialist support for people with dementia, with sound managerial experience. We acknowledge that she has been actively engaged in quality reviews and audits with the Registered Providers. Care Homes for Older People Page 29 of 36 Evidence: She has achieved her Registered Managers Award, NVQ level IV, and numerous qualifications completed over the past 12 years of working in the care sector. We have identified in this report a number of issues to which the Care Manager has acknowledged and demonstrated a positive response and reinforced her commitment in promoting best practice to improve the service delivery. We also discussed the management and direction issues with the Area Manager and established the foundation for moving the Home forward. An examination of administrative, monitoring, planning and care records showed to us a diligent attitude to effective record keeping. We found them to be well maintained in ensuring that the peoples rights and best interests are safeguarded. The Manager offered evidence of procedures and safe working practices in which the policy and procedure manual was reviewed in January 2009, but would be of greater help to staff to be updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties and Safeguarding regulations. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. Accidents occurring to those people we case tracked were seen to be cross checked with care plans, and logged into day report. We would advise that the accident log, following analysis be placed in the persons care file. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning, review and monitoring, and of the general environment, including a full unit inventory of risk. Health and safety notices can be seen throughout the Home, although chemicals safety notices should be prominent in appropriate areas of use and storage. We found that formal staff supervision has been established as firm practice, although it was agreed that a delegated, cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. We found an improved overall standard across a broad spectrum of service and care, with the appointment of the present Care Manager. There have been substantial advances in staff moral and training, although address to a poor staffing level is required. Care standards have improved with the review of care systems and staff training, although much remains to be achieved with a service steeped in institutional ways and practices, especially in accommodating the needs of people with dementia. We have recognised the willingness on the part of the Providers in their support and Care Homes for Older People Page 30 of 36 Evidence: direction given, demonstrating their commitment to securing a good standard of service and care at Hilcote Hall. Care Homes for Older People Page 31 of 36 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 32 of 36 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 1 27 18 It is evident that the 31/08/2009 demands placed on Hilcote Hall, through increased dependency of people with dementia care needs, that staffing levels will need to be improved to cope with the demands. We advised that an extra member of staff will be needed for each shift To ensure an adequate number of staff are available to secure care quality and supervision. 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 1 That the Service User Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. That the Registered Manager reviews the inconsistent night 2 7 Care Homes for Older People Page 33 of 36 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 report system, to establish an agreed report for all people, every night. 3 8 That people on high dependency care have a two hourly monitoring chart to identify fluids and nutrition intake, oral and personal care given, and attention to pressure areas, to evidence a good standard of care. We noted a significant usage of institutional notices throughout the Home, that needs a serious address to make the Home more like a personal living space than an institution. It is our recommendation that continuing development of creative ways of providing activities, including adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Hilcote Hall. We recommend that a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. We observed the standard use of blue disposable plastic aprons being given to most people having a meal, and would ask for a review to enhance the ethos of dignity in receiving care. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. To review the policy of issuing institutional notices and signs, which over-structures living style and homeliness. That the carers station be secured to ensure that care files are kept safe to maintain a good standard of confidentiality. That portable bedroom curtains be discontinued and replaced with tracked curtains, to ensure the health and safety of people living in the home, and staff working in those bedrooms. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. That the use of communal clothing cease forthwith, to ensure the safety and dignity of people living in the home. 4 10 5 12 6 12 7 12 8 9 10 11 16 19 19 24 12 24 13 26 Care Homes for Older People Page 34 of 36 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 14 26 That a thorough review of the heating system be undertaken to ensure that temperatures of hot water supplied do not exceed 42 degrees Centigarde, to ensure the health and safety of people living in the home. That the service ensure that the Home meets the minimum expected standard of staff trained to the National Vocational Qualification (NVQ) at level II or III by April 2010. That immediate address is given to staff training in dementia awareness, to meet the needs of people living in the Home. That attention be drawn to standards of care staff dress and presentation, to maintain a safe and professional standard when dealing with people. That accident logs be kept in the persons care file, and not held in a communal file, to comply with the requirements of the Data Protection Act and good practice. That the policy and procedure manual be reviewed to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties and Safeguarding regulations. 15 28 16 29 17 30 18 37 19 37 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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