Inspection on 25/09/06 for Hill Ash House

This inspection was carried out on 25th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Hill Ash House 04/06/09

Hill Ash House 08/01/09

Hill Ash House 14/12/07

Hill Ash House 21/11/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hill Ash House Hill Ash House Ledbury Road Dymock Glos GL18 2DB Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 25th September 2006 12.30 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 Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill Ash House Address Hill Ash House Ledbury Road Dymock Glos GL18 2DB 01531 632003 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) European Healthcare Operations Ltd Mrs Alison Margaret Cooke Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21st November 2005 Brief Description of the Service: Hill Ash House is an extended Grade 2 building, set in its own extensive grounds. It offers both residential and nursing care to older people over the age of 65 years. There are ample communal rooms and bedrooms are single with ensuite facilities. A shaft lift offers access to the upper floors. Specialised equipment is provided to meet differing needs and external health care professionals such as the GP, Dentist Chiropodist are contacted as required. The Home has a qualified nurse on duty at all times and ample staff to meet the needs of those that live at the Home. There are extensive grounds that can be enjoyed by the residents in the milder weather. The local bus stops in the village of Dymock, which on foot is some distance from the home. In some cases and with prior arrangement only, a lift can be organised to and from the bus stop. As from June 2006 the current fees for the home range from £400.00 to £700.00. The home is currently deciding how to make previous inspection reports accessible to visitors. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection over two days. The first day was between 12.30pm and 8.30pm and the second day was between 10.15am and 7.15pm. The Registered Provider and Registered Manager, including other senior members of staff were available to contribute. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Several residents and staff were spoken with including available relatives. The care being received by four residents was cross-referenced with the written care plans and additional care records were also inspected. Several records pertaining to other residents were also inspected, which demonstrated how external health care professionals get involved. The availability of relevant information such as general information on the service, how to make a complaint and financial information was explored. How residents make choices, have their preferences met and have their privacy and dignity preserved were all looked at. Staff training records were inspected along with recruitment records and other arrangements to help protect residents. Systems pertaining to the home’s management, its administration, maintenance, health and safety and general upkeep were all inspected. What the service does well: This home offers comfortable, safe and clean accommodation which residents are free to personalise with their own belongings when they move in. Residents are actively encouraged to maintain links with family and friends and to go out when they wish to. For those unable to independently go out there are opportunities to do this with the staff and to join in a variety of activities. The service takes its responsibility to protect vulnerable residents very seriously and continues to improve systems that help towards this. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Some basic information about the service needs to be completed and then made available to residents and visitors. The pre admission assessment could be more robust and recorded more fully. A more individualistic approach to care planning with the residents more fully involved may help the more specific needs and preferences to be identified. A formal monthly audit would highlight the shortfalls within the medication system. For some staff an update on infection control practices may be necessary. A review of the staff numbers and a reminder for all staff regarding the length and frequency of allocated breaks should help ensure that there is ample staff on duty at any given time to meet the needs of the residents. Recruitment practice needs to be robust as far as receiving references is concerned. Some staff have not received updated basic training, these staff need to be reminded that some of these trainings are mandatory. Formal supervision has begun for some staff and needs to be taking place for all staff by 30/11/06. This requirement has not been complied with fully since the last inspection. On this occasion the timescale has been extended as indicated in the requirement made. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement improvement to secure compliance. Alternative arrangements must be made regarding emergencies that occur within the independent living area. Please contact the provider for advice of actions taken in response to this Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 8 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 Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 9 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 & 6 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Measures are being taken to improve the content and availablity of the information on the home for exisiting residents and visitors. Arrangements are in place to show the appropriate person what monies are due to be payed, although not all residents are receiving information regarding their ‘free nursing’ entitlement. The recorded content of some pre admission assessments does not demonstrate that the home has carried out a comprehensive assessemnt of needs prior to admission; in order to ensure the home can meet the individual’s needs. EVIDENCE: A copy of the homes Statement of Purpose has been forwarded to the Commission. This requires some additional information and some minor alterations and therefore has been returned to the Registered Manager. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 10 A decision will then need to be made as to how the home makes visitors aware of this information. On an initial visit to the home prospective residents or their representative are given a booklet with some information, it is not clear if all existing residents have a Service User Guide and when this is given to a new resident. The administrator showed the Inspector several examples of records kept pertaining to the purchasing of sundries. The subsequent invoicing of these was very organised and the information easy to follow. The home needs to develop a system that informs the resident or their representative, if they are being funded, of the amount they are receiving for the Registered Nurse Care Contribution (RNCC) if applicable. This information at present is only supplied to those who pay independently. One resident knew he had been assessed for this and specifically asked whom he should contact to find out what he was receiving. This was referred to the Registered Manager to ensure that this resident was furnished with the correct information. The home’s terms and conditions have recently been reviewed and rewritten, an example of which was not seen during this inspection and therefore needs to be forwarded to the Commission along with the Service User Guide. It is understood that a copy of the terms and conditions is given to the prospective resident before they move in. An example of a pre admission assessment was seen for one recently admitted resident. Another example was for a resident had been out to see the home prior to moving in, but the pre admission assessment was extremely brief. One other resident was admitted to the home from the independent living flats attached to the care home. This was in effect an emergency admission, with little assessment of needs recorded. The Inspector also understands that it is the qualified nurse that attends any emergency within this unregistered part of the building. This action must be reviewed, as it effectively means that the registered nursing home does not have the presence of a qualified nurse in the time that she is making her assessment elsewhere. Other arrangements, apart from the qualified nurse attending, will have to be made and decisions on what happens next in the case of an emergency, made in the same way as would occur in a normal domestic household. This home does not provide designated rehabilitation. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The majority of care needs are planned for giving staff guidance on how to meet these needs, although some more individual care plans need to be more specific and kept up to date. Arrangements are in place to ensure residents have access to specialist health care professionals in order to help meet their health care needs. The medication system is generally safe, protecting residents from poor practice. Residents’ privacy and dignity is upheld. EVIDENCE: Four residents’ care files were selected to be read in detail and the care being delivered cross-referenced with the documentation. Additional care records were inspected during the course of the inspection. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 12 One resident is totally dependant on the staff for all care needs. There were relevant care plans in place illustrating how this care was being delivered. Specialist needs were also planned for and were being met according to the written plan. These related to nutrition and pressure relief. This resident’s weight had not been recorded since June of this year due to a problem with the resident’s posture. The home must consider purchasing scales that are designed to get around this problem i.e. those attached to a hoist rather than a design that requires sitting on. This resident’s nutrition is delivered via a Percutaneous Endoscope Gastrostomy (PEG) feed, so her weight should be recorded. There was evidence to show that external health care professionals are also involved in this resident’s care. This included the Community Dietician, Chiropodist and Continence Advisor. Another resident’s care file demonstrated that the family visited regularly and often took their loved one out. It also recorded that this resident enjoyed various activities and entertainment provided at the home and that she attended Holy Communion. The records confirmed that she also receives regular chiropody and has seen the dentist. When talking with this resident she sounded very ‘chesty’ and had a loose cough. The resident explained that she felt this was her main problem and how at times she found being breathless very debilitating. The staff confirmed that this tended to be a problem each year for her, which tends to lead to chest infections. However there was no care plan indicating this or any planned action to guide staff on early identification of a chest infection. Another resident’s care file showed that she was receiving some care from the mental health team. A different resident’s care file for mobilisation was not relevant to what the resident was now doing. She had in fact progressed from how this was currently reading due to support and motivation from a night nurse. The medication system, its storage, the administration of medicines and all related records were inspected. Since the CSCI Pharmacist inspected the home in 2005 the Registered Manager has improved the storage and administration practices within the home. There were some shortfalls which are listed below: • Handwritten instructions on two residents’ medication administration records (MAR) sheets, were not accompanied by the signature of the person who wrote the instruction and the person who had checked this for mistakes in transcription. • The same was found for an alteration to the printed instruction on another resident’s record. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 13 • • • One resident’s care plan for epilepsy did not include specific guidance for the use of the drug that had been prescribed to be given in the event of a severe seizure or continuous seizures. Although the home has a medication policy this did not include the new regulations for the disposal of medication. Guidance given to staff in the event of a drug error did not include notification to the Commission via regulation 37. The storage cupboards met with all present criteria and the storage of external medications/creams etc was correct. There were no controlled medications. The residents’ privacy and dignity was seen to be upheld at all times. One resident explained that she did not like being washed by a male care staff. She was able to confirm that this is upheld and that staff always carry personal tasks out in private. Staff were heard speaking to residents in a respectful manner, one resident said the staff were all nice but that some were more respectful than others. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to enhance residents’ social and recreational needs, including their religious preferences. Contact with family and friends is actively encouraged in order to add to the residents’ quality of life. Residents are able to exercise choice and control over their lives. The food being provided is meeting the needs and preferences of the majority of the residents, although the preferences of a few may need checking. EVIDENCE: Residents confirmed that they could spend their day as they choose. Several were heard to be making individual choices. Two residents said they like to sit outside in the courtyard for as long as the sun was out; they clearly enjoyed the fresh air and each other’s company. Another resident prefers to remain in her bedroom when in the home, but clearly has a very active social life outside of the home. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 15 Another resident who was visited during a previous inspection has now become more confident in spending time in the lounge and mixing with fellow residents. Several residents explained that if they need help to get back to their bedroom or go from their bedroom to the lounge, they only have to ask and the staff will oblige. In contrast the Inspector spoke with a resident who said she was finding it difficult to adjust to living in a care home and preferred to spend time on her own. The Registered Manager said she was aware of this and makes a specific effort to ensure she visits this resident on a regular basis. The resident agreed she enjoyed her chats with the Registered Manager and finds her very approachable. There is a mixture of activities and social gatherings organised, these include theatre trips, rides out to the forest area and garden centres, in house games and crafts and visiting speakers. On a monthly basis there is a Holy Communion Service and Music Therapy. The Registered Manager confirmed that the home would endeavour to meet any individual’s religious preferences. Overall there was a mix of residents who like to join in and those who prefer not to. Visitors are welcome at any time and several residents have daily visits by family members or friends. Some have made friends with residents from the independent living flats, who sometimes share meals and join in the activities within the home. Nearly all the residents agreed that the food was tasty and plentiful. One resident has to have a specific diet for health reasons, but has added her own restrictions to this as well, making this a challenge for staff to provide a relatively healthy diet. A care plan has been devised to give staff guidance on this. One resident in her bedroom had been forgotten at lunchtime and was offered an omelette at 2pm. This was pointed out to the Registered Manager so that she could check that the procedures in place to ensure this did not happen were being followed. The residents can eat their meals where they choose. It was noted in the attractively laid dining room at lunchtime, that residents prefer to sit in the same place each day. During the evening one resident, who had eaten her meal in her bedroom, commented that she did not like fried foods. She had been served a fish cake that had been deep fried, so very little had been eaten. This resident’s dirty plates were still in her bedroom at 8pm, for this inspection this was presumed to be because of the current staffing problems in the kitchen. Residents that were in bed during the day had a drink alongside them at all times. The Registered Manager was able to confirm that arrangements are in place to ensure the menu plan is now followed. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 16 A survey carried out by the home in July of this year showed that 91 of the comments back demonstrated that residents were happy with the food and activities provided. Some guidance on advocacy is required for residents and visitors in the home. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The home has a complaints system that is accessible and which will take complaints seriously and endeavour to sort the problem out. There are arrangements in place to help protect residents from harm or abuse. EVIDENCE: The Registered Manager keeps a complaints file. This was seen during this inspection and contained two previous complaints pertaining to the interruption of telephone services in residents’ bedrooms, which was experienced by the home in 2005 at the time of the purchase by the new provider. Letters were present demonstrating the Registered Manager’s response and the action taken. This was all carried out well within the procedures stated timescale. The complaints procedure is given to new residents along with other key information at the time of admission. A copy of the complaints procedure was not obviously on display at the time of this inspection. This was rectified the next day by placing a copy in the main reception area. Consideration should also be given to placing a copy in an area where residents could easily read it as well. Most residents spoken to said they would voice a concern or complaint and knew whom they would direct this through. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 18 One resident said she has never been able to complain and has always put up with something wrong rather than complain. This resident did also confirm that her family would probably do this for her if she asked them. Arrangements have been made to improve staff awareness of adult abuse issues, particularly the abuse of the elderly, although some night staff were identified as not receiving this training yet. The second training session on this subject was provided earlier this month. The home has a policy with procedures that relate to the protection of vulnerable adults dated August 2005. The guidance within the procedure is clear for staff to follow and a reference is made to the Department of Health Guidelines ‘No Secrets’. All residents spoken to confirmed that the staff were kind towards them and that they felt safe living in the home. Many knew whom they could go to if they were unhappy about something and felt confident that this would be acknowledged and dealt with diplomatically. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 19 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, 21, 22, 24, 25 & 26 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The home continues to improve the environment and facilities for residents. Arrangements are in place to access specialised equipment when needed. Residents have the freedom to personalise their own bedrooms. The home is safe and clean to live in therefore enhancing the residents’ quality of life. EVIDENCE: The environment has continued to improve over the last year, a continuation from the purchase of the home in 2005 by the present Registered Provider. This also includes the external grounds, which were looking extremely well kept at the time of this inspection. A lot of decorating and refurbishment has been carried out inside the home this year and was still in progress at the time of this inspection. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 20 Areas which are not so obvious to the eye, but which make the home safe, have received a huge investment and include systems such as the fire prevention system, hot water and heating system, water storage systems, waste systems and soon a total refurbishment of the main kitchens. This is all carried out according to a planned programme and under the management of the company’s Estates Manager. The new maintenance person is responsible for the upkeep of the premises including many of the health and safety checks that are carried out routinely. These routine checks include the regulating of hot water outlets to minimise the risk of scalding, checks on radiator guards to reduce the risk of burns, checks on emergency lighting systems and portable electrical appliances. Records for all of these were seen. He also delivers the fire training having been trained himself by the Fire Services to do this. The communal areas have been decorated and refurbished and now offer comfortable and welcoming accommodation with a variety of seating. A television and music system are available. Bathing facilities provide a mixture of non-assisted and assisted bathing. There are ample toilets near to communal rooms for residents to use. Various pieces of specialised equipment are in use in the home. This includes equipment for safe moving and handling, specialised electric beds and crash mats. There are however no handrails throughout the home. This was highlighted by one resident who lives along a particularly long corridor in the new annex, as being a problem for her. This was referred to the new provider for him to organise. Eleven bedrooms have been either redecorated or completely refurbished. One resident’s bedroom was due to be decorated. She explained that she has been able to choose the colour scheme and is soon to pick which carpet she likes. Most bedrooms have been personalised by the resident and their families with favourite pieces of furniture and belongings being added. Most bedrooms have en suite facilities. The newly created post of housekeeper ensures that the cleaning and general housekeeping is well organised. The home appeared clean and well run during this inspection and several residents were able to confirm that their rooms are vacuumed and dusted daily. The home has arrangements in place for infection control, however cleaning staff were observed to be wearing the same plastic gloves they had been working in when collecting forms from the administrator. This indicates that they probably require an update in the theories behind the use of gloves and good hand washing practices. The home has made appropriate arrangements for the collection of clinical waste. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 21 The laundry looked clean and was organised. One resident commented that her clothes come back in good order and staff will sew on loose or lost buttons if they are asked. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 22 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, 28, 29 & 30 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs and preferences, in some situations, are not always being met either because of not enough staff or a poor use of time. Care is being delivered by a majority of staff that have been trained to a national accepted level in care. The recruitment practice in some cases is not robust enough to help protect residents. The arrangements for training staff in mandatory subjects have improved thus helping to provide safer care for residents. EVIDENCE: Although this set of outcomes has been assessed as adequate, care needs to be taken to ensure good recruitment practices are used at all times. Staffing numbers were discussed, as it was a general consensus amongst the staff that the residents’ needs were high at present. Staff numbers had been increased a few weeks prior to this inspection because the number of residents had increased and it had been a topic at the last staff meeting earlier this month. However, some residents are being got up or washed just in time for lunch and some would like this to happen earlier in the morning. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 23 When asked by the Inspector why one resident was not using her specially adapted wheelchair, they explained that it takes at least two staff members to manoeuvre her into the chair and one to remain with her for safety reasons, as is written in her care plan. They said they just do not have time to do this most days. These examples were discussed with the Registered Manager who considers there to be enough staff, but she wonders if they are using their time effectively. Either way she will review the situation. She explained that there were staff shortages within the kitchen at teatime, as there was no one to wash up at present. The arrangements that have been put in place are sensible, but the home will need to sort this out as soon as possible as it is putting a strain on already busy care staff. The home has been able to increase the numbers of staff undertaking training in the National Vocational Award (NVQ) in Care and now has a high percentage of staff holding the award. The recruitment files of four staff were inspected. Two of the staff had been employed before their second reference had been obtained, which does not meet with the Care Home Regulations 2001 and which has been a requirement within this home before. All had clearances by the Criminal Records Bureau, which included a check against the list for the Protection Of Vulnerable Adults (POVA). Most staff are receiving training in basic mandatory subjects, which include fire training, moving and handling, infection control and food hygiene. Dementia care training is also given and eight staff currently hold a first aid certificate this could do with increasing. Records pertaining to one carer’s induction training were seen. Three nurses have attended a mixture of trainings in wound care and continence & bladder care. There was not a lot of evidence to suggest that all these staff are updating appropriately. The Registered Manager should give consideration to ascertaining what skills her qualified staff have and if these meet the needs of the home. There maybe some training shortfalls. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 24 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, 35, 36 & 38 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager has clear lines of responsibility and runs the home in a manner that takes into account the views of the residents living there. Residents’ financial interests are safeguarded. Not all staff are receiving adequate supervision in order to either identify and stamp out poor practices or acknowledge good practice. This form of staff support ultimately benefits residents. The home environment is being run safely for the benefit of the residents who live there and the staff who work there. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 25 EVIDENCE: Although many of these outcomes are good, the repeated requirement for all staff to receive adequate supervision has lowered the overall outcome to adequate. The present manager is registered with the Commission. She is a Registered Nurse and holds a national qualification in management. She is planning to further her knowledge in management skills next year by studying for a higher qualification. The management infrastructure within the company has become more organised and settled over the past year with lines of accountability being clearer and this has included the Registered Manager’s own role. The company still needs to clarify the immediate management structure with the home; at the present time there is not an officially recognised deputy to the manager. Meetings are held to provide a forum for topics to be discussed or new information to be passed on. The last housekeeping meeting was in January of this year and the last general staff meeting was earlier this month. The Inspector is unaware of a recent relatives/residents meeting. The Inspector did however speak with two relatives at the time of the inspection, who both confirmed that they are able to talk to senior staff if they need to and that they get updated on their relatives condition. The home has been developing its quality assurance system. It does gather the views of residents and visitors by organising a survey, the last carried out in July of this year. The Registered Manager explained that management meetings are held and the results discussed with relevant teams. It is intended that action plans will be developed from the various audits, which will provide a formal structure to improving the overall service. This will help the home carry out its ‘self assessment’, which will be required by the CSCI in the New Year. At the present time falls and accidents are being audited. The medication system is being checked as are care plans, but neither are being formally audited. One resident at present has a small amount of money being kept safely for her by the administrator. This resident withdraws the amount she wants and signs for this herself. The nursing staff were keeping three other amounts of money securely but fairly informally, which were one off amounts left by relatives for hairdressing and chiropody. All of which had relevant receipts, but one amount now needs to be kept in a more formal way because of its amount and frequency of use. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 26 Records kept by a Registered Nurse indicating the date and subject discussed for the supervision of four staff were seen. This Registered Nurse explained that the Registered Manager was also supervising a small number, but records were not seen of these. Qualified staff and night staff are not receiving supervision yet. Domestic staff and kitchen staff are not receiving formal supervision either at present, although the housekeeper works very closely with this group. Formal supervision will need to be commenced for these groups as soon as possible as this has been an ongoing requirement for various reasons since 2004. The Registered Person has been given until the 30/11/06 to comply with this in full. Arrangements are in place to ensure the home is run safely and many records and certificates were seen to demonstrate this. The home also adheres to the Control of Substances Hazardous to Health Regulations (COSHH) by securely storing all cleaning fluids and other potentially dangerous liquids. Risk assessments are also written for general situations and usually for individual situations demonstrating how risks are reduced. A resident who has suffered frequent falls in the past had a risk assessment indicating the actions being taken to help to try and reduce these. However, a situation that posed a risk to a resident a few days before this inspection had not been risk assessed. Accidents within the home are being recorded and the Commission is being notified when appropriate. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 27 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 1 X 3 Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4(1)(2) Requirement Timescale for action 18/12/06 2 OP2 5A 3 OP9 13(2) 4 OP22 23(2)(n) The Registered Manager must complete a Statement of Purpose. Forward a copy of this to the Commission and make residents and visitors to the home aware that this is available to read on request. The Registered Persons must 18/12/06 provide a statement for those where a nursing contribution is paid informing the person of the amount and how this is taken into account for the purpose of calculating fees or invoicing. (This is with reference to the RNCC amount being received by funded residents) The Registered Manager must 30/11/06 make arrangements for the recording and safe administration of medications. (This is with reference to the identified shortfalls within this report). The Registered Persons must 30/11/06 ensure suitable adaptations are made, and such support as maybe required by residents that are old and infirm. DS0000064284.V313999.R01.S.doc Version 5.2 Hill Ash House Page 29 5 OP27 18(1) (Handrails are required along the corridors in the home starting with those needed in order of priority). The Registered Person must taking into account the size, layout, numbers and needs of the Care Home ensure an appropriate number of qualified and competent staff are employed to meet the needs of the residents and facilitate the smooth running of the Home. (This is in relation to having enough staff to get residents up in the mornings and at teatime to wash up) 30/11/06 6 OP29 19 Schedule 2(3) 12. OP36 18 (2) The Registered Manager must 30/11/06 when recruiting staff obtain 2 written references, including, where applicable, a reference relating to the person’s last period of employment, which involved work with children or vulnerable adults, of not less than three months duration. The Registered Manager shall 30/11/06 ensure that all staff working at the Care Home are adequately and appropriately supervised and that this can be demonstrated through records kept. (Timescale of 30/6/04, 4/4/05 & 30/9/05 not met)(Has been partially met by 28/02/06). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000064284.V313999.R01.S.doc Version 5.2 Page 30 Hill Ash House 1 2 3 4 5 6 7 8 Standard OP3 OP7 OP8 OP14 OP16 OP22 OP26 OP30 9 10 OP32 OP33 Each pre admission assessment should follow a set format, which meets all the criteria within standard 3.3. There should be a greater emphasis on involving the resident with their care planning. An alternative type of weighing scales should be purchased for those who are unable to sit on a weighing seat. Guidance regarding Advocacy and Advocacy Agencies should be located where residents and visitors can read it. The complaints procedure should be placed in an area that residents can see it and thought should be given to using large print. Signs or other warnings should be placed in appropriate places to give warning of steps ahead in the corridors. Cleaning staff should receive an update in good infection control practices and hand washing. There should be a record kept of qualified staff trainings and updates relevant to the skills they use in the home. Shortfalls identified should result in that member of staff updating their skills. Thought should be given to a regular forum for residents and relatives to meet. Audits should be formalised and a consistent record kept which in turn generate recorded actions plans that have short and long term goals and which are evaluated. Hill Ash House DS0000064284.V313999.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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