Inspection on 08/01/09 for Hill Ash House

This inspection was carried out on 8th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill Ash House 04/06/09

Hill Ash House 14/12/07

Hill Ash House 25/09/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hill Ash House Hill Ash House Ledbury Road Dymock Glos GL18 2DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Hill Ash House Ledbury Road Hill Ash House Dymock Glos GL18 2DB 01531892980 01531890767 mpearce@ehguk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Healthcare Operations Ltd Name of registered manager (if applicable) Julie Anne McKinnon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following category of service only: Care Home only _ Code(PC) to service users of either gender whose primary care needs on admission to the home are within the following category: Old Age not falling within any other category. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age not falling within any other category (Code OP) Date of last inspection Care Homes for Older People Page 4 of 29 care home 36 Over 65 36 36 0 0 Brief description of the care home Hill Ash House is an extended Grade 2 building, set in its own extensive grounds. Following a change in the homes registration it now offers personal care only to older people. 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. 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. Information about current fees was not obtained during this inspection. Copies of the homes Statement of Purpose and Service Users Guide are displayed in the main entrance to the home. Care Homes for Older People Page 5 of 29 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: The inspection visit was carried out by one inspector over two days in January 2009. The Group Projects Manager of the registered provider who was temporarily managing the home was present for the second day of the inspection visit . On the first day the manager of another home in the group who was familiar with Hill Ash House was present. The inspection consisted of a tour of the premises and examination of residents care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a case tracking exercise. During the inspection visit four residents were spoken to, to gain their views of the service. Care Homes for Older People Page 6 of 29 An Annual Quality Assurance Assessment (AQAA) form was completed by the home and forwarded to the Commission prior to the inspection. This contained the information that we asked for. 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 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Care Homes for Older People Page 9 of 29 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 10 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process does not always ensure that information from local authorities is received about a residents needs before care in the home is offered, so that residents cannot be sure that they will receive the care they require. Evidence: The assessment documentation for a number of residents recently admitted to the home was looked at. These had been completed following an assessment of the persons needs recorded on a pre-admission assessment document. Although the form had been updated since the previous inspection it did not include a specific area for recording any information about a persons history of falls. With one example looked at this information had been recorded on the reverse of the last sheet of the document. Where residents had been funded by a local authority, information in the form of a care plan had been obtained. Although the home had carried out their assessment prior to the resident moving into the home, the local authority had been slow to supply Care Homes for Older People Page 11 of 29 Evidence: theirs with two dated on the same day that the resident was admitted. The home should insist on receiving the local authority care plan or assessment prior to the resident entering the home to ensure that their needs can be met. The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 12 of 29 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. Some further work still needs to be done around care planning, medication record keeping and storage in the interests of residents. However health needs are being met and privacy and dignity is being upheld. Evidence: The care documentation for a number of residents was looked at. One resident had been in the home for nearly a month and no care plans or risk assessments had been completed. Another had been in the home for over three weeks and had no risk assessment completed for moving and handling although risk assessments had been completed for falls and pressure area care. A resident admitted for respite care six days before the inspection visit did not have any care plans or any risk assessments. The lack of a moving and handling risk assessment was concerning as the funding authoritys care plan included such statements as Difficulty in getting out of chair and to assist you with transfers as needed. One resident who had been in the home for around six years had their last care plan review in October 2008, their moving and handling risk assessment had not been reviewed since July 2008. There was recorded Care Homes for Older People Page 13 of 29 Evidence: evidence of residents receiving input for health needs from visiting professionals such as chiropodists, GPs and dentists. Arrangements for medication administration and storage were looked at. Since the previous inspection, medication storage had been moved to another location in the home. storage temperatures were being monitored and records showed that some temperatures were above 25 degrees Celsius which is too warm for most medication. It was noted that there was an electric heater in the room which was on at the start of the inspection making the room very warm. The use of this heater must be monitored in the interests of storing residents medication at the correct temperature. Bottles of liquid medication had been dated on opening as an indication of the expiry date. One bottle of Gaviscon however dated February 2008 had not been dated on opening, this should have been used within six months and so may have been out of date. Medication stored in the refrigerator had been stored in the correct temperature range as records showed. As at the previous inspection it was found that some handwritten directions on the Medication Administration Records (MAR) had not been signed or dated by the person writing the directions and there was no indication such as a signature to indicate that the entry had been checked by another member of staff. Some protocols were in place to guide staff in giving medication prescribed on an as required basis although a number of residents did not have these in place. Additionally some medication directions were printed as directed these should be clarified with the GP or pharmacist as a way of checking that the dose is being given as originally intended. This is particularly relevant with such medication as Lorazepam which was seen with one resident. it was noted that the MAR entries for the 6th January 2009 included some areas where medication administration for Diazepam and Lactulose had not been signed for one resident. Care staff had been undergoing training in medication administration including an accredited course. When spoken to staff described the challenge of taking over the responsibility for medication administration following the home changing its registration from a care home with nursing to a care home providing personal care. A medication audit document was seen dated October 2008. Two residents spoken to confirmed that staff knocked on doors before entering and were polite to them. Care Homes for Older People Page 14 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an activities programme, good social contact and a variety of meals served in attractive surroundings. Evidence: Activities in the home are provided by the housekeeper who works for fifteen hours a week organising activities. A monthly newsletter is produced entitled The Hill Ash Chatterbox and distributed to the residents. The latest edition from December 2008 contained news about recent activities in the home and photographs taken during the Christmas celebrations. Activities in the home had included bingo, yoga and a trip out to a pantomime in Malvern. A musical entertainer also visits the home and there are monthly visits form a mobile library. Holy Communion is held in the home once a month for all Christian denominations. The home also has the details of a local Roman Catholic Priest if any visits should be requested by residents. The home has been working with a local care home support project to bring the home in closer contact with the local community. This has resulted in older people from the surrounding area attending film shows in the home followed by afternoon tea. The homes AQAA document stated All service users are able to receive visitors in privacy Care Homes for Older People Page 15 of 29 Evidence: and they are able to see whom they choose, there is no restriction on visits or on times of visits. Despite the rural location of the home, residents are able to access to transport through the use of dial a ride and the home has the use of a minibus and a wheelchair car. Information about advocacy services is now more widely available in the home than it was at the previous inspection. Residents are able to personalise their individual rooms with a number of items including furniture. The home has a six weekly menu which makes use of seasonal vegetables. At lunch there is a choice of main dish which on some days includes a vegetarian option. There is also a diabetic option for dessert on the menu. A record is kept of any alternative meals provided to residents that are not part of the menu. Supper consists of a choice of a cooked snack or soup as well as cakes or a dessert. Two residents spoken to described the meals as Very Good and another said they were Very nice and had enjoyed the Fish and chips served that day for lunch. Another described the meals as Excellent and cooked well. Care Homes for Older People Page 16 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available if any resident or their representative should wish to make a complaint although some information about how complaints received had been dealt with was not available in the home. There has been an improvement in the number of staff trained in protecting vulnerable adults that should ensure residents are protected. Evidence: Information on how to make a complaint is available in the home. The Homes AQAA document stated that three complaints had been received in the twelve months prior to December 2008. We were aware of one of these complaints although information relating to the other two could not be found in the home at the time of the inspection visit. In respect of residents legal rights the home has information relating to the Mental Capacity Act 2005 and the AQAA document showed that there was an awareness of the needs of residents who may lack mental capacity in some areas. The home has a policy for protecting residents from abuse that was on display as well as a whistle blowing policy. The homes AQAA document stated Staff undergo POVA training during induction and as annual updates. Records showed that the majority of staff had received adult protection training at some point although there was no evidence of annual updates being undertaken. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of living in a well-maintained and clean, environment with personalised individual rooms. Evidence: A tour of the premises was undertaken. All areas of the home inspected were found to be clean and well maintained following a recent refurbishment. In particular a number of bedrooms on the top floor had been extensively refurbished with en suite facilities added. These rooms were unoccupied on the day of the inspection visit. Two bathrooms had also been refurbished and provided with new baths one being a spa type bath. The entrance hall contained information about the home and about planned activities. There are well kept gardens around the home with car parking at the front of the home. A small courtyard provided with seating is available for use by residents when the weather allows. Residents rooms were comfortable and contained various degrees of personalisation with some enjoying views of the countryside surrounding the rear of the home. Some rooms on the ground floor at the rear of the home had their own individual access to the garden. The laundry had washable floor surfaces although the walls were in need of some attention to flaking paint to ensure a washable surface. There had also been some problems with a water leak at the rear of one of the machines. Arrangements for hand Care Homes for Older People Page 19 of 29 Evidence: washing were in place. It was noted that hand cleaning gel dispensers had been located at various points around the home as an aid to infection control. Care Homes for Older People Page 20 of 29 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. Sufficient staff are deployed and training is provided in a number of areas to meet residents needs. However an improvement in one aspect of recruitment procedures would more fully protect residents. Evidence: With the change in registration of the home to provide personal care only, the home no longer employs registered nurses. In addition to the manager the home is staffed with four carers in the morning and three in the afternoon and two waking staff at night. It was reported that the numbers of care staff would be increased when the home reached an occupancy of twenty five residents. Ancillary staff consist of a housekeeper (who also organises activities),three domestic staff, a chef, a kitchen assistant, an administrator and maintenance and gardening staff. Based on information supplied on the AQAA document the home still had just under 50 of staff trained to NVQ level 2 or above. Records for recently recruited members of staff were examined. With two staff all the required checks had been made before employment in the home. For one member of staff there was no information about employment after a certain date and no evidence that this had been discussed at interview. Care Homes for Older People Page 21 of 29 Evidence: The home has a document for induction training that covers the common induction standards for social care in England. Evidence was given of training carried out by staff in relation to the needs of residents in the home including sensory deprivation awareness and a falls workshop. Care Homes for Older People Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the departure of the registered manager the home had been managed in the interests of residents safety and well being, however some quality checks may not have been undertaken recently. Evidence: At the time of the inspection visit the registered manager of the home had resigned. The home was being managed by an acting manager who had previous management experience. A new manager had been recruited and was due to start work in February 2009. A number of quality assurance audits had been undertaken such as care plan audits, health and safety audits and environmental checks. An infection control audit had been carried out in December 2008. A suggestions box is available in the home. In the past various satisfaction surveys had been carried out although it was reported that there had not been any recently although there were plans for a health care professionals Care Homes for Older People Page 23 of 29 Evidence: survey. A relatives and residents meeting had been held in November 2008, the minutes of this meeting were looked at and showed that relatives had raised various issues about the service provided and had received responses from the Manager. A folder containing regulation 26 reports was looked at, the last report from the registered provider was of a visit on the 31/01/08. It was unclear if monthly unannounced visits had been carried out since then. Reports of any such visits must be kept in the care home. The arrangements for looking after residents money was looked at and satisfactory arrangements were in place with records kept. An audit had been conducted by the home the day before the inspection visit. Secure storage is available in the home. Staff had received training in first aid, food hygiene, fire awareness, moving and handling and infection control. Portable electrical appliances were due to be tested in the week following the inspection visit. The electrical wiring had been checked in 2005 and was therefore not due another check at the time of the inspection visit. Central heating systems had last been serviced in April 2008. A risk assessment had been completed for Legionella with checks in place in relation to this. Regular monthly checks were also made on hot water temperatures with records kept. The home had a fire risk assessment that had been completed in December 2008 and was due for review in a year. Checks had also been made on window restrictors. As at the previous inspection, it is recommended that the Home conduct a risk assessment regarding the security of the premises. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) The Registered Manager 29/02/2008 must make arrangements for the recording and safe administration of medications. (This is with reference to the identified shortfalls within this report). This requirement has been repeated from previous inspections. Care Homes for Older People Page 25 of 29 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 7 15 Residents must have care plans for all their assessed needs. This is so that staff have clear information on how a residents needs can be met. 30/04/2009 2 8 13 Where residents have needs in respect of moving and handling then a risk assessment must be completed by the home. This is so that staff have clear information on how a residents moving and handling needs can be met in a safe way can be met in a safe way. 30/04/2009 3 9 13 Arangements must be made for the recording,safekeeping and safe administration of residents medication as detailed in this report. This is so that residents medication is stored 30/04/2009 Care Homes for Older People Page 26 of 29 correctly and there are accurate and safe styems in place to ensure that their medication needs are met. 4 16 17 A record must be kept of all complaints received by the home and of any action taken in respect of these complaints. This is so that the home can demonstrate that any complaints have been investigated in the interests of people using the service. 5 29 19 Before a person starts work in the home, all the information and documentation specified in Schedule 2 of the Care homes Regulations 2001 must be obtained. This is to ensure that residents are protected through robust recruitment procedures. 6 33 26 Reports of visits made by 30/04/2009 the registered provider must be kept in the home. This is so that they are available for inspection and for the reference of the manager of the home. 30/04/2009 30/04/2009 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 3 The home should insist on receiving written information Page 27 of 29 Care Homes for Older People from local authorities about a prospective residents needs before they are admitted to the home. 2 3 4 5 3 3 7 8 A record should be made of the date of receipt of any care plan received from a residents funding authority. The pre admission assessment form should include an area to record information about any history of falls. To check that they represent residents current needs, care plans should be reviewed on a monthly basis. Moving and handling risk assessments should receive regular review to check that they still reflect residents needs. Attention should be given to the flaking paint on the wall in the laundry and the leak behind one of the machines. More care staff should undertake an NVQ. Complete a risk assessment exercise for the security of the premises. 6 7 8 26 28 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!