Inspection on 21/01/09 for Hill Brow

This inspection was carried out on 21st January 2009.

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

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

Other inspections for this house

Hill Brow 14/02/07

Hill Brow 10/01/06

Hill Brow 01/09/05

Hill Brow 04/02/05

Hill Brow 24/11/04

Hill Brow 03/02/04

Hill Brow 16/09/02

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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 Brow Beacon Hill Road Ewshot Farnham Surrey GU10 5DB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Damian Griffiths     Date: 2 1 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 32 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Hill Brow Beacon Hill Road Ewshot Farnham Surrey GU10 5DB 01252851011 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : margo@woodlands-hillbrow.co.uk Woodlands and Hill Brow Ltd care home 32 Number of places (if applicable): Under 65 Over 65 0 32 dementia old age, not falling within any other category Additional conditions: 32 0 The maximum number of service users to be accommodated is 32. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Hillbrow provides accommodation for up to 32 people who are within the category of older people, some of whom may have dementia. The home aims to provide a homely and relaxed environment for service users. The home is owned and operated by Woodlands and Hill Brow Ltd a family business who also have a second home in the area. Staffing is provided twenty-four hours a day. Visitors are welcome and service users families are encouraged to play an active part in their relatives life where appropriate. Care Homes for Older People Page 4 of 32 Brief description of the care home The home has well-established links with local General Practitioners and nursing services to support and enhance the care provided. The home is situated between the towns of Farnham and Fleet and is set within its own grounds. Accommodation is provided on two floors. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place over nine hours. A tour of the premises took place and a number of documents and files including six service user care plan folders, five staff recruitment files, quality assurance information and the Annual Quality Assurance Assessment, AQAA, there was submitted to CSCI prior to the inspection were examined as part of the inspection process. A selection of CSCI surveys were distributed during inspection to residents, relatives, care staff and visiting healthcare practitioners. Results of the surveys are included in this report. Comments received during the inspection and appearing in the homes Annual Quality Assurance Assessment are also featured in this report. In the interests Care Homes for Older People Page 6 of 32 of confidentiality some words have been changed. The service users at Hill Brow preferred to be described as residents. Weekly costs ranged from 582 to 780 pounds. What the care home does well: What has improved since the last inspection? What they could do better: The home continues to offer an excellent service to residents. Care Homes for Older People Page 8 of 32 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. Service users considering taking up a residency at the home received a full preadmission assessment of their care needs to ensure that the home could provide the support required. Evidence: A relative of one of the service users completing the CSCI survey commenting about choosing the home had written; We made a thorough examination of about six homes before selecting Hill brow, and have NOT regretted our choice. The staff are so kind. 6 Service user care plan were inspected including those belonging to new residents to the home. Records such as the assessment document for potential residents provided evidence that indicated that all of the service users had received a pre-admission assessment. Care Homes for Older People Page 11 of 32 Evidence: The home had submitted an Annual Quality Assurance Assessment,AQAA. The home considered that it did well when arranging preadmission visits and it stated; we go to great lengths to find out as much information about residents before their admission. We invite them to join as day residents while waiting for a vacancy. We offer the service users guide and a preadmission visit so people have a written format of the services provided before the decision is made to choose a home. During the inspection 5 residents kindly agreed to complete CSCI surveys that asked questions about the home. The residents confirmed that they had received enough information before they moved into the home. The home had completed a Statement of Purpose and a booklet titled; Hill Brow Elderly Persons Residence Service Users Guide providing information to assist and inform potential service users. This was confirmed in a CSCI survey, as follows; my friends arranged all the business and I had plenty of information about the place before I moved in. Another resident simply said; Satisfied. The surveys indicated that the majority of residents had received support from their relatives with the moving in process. Comments from a relative completing the CSCI survey; I visit weekly and am kept informed of anything relevant should something occur of which I should be aware in between visits. Two CSCI surveys were completed by healthcare practitioners visiting the home; one stated that; staff are polite and welcoming. The home had developed a new preadmission assessments that reflect the recent Mental Capacity Act (2005). Residents would be asked in more depth about their decision-making capacity and to confirm what arrangements had been made with friends, family, advocates and representatives about current and future arrangements relating to significant events that may occur during their residency. Care Homes for Older People Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefited from the homes practice of regular care plan reviews that ensured residents care needs were catered for and any risk assessed was managed. This included medication required to maintain daily health and safety. Evidence: 6 care plan folders were inspected to confirm how the home had used and recorded the information gathered from the initial care need assessments. The residents care plans were comprehensive and easy to read. Each folder contained a photograph of the particular resident and the details matched the assessed needs that can also be found in same folder. Care plans contained details of the residents life history and other biographical information such as; where born, what school attended and current family situation. This information was listed in each of the care plans. It was the homes policy to review the residents care plans 24 hours after moving in and again after one month. Evidence was in place to confirm that the residents care needs were reviewed on a monthly basis.Care plans recorded how the home provided the residents care on a daily basis. Care had been taken to ensure that an accurate reflection of the Care Homes for Older People Page 13 of 32 Evidence: residents care needs was recorded, each member of staff was responsible for their key residents. This arrangement ensured that the residents were able to identify a member of staff who would be there to assist with a variety of activities that had been identified during the assessment period and saved the residents from giving information repeatedly to different care workers. One relative completing the CSCI survey confirmed that the care home gave the support to their friend; the support has increased with the increasing level of incapacity of Mrs X. Risk assessments had been completed where necessary to ensure the safety of residents and care staff, providing necessary information in order to provide the appropriate support. For instance some residents experiencing falls were issued with an alarm pendant allowing the resident the independence and freedom to move about the home. The added safeguarding bonus of charts detailing residents falls were also in place,up-to-date and showed evidence of healthcare practitioner involvement such as,physio and occupational therapists. Risk reduction programs had been devised as stated in the homes statement in the Service User Guide; as requested and required, arrangements are made for visits from or to GP, district nurse, optician, dentist, physio, sure that this and other practitioners. Medical records were present in each care plan folder relating to the care and attention of residents, nutritional intake, skin care and GP visits to the home. Visiting healthcare practitioners confirmed that the care staff always acted upon any advice given to them about the residents healthcare needs. Three CSCI surveys completed by the residents relatives all confirmed that the home supported residents to live the life they chose . Five CSCI surveys completed by the residents confirmed that they receive the care and support they needed. Three CSCI surveys completed by care staff at the home confirmed that they were always given enough time to meet the needs of the residents they supported. Details of the homes medication policy and procedures could be found in the homes Service Users Guide informing the residents of the homes methods of medication administration and briefly detailing what support the home offered in this area. Senior care staff were observed administering the residents daily medication requirements. Medicines were securely stored in a lockable trolley that locked whenever the senior carer left to administer the prescribed medication. Where necessary blister packs were in use and each time the prescribed dose was administered it was recorded in a Medication Administration Record, MAR. The medication records of three of the residents showed that medication had been administered by the senior carer on duty whose signature matched the specimen signatures within the MAR. The MAR showed evidence that care had been taken to Care Homes for Older People Page 14 of 32 Evidence: provide a liquid form of medication for residents who experienced difficulty swallowing tablets. Medication protocols and allergy warnings for individual residents were available promoting caution and safety. Evidence was in place showing how safeguards were consistently promoted such as; reminder cards to assist and prompt staff. Controlled drugs were recorded in a separate record and as stated in the homes, Service User Guide, had been signed by two staff members following administration. All medication spoilt, out of date or no longer required had been recorded and disposed of safely. CSCI had received notification about an investigation conducted by the home relating to a member of staff incorrectly recording the MAR. The home had informed all the appropriate parties including the local authorities. The home was able to show what action they had taken to reduce the likelihood of this happening again. Evidence was in place to show that senior care staff received training from a well-known pharmaceutical company. Care staff completing the CSCI who administered medication confirmed that they had received enough training and information about health care and handling medication. Staff were observed ensuring that residents privacy and dignity was considered andthat they were sensitive to their needs, knocking and closing doors whenever entering residents rooms. The health care practitioner completing the CSCI questionnaire confirmed that the home, always respected individuals privacy and dignity. Residents consulted confirmed that care staff listened and acted upon what they said and were always or usually available when they needed them. Comments received were; staff, do their best cannot fault them. They are very busy but when they have time they are always helpful. Another healthcare practitioner who regularly visited the home had completed the CSCI survey and confirmed that residents privacy and dignity was always respected, commenting; all treatments were conducted in the residents rooms. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home encouraged and welcomed family and friends to participate in activities and events and to maintain relationships and promote fun activities. Relatives family and friends were consulted about issues at the home, that were important to ensure a good quality of life was maintained. Evidence: A relative completing the CSCI survey on the day the inspection commented in the section titled; what do you feel the care home does well; personal care especially at night. Nice food, cheerful, baths and the opportunity for hairdressing etc.As stated in previous section, the care plans detailed each residents background including their likes and dislikes and the sort of activity they enjoyed and were accustomed to. An activities coordinator ensured that residents received a photocopied list of the activities , and menus, for their convenience in the main lounge area. A picture accompanied the printed description of each activity including; giant crossword, hairdressing , dominos, skittles and foot spa. The home encouraged volunteers to work at the home, a volunteer had organised regular, poetry readings that were appreciated by the residents. Care Homes for Older People Page 16 of 32 Evidence: Evidence showed that the home considered the residents interests, likes and dislikes the priority and had recorded these in an , Activity Profile in order for it to be included in the activities programme. The Residents Meeting listed activities that had been arranged for the Christmas holiday period this included; Bell ringers, two choirs, entertainment from schoolchildren from the local stage school, a trip to the pub, visits to a garden centre, visit to the panto and holy communion on Christmas Eve. The manager advised that residents were allowed to choose how they spend their time at the home and one of the CSCI surveys had included a comment; residents seem to spend a lot of time in their rooms. A resident who prefer to spend time in their room was consulted. The resident confirmed that they chose to spend a lot of time in their room because, they had everything they needed. Currently there favourite activity was bird spotting and watching them feeding at the bird table situated outside the patio window. Staff had ensured that the bird feeders were always filled with bird food. In the interests of the residents the home also had two cats in residence who were also able to exercise their individual choice. The home had recently implemented a risk assessment that stated; all animals must be kept out of the kitchen. Records showed that the home had ensured that residents with Alzheimers care needs regularly visited local centres of excellence that provided specialists advisers and workers who providing weekly clinics, drop-in cafe and social events. Regular contact with these independent groups made sure that regular and updated information about practice and equality and diversity provided a regular source of information. Family, friends,health and social care practitioners were all welcomed and encouraged to participate . As stated in previous section the home had designed and improved the assessment form to record the service users ability to make their own choices in relation to their the level of memory loss and dementia care need. This recognised the importance of ensuring that residents had the opportunity to commit their choices to record or if unable to, ensure that relatives and the home worked together in the best interests of the resident. The home had ensured that equipment was a made available that enabled residents to remain as independent as possible. For example one resident was observed using a dinner plate with simple click on addition enabling the resident to eat with one hand. The homes AQAA stated; all residents are given personal schedules relating to planned weekly activities in the home. We involve relatives and friends in all activities provided for in the home. This was confirmed in the minutes of the November 08 Residents Meeting detailing how successful the Garden Party had been in raising Care Homes for Older People Page 17 of 32 Evidence: money for a local charity. Relatives, friends and representative of residents were welcomed into the home and were included in the homes regular newsletter where a section was dedicated to the Relatives Newsboard. This was confirmed by the three relatives completing the CSCI surveys, in the section titled; What do you feel the care home does well; The quality of staff , friendliness of staff, good accommodation, well looked after most pleasant gardens. The homes AQAA stated that; We have a new cook who is heavily involved in ensuring that meals and snacks provided are not only nutritionally sound but meet the approval of all residents. A four week menu plan was in place, prominently displayed and available to residents in the main communal area. The menu contained a selection of nutritious food that had been chosen by the residents. In order to offer the residents the opportunity to choices they may not have tried before the chef had introduced a , Chefs Special. The chef had intended to expand and trial a six week menu plan in future. The home had made sure that residents choices were respected and periodically made available a questionnaire to confirm their views. The Resident Feedback Questionnaire relating to Catering and Food listed five questions that included; Are you happy with the food provided an additional snacks, have you any suggestions and, Does the home reflect your individual requirements such as your religious or cultural needs. The first item on the agenda of the residents meeting of November 2008 was about the food. The first line stated; since last meeting residents have been happy with the food it was agreed that we do have enough stewed fruit but residents can always ask for it as an option instead of desert of the day. Residents consulted during lunch agreed that they were enjoying their meal and it was noted that some residents had been supplied with equipment that support them to remain independent. Residents completing the CSCI survey on the day the inspection in the section entitled; do you like meals at the home, make the following comments; Alternatives available if required. The food is not good but they are very helpful including an alternative if one asks. Perfectly good enough, I attend the residents meetings and they do very well to listen to us. For out of five residents agreed that they usually liked the meals prepared and one resident only like the food sometimes. The the home is very open to the residents suggestions and the chef ensured that residents always had an opportunity to try something new. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents felt confident that any concerns they may have would be listened to and acted upon by the care staff and manager. The home recognised the need to be aware of safeguarding issues and made sure staff training was in place so that care staff were confident to follow Hampshires safeguarding procedures and action any concerns that may arise. Evidence: The Complaints Procedure was clearly displayed on a noticeboard within the entrance of the home. The Service Users Guide made available to new residents, gave details of how to contact CSCI and detailed timescales to be followed in the event of a complaint being made by residents, relatives and their representatives. Records were available to confirm the homes practice. The homes AQAA stated; We deal with the complaints before they become an issue. Records showed that this was not always the case. Details concerning a resident who persistently made complaints about things going missing were detailed in the complaints book. They showed how the home had managed the complaint by working closely with the resident and their family to understand the nature of the complaints and by doing so home was able to empower the resident and resolve the complaint. The residents completing the CSCI survey confirmed that they always and usually Care Homes for Older People Page 20 of 32 Evidence: knew who to speak to if they were not happy, commenting; Several senior staff available, the manager, it would be better if there was always someone in the office that one could talk to or to ask for help. All residents confirmed that they knew how to make a complaint. It was observed throughout the inspection that the manager practiced and encouraged and Open Door Policy . The homes AQAA reported; We ensure all staff are trained in all types of abuse awareness as soon as they arrived at Hill Brow. The three CSCI surveys that were completed by care staff confirmed that they were aware of the homes policies and procedures relating to safeguarding adults and discussions with care staff confirmed that they were aware of the required action in the event of a safeguarding issue occurring. Evidence was in place to show that the home had responded to what it considered to be a Safeguarding Alert by following the Hampshires Safeguarding Procedures, the home had contacted the local authorities and CSCI. Care Homes for Older People Page 21 of 32 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. The home provided service users with a clean, tidy and homely environment that enabled them full and safe access throughout. Evidence: A tour of the premises was conducted in and around the home. The homes gardens provided the residents with a paved walkway that surrounded the home and that led to lawns and a pond stocked with goldfish. The lawns, shrubs, trees and plants had been regularly maintained by the gardener employed by the home. Residents consulted during inspection all agreed that the garden was very much enjoyed and provided and essential quality to life at the home. The minutes of the November residents meeting showed that there was some concern expressed by the residents about the local heron that was taking the goldfish. Residents completing the CSCI survey confirmed that the home was always clean and tidy and the homes two lounges were comfortable, airy and above all homely. This was especially so in the conservatory area. Residents had the choice to relax in the TV room or in a second lounge to enjoy peace and quiet or conversation with other residents all families and friends, as commented in the homes, Statement of Purpose. All residents rooms had views of the garden. There were two lifts available to reach Care Homes for Older People Page 22 of 32 Evidence: the first floor of the residents accommodation. The homes original lift was still in working order but only used in case the other lift was being maintained. The residents rooms reflected their personality and and contained their chosen possessions and furniture. A resident who chose to spend a lot of their time in their room confirmed that they enjoyed, reading, listening to the radio and watching the birds through the window and when, during warm weather they enjoyed spending time in the garden. The homes AQAA confirmed; We have a continual written maintenance and improvement programme. Regular maintenance of gardens and easy, safe access to use the gardens 365 days per year. Residents were observed returning from a walk around the garden suitably dressed for cold weather. During the inspection tests to all the electric systems were being carried out. The home had its own full-time maintenance person who ensured that the homes cycle of repairs and refurbishment was implemented and who was also available to assist the residents with any maintenance enquiry or problem. A residents completing the CSCI survey when commenting about staff responsible for maintenance said; they were always around to help out . Residents bathrooms and the WCs contained equipment to ensure their care needs were met and were clean and tidy. The November 2008 newsletter confirmed that; changes and improvements had been made over the year. Many of the bathrooms have been refurbished, common areas have been painted and carpeted, residents rooms have been we carpeted and the conservatory has been spruced up. The utility room used for laundry and washing machines with a sluice cycle and area for hand washing equipped with paper towels and liquid soap. This area was also clean and tidy and provided a safe space for care staff working in the area. The manager advised that the home was considering employing a housekeeper to take sole responsibility for this area of support. Care Homes for Older People Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home provided residents with an enthusiastic and well-qualified staff team to ensure that their care needs would be met. The homes recruitment procedures ensured that new care staff were thoroughly vetted and that they received induction training to ensure the safekeeping of the residents. Evidence: Staff rotas showed that there was a minimum of four care staff available in the mornings, not including the manager and deputy manager. Three staff work in the afternoon and two waking night care staff,a cleaner and cook. The manager advised that the home was considering employing a housekeeper to take charge of laundry management. It was evident from the CSCI surveys that residents felt supported by the care staff at the home. They confirmed that they always received the support they needed, staff listened and acted on what they said and staff were always available when they needed them. The homes AQAA advised that it employs fourteen full time care workers including 12 who have achieved National Vocational Qualification, NVQ, level 2 or above. All care staff had received an induction programme when starting work at the home. The Care Homes for Older People Page 24 of 32 Evidence: Service User Guide set out an easy to read summary of the homes staffing levels and their qualifications. The manager holds a Train the Trainer qualification and was able to offer regular in-house training to all staff. The personnel folders of five care staff was inspected for details of qualifications, training and the homes recruitment practice. Files included new care staff to the home who also able to give a brief account of their understanding of the homes policies, training and their current responsibilities on the day the inspection. The care home is required to ensure that recruitment practices are robust and stringent vetting procedures are pursued prior to care staff being employed at the home. The inspection of five personnel files showed evidence that the following documents were in place. There was evidence of, Protection of Vulnerable Adults, known as a PoVA first check and notifications from the Criminal Records Bureau,CRB confirming staff suitability. Other evidence required to clarify care staff backgrounds included; job applications, references, photo ID including passport details were in evidence in care staff files. There were two instances of insufficient employment history in application forms. The manager confirmed that she would talk to the the appropriate care staff and ensure that their employment histories were completed. Care staff files showed evidence of training that was relevant to the care needs of the residents at the home including a range of health and safety training such as fire safety, infection control, manual handling and hoist practice, food hygiene. More specific resident focused training such as; dementia care, falls management sensory loss, stoma care and diabetes care ensured that residents care needs were being met. There was also evidence to show that training courses relating to; Parkinson, Stroke awareness and Palliative care had been received by care staff and evidence of a 12 week induction programme currently in use. The home was particularly aware of the need for bereavement and loss awareness training in the light of care for older people and had taken great care to introduce palliative care training for staff at the home. The AQAA stated; Our staff have attended training and become experts in palliative care we had encourage residents, relatives and friends to join all our training sessions to improve their knowledge of how the home is run. Relatives completing the CSCI survey confirmed that care staff had the right skills and experience to look after the residents properly. Comments included; Mrs X seems to be the most kindly looked after and staff here are always very sweet and caring in my presence. Care Homes for Older People Page 25 of 32 Evidence: New care staff confirmed that they had received induction training and were aware of a range of the homes policies. Care staff were required to sign each policy after reading and received input from recognised training bodies. Details of staff appraisals were in place enabling the home to be aware of the training needs of their staff. The three care staff completing the CSCI survey confirmed that they; always had the right support to meet the residents diverse care needs and received training which was relevant to their role and kept them up-to-date with new ways of working. Comments included, in the section titled what does the home do well; help me if I want to know anything and give good support when needed, good atmosphere, nice environment, trips for the residents. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives benefited from the the homes management ethos and were asked regularly for their views on the homes provision of care. The home ensured that provision was made for the safekeeping of residents monies. Health and safety was promoted in order to safeguard the residents relatives and care staff at the home. Evidence: The manager had attained level 4 NVQ registered managers award and due to her continued service at the home had gained essential insights relating to residents care needs,local knowledge of the community and what support was available from health and social care providers. There were no areas of concern to report to the manager following inspection of Hill Brow. There was only one issue for improvement relating to care staff and their employment history records. The manager advised that she would ensure that the care staff Care Homes for Older People Page 27 of 32 Evidence: employment histories were completed. Residents and their relatives, new to the home received ample information and opportunities to visit including day visits. Care need assessments were in place regularly reviewed following the initial preadmission assessment as were care plans and risk assessments. Residents consulted on the day of the inspection enjoyed ths activities that had been arranged, hoop-la and the big crossword was proving to be a favourite. Residents who prefered to stay their own room were content with their choices. The manager contacted the local authority when there was potential safeguarding issues to discuss. The home and grounds were well maintained and presented a safe and accessible environment to residents,families and friends. Staff training matched the care needs of the residents who were satisfied with the care service they received commenting; I find it hard to say what they could improve on, I think they do very well. I am quite happy here so far. A response from a relative of one of residents commenting on the care she observed; staff here are always very sweet and caring in my presence There were more compliments available alongside the complaints book giving evidence of a balanced managerial approach. The homes annual business plan detailed objectives and top of the list was Achieving Quality . The family run organisation were currently planning the opening of a new Dementia and Terminal Care Unit beside the existing home. A comment received in the CSCI survey supported this new development, in the section titled how do you think the care home can improve; the nursing wing and dementia wing will be a great help. Care staff consulted felt supported by the manager and the home is applying for consideration in the Investors in People award. There was plenty of evidence to confirm that residents their relatives and representatives were involved with the running of the home and their views sought. This included; minutes of residents meetings, the newsletter, emails, meal planning and the homes own quality audit were readily available for inspection. References of a variety of consultations with residents and relatives are included throughout the body of this report provide further evidence of the homes commitment to involve all interested parties in the running of the home. One resident felt that the terminology used to advertise Hill Brow for example on the cover of the service users guide, Hill Brow Elderly Persons Residence, and the overuse of the word, Elderly, represented a negative stereotypical view of older people and in particular the residents at Hill Brow. The manager agreed to discussed this at the next residents meeting. The home took responsibility to ensure the safekeeping of small amount of residents money to ensure residents were able to access local facilities and to make purchases, such as hairdressing. The inspection of one residents petty cash was inspected. There was evidence to confirm that procedures were being followed. Receipt books and cash held were checked, monies counted and these tallied with the recorded amount. Care Homes for Older People Page 28 of 32 Evidence: The promotion of health and safety was evident during the inspection as the electrical systems were being tested including fire alarms. There was evidence of maintenance and recent refurbishment throughout the home. Staff responsible for maintenance were knowledgeable about the areas of risk throughout the home. The local authoritys Environmental Health Department had recently inspected the home and confirmed under its own food safety scheme titled safe2eat awarded the home an Excellent rating. Due to the homes overall efforts and robust approach to health and safety there were no concerns in this area. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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