Inspection on 10/01/06 for Hill House

This inspection was carried out on 10th January 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill House 10/09/07

Hill House 16/06/06

Hill House 30/08/05

Hill House 24/02/05

Hill House 16/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Hill House Station Road Pulham St Mary Diss Norfolk IP21 4QT Lead Inspector Mrs Judith Huggins Unannounced Inspection 9.10 10 January 2006 th Hill House DS0000027489.V272888.R01.S.doc Version 5.0 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 House DS0000027489.V272888.R01.S.doc Version 5.0 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 Adults 18-65. 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 House DS0000027489.V272888.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hill House Address Station Road Pulham St Mary Diss Norfolk IP21 4QT 01379 608209 01379 608209 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) Care Perspectives Partnership in Care Limited Mrs Christina Bleach Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: Hill House is a large detached home with accommodation on two floors. It provides personal care and accommodation to 8 adults with learning disabilities and some degree of challenging behaviour. All service users have single bedrooms. There is a large through lounge with a central chimneybreast, and separate dining room. The back garden is fenced all round and gated at one side and between the main home and garage, providing a secure area for service users to enjoy fresh air or play games, weather permitting. Participation in domestic activities including cleaning, laundry and cooking is considered part of daily life for service users, with support from carers, and within their capabilities. Ancillary staff provide additional assistance. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted approximately four hours. During the inspection, part of the home was seen, a new member of staff, the manager, assistant manager and two residents were spoken to. One other resident was spoken to but in common with the majority of people living at the home, has significant communication difficulties. (At present, 7 people live at the home.) A selection of records was looked at. What the service does well: What has improved since the last inspection? At the last inspection there were concerns the way the administration of medicines was recorded. The manager and staff responsible have worked hard to improve this – with additional training and audits of records. At this inspection there were no gaps in records, and the way medicines were prepared for giving to residents, together with records made, was good. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None. None of the standards was inspected. The key standard was checked at the last inspection. EVIDENCE: Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8 Residents (or their representatives) know that assessed and changing needs and goals are reflected in their individual plan. Residents are consulted on and participate in aspects of life at the home within their capabilities. EVIDENCE: Care plans are reviewed regularly and personal goals are documented. An advocate visits the home regularly, based on the visitors’ book and information from the manager. However, the involvement in supporting residents with their care plans is unclear – either in preparation for these, or in following up afterwards. On one of the three individual lifestyles plans seen, there had been no advocate present at six monthly review meetings since before July 2003 (the earliest set of notes on the file). There is minor slippage in recording progress towards goals, although there was evidence, where there are concerns, that these were reviewed at the planned “individual lifestyle plan” meeting, rather than at the time specified on the goal sheet. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 10 The abilities of residents to understand and communicate mean that it is difficult for them to participate in the development of polices, staff meetings and representation within the management of the home. However, residents spoken to confirm involvement in the day-to-day running of the home, in relation to domestic activities. This includes some responsibility for helping keep their rooms tidy and for laundry. The inspector was particularly pleased to note the interaction between one resident and the member of domestic staff. Despite communication difficulties there was conversation and discussion about activities and the person was encouraged to assist with the simple domestic task of opening a cupboard door. Efforts are made to ensure people understand information about the home – with the advocate being involved in explaining the resident’s information leaflet and recording this on the previous version. The document has been revised and updated, using simple and clear language. The new version has been included in the care plan files for some residents, but there is no further evidence that the “updated” version has been explained or discussed. Residents are informed and consulted about the activities available to them each day. Two were aware of and prepared for a planned lunch trip out. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 16 and 17 Residents engage in appropriate leisure activities and their rights and responsibilities are recognised in daily lives. Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: Each resident receives input from separate day care staff, based on records seen. Notes record that people participate in a range of activities supported by these staff and staff from the home. Two residents were going out for lunch on the day of the inspection, another was anticipating a trip during the afternoon. People have equipment in their rooms reflecting interests and hobbies such as music, video or television, and evidence of some craftwork. The resident’s information leaflet sets out people’s rights and entitlements, such as eating on their own or with others, having privacy and how this will be upheld and their responsibilities for domestic tasks such as helping to keep their rooms tidy with staff support. Risk assessments document where these areas might be compromised, such as where they might be unable to hold a room or house key, but this is Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 12 balanced by the instruction to staff that they must knock before entering rooms. Residents receive their mail unopened based on documentation seen, and risk assessments support where staff need to be present when it is opened because the person would not understand or take care of the content. This is good practice. The assistant manager assumes responsibility for devising menus and, she says, takes into account the likes and dislikes of residents. These are documented in care records and two residents confirmed involvement in choosing the main meal of the day. Lunch menus are more flexible and generally not recorded as meals are made as and when residents wish, or they may take these out based on daily records and discussion with two residents. The menus for main meals seen show a range of different types of meals, balancing residents’ wishes with healthy options. Cupboards show a good range of ingredients is in stock, and fresh vegetables were seen. The assistant manager confirms that meat is sourced locally and that the majority of vegetables used are fresh. This is good practice. The weights of residents are checked and recorded regularly, and in one case show some significant recent gains which need monitoring. It is known from previous inspections, from a risk assessment and from discussion with staff, that one person continues to prefer to eat on their own, as this reduces anxiety and agitation. This is facilitated. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 in part. Residents receive personal support in the way they require and insofar as they are able to express a preference. Their physical and emotional health needs are met. The management of medication has improved since the last inspection, so that residents are more fully protected by procedures, EVIDENCE: Staff have found ways of delivering personal care to residents, which minimise their anxieties and any agitation. These are recorded on care plans setting out how the staff team will be “successful” in supporting each person. There is evidence on records and from observation that preferred times of rising and retiring are respected, subject to the responsibilities of daytime activities. On the day of the inspection, one person had come to see staff wearing a dressing gown, as they did not need to be ready for daytime activities so early. Another was wearing pyjamas when coming to ask staff a question. Records show that one person does not like to go to bed before night staff arrive, and that on occasions the person may fall asleep in the lounge. To satisfy the person’s preference, staff are instructed to allow this via the care plan. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 14 There are some issues with keyworking due to vacancies. See comments elsewhere regarding advocacy input. There are monitoring sheets in use showing that health care concerns are recorded and followed up with the appropriate person and that routine checks are also made (for example with the dentist – with the agreement of the resident’s concerned). There is access to psychology within the provider’s company and evidence of involvement of other specialist such as psychiatric services where this is needed. The full medication standard was not reinspected, having been checked at the previous visit. However, requirement was made at that inspection about the recording of medicines. Since then, the manager and staff responsible have worked hard to improve systems. The manager says that further training has been delivered and as a result, additional advice secured about the recording of medication. Records of medication administration for each resident were checked and show no omissions on this visit. The person administering medication during the inspection did so to one person at a time, making reference to the medication administration chart and labels, and ensuring that the cupboard was securely locked when unattended. The record was observed as signed after the medication was taken. There was very limited secondary dispensing of necessity, given an outing in which residents participate. There is a separate recording sheet for checking and dispensing this. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None Neither standard was inspected as both were checked at the last visit. EVIDENCE: Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 in part. There are shortfalls in the maintenance of a homely and comfortable environment. There remains a minor shortfall in cleanliness. EVIDENCE: There have been no changes in the shared or personal space available to each person. It is in keeping with the local community. Residents are able to access the main lounge freely. Access to the kitchen and dining area is restricted (documented in risk assessments) due to behaviour and abilities. There were significant problems with the temperature of the home on the day of the inspection as the boiler had broken on the previous Sunday. It had not proved possible to repair and the nature and abilities of residents meant that portable, temporary heating was really only practicable in the lounge. The remainder of the home was cold and unheated. Two residents agreed it was cold. One did not like having to use a different bathroom. The manager had done was she could to stress the urgency of the situation with the maintenance department, based on discussions with her. An immediate requirement was left. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 17 The failure of the boiler meant that the main part of the home had no hot water. Residents had to use the facilities at the far end annexe. During the course of the inspection a replacement immersion heater was fitted and there was hot water in the main part of the house at the close of the inspection. No requirement was therefore made. At the last inspection recommendation was made regarding the accumulation of debris behind machines in the laundry. This is difficult to access, but the continued accumulation presents the potential for blockage of vents or increased fire risk, as well as potential cover for vermin. Debris includes fluff and socks. The tumble dryer is also not working but arrangements have been made for clothes to be dried at another home a few miles away pending repair. The dishwasher is not working at present. The manager believes this is due to lack of water pressure at the moment. This, together with the lack of hot water in the main home without recourse to boiling kettles, presents concerns for thorough cleaning of crockery and utensils and has resulted in additional workloads upon staff. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 in part, and 35 Standard 33 was inspected only in relation to recommendation made at the last inspection. Records do not support that training is delivered as set out in standards, although there is a good range on offer to help meet residents’ needs. EVIDENCE: Some new staff have started at the home, but there has also been internal promotion and outstanding vacancies remain. The manager says she believes they are to be advertised this month. She says there are three vacancies at present. The recommendation is therefore repeated. It is acknowledged that existing staff are covering these hours at present and as there is little demand for annual leave at present, the manager says this has not been a problem. The “in house” induction records for two new members of staff were checked. These have not been fully completed and signed off, although discussion with one of the members of staff showed that a good range of information had been covered. Additionally, staff have covered BILD induction competencies, but one person starting in October has not yet had the results and assessment back and so there are – as yet - no supporting records of completion and the standard achieved. The person concerned confirmed completion of the company’s induction programme. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 19 Computer held records show that staff have access to a range of training, but do not show that all have received the equivalent of five days paid training in the last twelve months. This may be because NVQ training days are not shown. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None None of the standards was inspected. EVIDENCE: Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 x x x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hill House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x DS0000027489.V272888.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 YA24 Regulation 23(2)(p) Requirement Timescale for action 13/01/06 2 YA24 37 3 4 YA30 YA35 23(2)(d) 18(1) IMMEDIATE REQUIREMENT The registered person must ensure the boiler is repaired/replaced and capable of maintaining all parts of the home at a reasonable temperature by 5pm on the due date. The registered persons must 31/01/06 notify the Commission of all events which adversely affect the well-being of residents (in this case failure of hot water and heating) and events specified in the regulation. The registered persons must 31/01/06 ensure fluff and debris is cleared from behind laundry equipment The registered persons must 31/03/06 ensure that there is evidence all staff receive a minimum of five days relevant training per year. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Hill House Refer to Good Practice Recommendations DS0000027489.V272888.R01.S.doc Version 5.0 Page 23 1 Standard YA6 2 3 4 YA8 YA33 YA35 The registered persons should ensure that there is evidence of the nature of advocacy input and how this supports people in the review of care plans and personal goals. The registered persons should ensure that there is evidence of efforts to explain information to residents where this is changed or updated. The registered persons should make concerted efforts to recruit to remaining vacancies. The registered persons should ensure training records for each staff member are kept up to date. Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hill House DS0000027489.V272888.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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