Inspection on 10/09/07 for Hill House

This inspection was carried out on 10th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill House 16/06/06

Hill House 10/01/06

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 Silas Siliprandi Unannounced Inspection 10th September 2007 10:00 Hill House DS0000027489.V350722.R01.S.doc Version 5.2 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.V350722.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V350722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill House Address Station Road Pulham St Mary Diss Norfolk IP21 4QT 01379 608209 P/F01379 608209 tbleach@partnershipsincare.co.uk www.partnershipsincare.co.uk Partnerships In Care Limited 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) Mrs Christina Bleach Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2006 Brief Description of the Service: Hill House is a large detached home with accommodation on two floors. It provides personal care and accommodation for up to eight people with learning disabilities and some degree behaviours that can be challenging to others. All service users have single bedrooms. There is a large through lounge with a central chimney-breast, 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 outdoor activities or relaxation. Participation in domestic activities including cleaning, laundry and cooking is considered part of daily life for service users but this has to be managed within a clear understanding of what people can actually do, and within a framework of staff support. Ancillary staff provide additional specific assistance. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place as an unannounced visit to the home on an ordinary working weekday on Monday 10 September 2007. The visit started at 09.50 and lasted until 6 pm The manager was not on duty, but senior staff on duty provided appropriate assistance and information. All of the key standards [see the body of the report] were looked at, and some of the other standards were also taken into account to help to provide a more rounded picture. This inspection took stock of the existing policies and procedures of the home, this was mainly only to look at any changes or additions that had taken place since the previous inspection. The records for some of the people living in the home were then gone through carefully. The reason for looking at these records is to see how thorough and careful the home had been in finding out what people needed. As well as finding out what people need and want it is very important to learn exactly how individuals prefer their care to be given. These same records were then looked at to see what the home was doing to provide care to meet peoples’ needs and to support them in their daily lives. During the inspection people living at the home were asked how they felt about how well the home had listened and learned about what they needed and wanted. They were asked to say how well they felt the home was supporting them in their daily lives. The staff on duty were also talked to about the same things The inspection also looked at staff training and general practices in the home [such as giving out medicines]. A tour was made of the inside and the outside of the building to see what kind of condition everything was in, and to find out if the home was generally properly suited to the people who live there. In addition to the information gathered during the visit the Commission has also used the written information it gets routinely from the company owning the home. The Commission also asked service users’ relatives or representatives to help in providing their own comments about the way they saw the home working. There was a good response to this request and the comments we received have been incorporated into the report. The weekly cost of care at the home is [around] £1,150.00. This varies from individual to individual according to assessed need. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 6 What the service does well: The home really does work hard to find out what people need and prefer. The process is thorough and detailed and is broadly supported by a sensible and sound set of records. It was not completely easy to communicate with people living at the home without first getting to know them better, but the inspector got a strong impression that people living at the home were positive about how well the home found out what they needed and preferred, and that [generally speaking] they felt that they were taken proper notice of in respect of their care needs. They also said that what they said did get acted on when they wanted something to change. Peoples’ healthcare needs are well recorded and actions taken in a timely way to assist in maintaining good health. There is a genuine intention to provide a wide range of support for daily activities both inside and outside the home. Despite constraints these good intentions are often brought to fruit. The goodwill and flexibility of staff is evident. Staff training is ongoing [and sampled staff commented positively about this]. The staff sampled for interview proved to have a good knowledge of the people they were working and a genuine enthusiasm to promote their welfare. They also were properly knowledgeable about the duties they were expected to carry out Service users relatives continued to have a generally positive view of the service and about the overall efforts of the care staff who work there. The manager of the home is well qualified [and continues with training to ensure ongoing professional development] and has appropriate experience to run the home. The provider takes steps to consult with a wide range of people [including the people living at the home and their relatives and representatives] to find out from others how well they are doing. This knowledge is then fed back to improve services The providers say that despite their efforts they cannot yet rely on getting the feedback they would like from some of the bodies [such as Local Authorities] that buy care at the home on the Service Users behalf. They have taken the robust view that they need to persist in these efforts and are looking at new and different ways of getting people to respond. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home really does have a good system for finding out what people want and how best to provide care responses. The present record system is maybe not exactly right for helping to keep track of those special care responses where people are actively ‘changing’ their lives. Some additional special /specific process and records may prove an answer. The owners of Hill House also identify a similar area of need. In common with many homes of this size Hill House has a very difficult balance to strike between ensuring that all needs are adequately met and [wastefully] providing more staffing resources than are actually needed. The present balance has edged much more toward the ‘low’ end of this scale than is desirable. The following areas all seem to have this issue as a common thread:Some service users’ needs [and associated behaviours] need re-assessment and staff provision and training need to be matched to what is found. Keeping on top of maintenance, decoration and cleaning seems to lag behind the ideal. While not all of this may be attributable to staffing level, some of it probably can be. The level of activities both inside and outside the home appear to be less than what the company itself originally planned for, and what would be expected when looking at the assessed needs and abilities of the people living at the home. Some comments from service users’ representatives echo this impression. For example, although comments were made about the overall satisfaction with the way in which staff behaved, these have to be put alongside other comments that highlight impressions that this can be a variable picture, that staff levels can affect what is going on, and also that [due to apparent levels of staffing] inexperienced staff can be put in a position where there inexperience is exposed by events. As already mentioned, the home is very good at finding out what is needed, and also it is good at keeping track of what is changing. The way in which Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 8 [and the speed at which] responses are then made sometimes lags behind the information to a greater extent than is desirable. For example, the needs [and associated behaviours] of some residents are well known, but continue to result in a greater level of inconvenience and risk to themselves and others than ought to be the case. This is not to say that the home has failed to notice the issues, or that it has failed to seek appropriate advice and input; it has done that in a very sound way. What is surprising is that the current level of unresolved difficulty still persists in this and some other areas. 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. The summary of this inspection report can be made available in other formats on request. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 9 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.V350722.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard two was inspected. Elements of standards 1,4 and 5 were also looked at. People are [in broad terms] given the information they need to choose a home that will meet their needs. They have their needs assessed and care responses planned to meet those needs. There is a clear contract detailing the services and support that will be received. The ‘suitability’ of the service for some service users has to be questioned. [See ahead to ‘Environment’ and ‘Staffing’]. This has an adverse impact on what would otherwise be at least a ‘good’ service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose is clear and to the point. It is [fairly] plainly written. It covers the expectations required. The Service User Guide [called the Residents’ Information Leaflet at Hill House] is equally to the point and also reasonably plainly written. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 11 Neither the Statement of Purpose nor the Service users’ Guide are available in any format other than printed paper. Information received from the home prior to the inspection said that the Statement of Purpose and the Residents’ Information leaflet had been reviewed within the last 12 months. Solid and detailed assessments lead on to detailed and individual plans for care. Contracts set out the individual terms and conditions in respect of accommodation and services. However, it was not possible to understand from this record exactly what specific staff time or skills were being contracted for to meet need as originally assessed by the individual purchasers of care. The home provides information to service users, which covers information about the service, and clearly sets out terms and conditions of occupancy. At this stage there is no means of sharing any of this information with service users other than in writing or verbally. The levels of ability and need of current service users is of a kind where difficulties in communication are commonplace. The service user records sampled were completed in depth. Not all information was as yet attributed to its exact source. It was not possible to look at any recent admission to the home to see how well the admission went because there have not been any. The policies covering this process did provide a good foundation, if they were to be followed all ought to be satisfactory. For example, the policy aims to avoid emergency admissions, and aims to ensure that any person thinking of moving into the home has several opportunities to visit prior to making a decision. In addition there was some historical evidence showing that potential service users [to fill a long-standing vacancy] had been given opportunities to visit and the outcomes of these visits is evidence that information is then gathered and used to gauge mutual suitability. This is good evidence that people are not just admitted to the home ‘because they are available’, but that there is instead a sound and proper practice of gauging mutual suitability. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 6,7 and 9 were inspected. Elements of standard 8 were also looked at. Standard 10 was not inspected. Individuals using the service do have their needs and views taken proper account of in the care responses and, in broad terms, do have appropriate actions planned. However, there are some staffing level issues that need attention. [See ahead to section on Staffing]. These issues are currently having an adverse impact on the way in which people are supported in the choices they can make about their daily lives and on an otherwise ‘good’ set of procedures. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 13 EVIDENCE: Sampled care plans seen include detailed personal, social and healthcare support needs. A noteworthy component being the “Communication Plan” that helps everybody understand the most effective way to communicate with a particular individual, with useful notes observing how that person makes their own wishes known. Activities and care responses are assessed for risk. Where certain individual behaviours or abilities are assessed as posing challenges or risks to others plans to manage or minimise these behaviours are drawn up. It did not always prove easy to ‘case-track’ [to see where a particular risk arose from for an individual, and then to understand what actions were taken, and how and why these then changed over time] with the service users selected for sampling. Where care responses prejudice individual rights reasons are properly recorded. Care plans and their associated risk assessments are formally reviewed every six months, but changes are often introduced via other routes at shorter intervals. The way in which daily notes are kept does not yet always make it as easy as it ought to be for key workers [staff with special responsibilities for one particular service user] to monitor changes and bring plans to fruit. The format presently in use is not helping the process. It was reported that the staffing levels currently provided curtail some activities; in particular the “activities co-ordinator”[who has specific responsibilities in activities, especially outside the home] has only a limited amount of time available so staff at the home do not receive the level of backup that was originally planned for. The abilities and needs [and associated behaviours] of some of the service users add to this time pressure and to the risk levels. Annual reviews are carried out with the involvement (where possible) of social workers and/or relatives. Key workers take a lead role in the service users review. Independent outside advocates are now said to play an increasing part in these processes, although it is evident that Advocate involvement is still at a fairly early and basic stage so far. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11 to 17 were all inspected, but the main weight of inspection lay on key standards 12,13,15,16 and 17. In broad terms people who use the service are supported to make choices about their lifestyle and the development of their life skills. Activities are provided in a way that is intended to provide a range geared to individual needs and expectations. However, the present arrangements for staffing are proving disadvantageous to the home’s own plans. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 15 EVIDENCE: Assessments and care plans give a very solid underpinning by finding out what people want and need, and plans are made to respond to those expectations. Service users do engage in activities at the home [including domestic duties tailored to individual abilities, that are worked out with the service user and then shown in the care plan]. Not everybody living at the home at present is capable of this kind of input. Service users also have activities outside of the home and transport is available [or hire cars can be used]. Examples of present outside activities being bowling, the cinema and shopping. Activities are supported by care staff and an ‘activities coordinator’ who is a member of day services staff employed by the group with a special responsibility to support appropriate activities. The amount of time available from the activities coordinator is limited. The needs of the service users are diverse and complex, with some high levels of care needs having a significant impact quite regularly. These factors do have an adverse impact on plans to develop skills and enjoy leisure activities. The level of ability and need of service users makes it inappropriate at present to look for formal outside employment, either paid or voluntary. The staff interviewed said that service users did get support to maintain links with friends and family. This comment was backed up by the comment cards received from service users and their relatives/representatives. This includes facilitating visits home by taking shared responsibility for travel for longer distances. Carers were observed talking to and interacting with service users throughout the inspection visit in a relaxed but respectful way. Meals are planned and prepared by both carers and [to a much more limited extent] by service users. However, there is evidently choice if planned options are not preferred. Menus seen show a good balance and range of food, but nobody in the home as yet had any formal training in nutrition. Service users play a very limited part [due to their abilities] in preparing their breakfast and mid-day meal, but are not much involved in preparing the evening meal. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 18,19 and 20 were all inspected. Standard 21 was also taken into brief consideration. The health and personal care that people receive is based on their personal needs. The principles of respect, dignity and privacy are, in broad terms, put into practice. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The underpinning process of assessment, planning for care and reviews of care form a very detailed and sound foundation for this process. Sampled records show a variety of matters being asked about and then followed up in a thorough way. There are prompts to help everybody remember appointments and reviews of care. Staff were able to explain in a coherent way how healthcare issues were picked up, followed up and kept in view. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 17 Training in the administration of medicines has kept pace with the system in use. The administration process was observed and seen to be carried out in a thorough and proper manner, in addition proper auditing processes were in place. The risk assessments show that none of the present service users are capable of administering their own medication with sufficient safety or reliability There was a level of general awareness about dying and death. The present level of staff training was not high in this area. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 22 and 23 were both inspected. People who use the service are supported to indicate their concerns. They have access to a robust and effective complaints procedure, are protected from abuse and have their rights protected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has good underlying policies and procedures for the protection of service users that is being increasingly backed up by accumulating staff training. A new record and process for following up ‘informal, complaints was seen There is as yet no real solution to the present problem of communicating an independent understanding of these processes to service users except by verbal explanation of written documents. Each service user’s file does have a pictographical explanation of the process, but staff said that none of the current service users were in a position to make use of this type of communication. The training for all staff includes reference to what abuse comprises of, and its varieties. This training is given as part of the induction process and as an annual refresher. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 24 and 30 were both inspected. Elements of standard 28 were also looked at in some detail. Standards 25, 26 27 and 29 were briefly considered in part only so as to add some extra detail. The physical layout of the home largely enables people to live in a safe and reasonably comfortable environment, with an appropriate location for the purposes of the home. The overall impression is properly domestic in scale and style. Some issues associated with certain behaviours, some maintenance/cleanliness matters and staff accommodation issues are having a significant effect on what is otherwise [at least] an adequate service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 20 EVIDENCE: The location of the home does mean that local amenities are very limited, including levels of public transport access. The building and grounds provide sufficient space both inside and outside. The main communal areas are in fair to good decorative order and were clean and tidy [without being oppressively so] on the day of inspection. They were [broadly speaking] in reasonable or good decorative order. Staff said that new lounge furniture was due to arrive imminently. Other areas were much less domestic in their decorative style and some were approaching or at the end of their service life. All of the considerable amount of varnished woodwork [doors and banisters] was in poor condition. Given the needs of some service users the suitability of the bathing and w.c accommodation was [at best] marginal. The home probably needs a specific sluice facility. The levels of cleanliness and tidiness in some areas was poor. Some examples being:- Bathroom bins were overfull, the bathroom floor was badly marked with what appeared to be lime-scale and w.c. pans stained. The kitchen cooker [especially the oven] was in need of cleaning. The upstairs landing carpet had numerous pieces of what appeared to be chewed apple on it. There was a very noticeable smell of faeces in the entrance hall, on the stairs and in the upper landing area. There was a strong smell of urine particularly in the area leading to the upstairs bathroom. Staff ascribed this as the results of specific needs and behaviours of service users. A temporary improvement had been made to staff accommodation since the last inspection, but no long-term improvement was yet in place. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 32,34 and 35 were all inspected. Several elements of standards 33 and 36 were also looked at. Standards 31 was looked at briefly to add some detail to the overall picture. The staff in the home are [by and large] trained and sufficiently skilled to support the people who use the service. Staff are, in broad terms, trained to support the terms and conditions of the service and the smooth running of the home. However, the present needs of the service users calls the present level of staffing in the home into question. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 22 EVIDENCE: Detailed records of staffing and staff training were not accessible for inspection. There is a difficulty to be overcome in providing the Commission with access to these records whilst still maintaining their inter-staff confidentiality. The home’s policies show them continuing with good, sound recruitment processes. These records also show the normal process of staff training continuing to make forward progress. Staff selected for interview were clear in their views that they were comfortable with the way in which training and management supported them in their job roles. The present staffing level is low when compared with the assessed needs of the service users and also as highlighted by some specific behaviours associated with individual needs. The levels of activities is also lower than that originally planned for, some areas already commented on in respect of cleanliness and tidiness may also reflect the level of staffing currently available. Records of staff appraisal and supervision are now well established with the staff interviewed making positive comments about the process. Service users and their representatives made positive comments about staff, about how helpful they were and how they did actually listen to and act on what was wanted. However, comments were also made about the fact that staffing could sometimes be experienced as at rather a low level and that while staff tried hard new staff could sometimes be experienced as lacking some key elements of knowledge or understanding relevant to the general needs of service users with learning difficulties, or with the specific needs and preferences of some service users. Staff interviewed were able to describe their roles in detail and showed a sound understanding of the wishes and needs of those they were working for. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 37,39 and 42 were all re-inspected some small reference was also made to standards 38 and 41. Standards 40, and 43 were not inspected. The management of the home is based on openness and respect. There is a quality assurance system that is developing in a sound way. The site manager is qualified and competent. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager has not changed and has qualification and good experience for the role. However, this qualification is not yet of the kind presently looked for in current standards. Evidence was seen of the manager continuing with training appropriate to their professional development in the last twelve months. Staff interviewed said that the formal process of supervising their work carried out by the manager was well structured and with a clear focus of supporting them in their roles. Specific time was put aside for the formal process, but staff also said that they were comfortable with the everyday [and more informal] part of the process too. The home has a Quality Assurance system including direct consultation with Service users and their relatives/representatives. The company plays a large part in this process, rather than making it the exclusive responsibility of the on-site manager. In written information to the Commission the manger said that the company had worked hard to get feedback from care purchasers, but with rather disappointing results. New initiatives were reported as being planned to improve this situation. The records sampled [during the body of the inspection] in respect of the care and attention provided to service users were all thorough, in good order and up-to-date. Staff interviewed were able to give sound and appropriate accounts of policies, procedures and practices relevant to health and safety [with the exception of those issues already covered]. Two sets of records were sampled at random relevant to relevant to safety issues. The record for testing tap water temperatures could not be found at first, when it was found the last entry could be seen to be as long ago as February 2007. Some difficulties also arose when looking at records for central heating and boiler servicing. The home does have a member of staff designated as the ‘Health and Safety Officer’ and they are supported by company training and company meetings. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 X 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 2 29 X 30 1 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 3 2 X X 2 X Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 Regulation 18. Requirement The persons registered must ensure continued progress toward increasing the number of staff holding an appropriate qualification. Continued from previous inspection with an extension of time. The registered person shall reassess the needs of the service users in the home paying particular attention to those specific needs that have led to [and may again lead to] behaviours which can be challenging [and pose risk, especially risks to good hygiene] to others and themselves. The persons registered shall ensure that the premises and facilities of the home meet the needs of service users. The persons registered shall ensure that all parts of the home are kept in a clean condition. The persons registered shall review the state of repair, decoration and maintenance of the home, both inside and out. DS0000027489.V350722.R01.S.doc Timescale for action 01/01/08 2 YA3 12, 14 and 15 26/11/07 3. YA24 23 26/11/07 4. 5. YA30 23 23 07/11/07 07/11/07 YA24 Hill House Version 5.2 Page 27 6. YA33 18 7. YA41 17 8. YA42 13 The person registered shall 07/11/07 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. That the person registered shall 07/11/07 ensure that all of the records detailed in Regulation 17 are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. That the person registered shall 07/11/07 ensure so far as is reasonably practicable the health, safety and welfare of service users and staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA28 Good Practice Recommendations It is recommended that an adequate alternative staff ‘sleep in’ area be identified that will not compromise staff comfort. This is a continuation of a previous recommendation revised in the light of changes since it was originally made. It is recommended that imaginative consideration be given to what potential there may be for increasing the range of accessibility to key sources of information [such as the Service Users’ Guide]. It is recommended that the home take stock of the way in which records [especially plans for care and daily records] currently assist management and staff in devising appropriate care responses. In particular it is a question of finding out if there is any better and more effective way of seeing exactly what really needs to be changed, looking DS0000027489.V350722.R01.S.doc Version 5.2 Page 28 2. YA1 3. YA2 Hill House at how well everybody [but especially key workers] can see what effect care actions are having on individuals. Improving these systems and records ought to assist in an even speedier and precise understanding of how well the home is doing what is has planned to do. It ought also to be easier and quicker to see how effective [or otherwise] its actions are in improving the lives of the service users. As ‘free’ benefit, this information would also be a powerful source of evidence to support Quality Assurance processes. 4. YA7 Standards 2 and 6 also apply. It is recommended that the home considers the merits of adding a ‘financial assessment and plan for care’ to the existing processes and records. This ought to help in clarifying and keeping a full record of what is actual present practice. This change ought also to assist in ensuring that there is a clear record showing how service users have actually agreed to the way in which their money is used and handled on their behalf. There would also be the fact that the normal process of review would automatically assist in maintaining levels of scrutiny and safeguard for both the service user and the provider. It is recommended that the home reviews the present advocate role, looking specifically to see if there is anywhere that the present independent advocate role could beneficially be strengthened. Examples in brief] might be; in formal case reviews, in comments made by service users to the commission and to re-enforce additional contributions to the day-to-day management and running of the home. This will assist in further ensuring independent support and scrutiny of the care afforded to some especially vulnerable people. 6. YA9 It is recommended that the home review the way in which risks to service users [for example risks involved in taking part in activities] are assessed and recorded. The basic foundation is clear enough, but following the train of changes and responses to those changes is less transparent and less straightforward. It is recommended that the home continues to assess and enhance the range of options/ activities aimed at service users personal development and quality of life. 5. YA7 7. YA11 Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 29 8. YA17 9. YA21 10. YA22 11. YA24 12. 13. YA27 YA37 It is recommended that the home gives extra thought to the current levels of general skill and knowledge available [and required] relevant to producing meals in the home. In addition it is also recommended that the home evaluate the benefits that might accrue from having staff trained [or recruited] with specialist dietary knowledge. It is recommended that the home reviews the present level of staff training in the particular respect of ‘dying and death’. There are many issues and practices crucial to ensuring appropriate conduct and support for everybody. It is recommended that the home considers the merits of including an automatic referral of any allegation, concern or complaint to the independent advocate concerned with the service user involved. It is recommended that the home seeks specific advice from the Environmental Health Officer in respect of some issues relevant to maintaining hygiene in the home. The present lack of a sluicing facility and means whereby the present levels of odour of urine and faeces can be eliminated and kept under proper control are suggested as potential starting points. It is recommended that the home considers the merit of installing an ‘instant’ or ‘power’ shower as suggested by staff. It is recommended that the home support the registered manager in achieving the current qualification standard. Hill House DS0000027489.V350722.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 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 © 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.V350722.R01.S.doc Version 5.2 Page 31 - 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!