Inspection on 16/06/06 for Hill House

This inspection was carried out on 16th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 2 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 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 Mr Jerry Crehan Key Unannounced 16th June 2006 09:45 Hill House DS0000027489.V301057.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.V301057.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.V301057.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 01379 608209 tbleach@partnershipsincare.co.uk 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) Partnerships In Care Limited Mrs Christina Bleach Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 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.V301057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 6 hours on 16th and 19th June. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. No comment cards were received prior to the inspection and the manager should consider ways in which they are more effectively promoted. However, feedback from purchasers, social workers and service users relatives was included in information provided by the home to the Commission prior to the inspection. What the service does well: What has improved since the last inspection? The manager had rectified problems with the home’s boiler identified as a problem at the last inspection. The proprietor and manager have paid close attention to the maintenance of environmental standards at the home. The manager has sustained the improvements noted at the last inspection with regard to the administration of medicines. There was evidence of good practice in the storage, administration and recording of medicines. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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.V301057.R01.S.doc Version 5.2 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.V301057.R01.S.doc Version 5.2 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): 2 The overall quality outcome for this standard is good. The needs and aspirations of people thinking about moving into the home are assessed. EVIDENCE: A wide range of information is collected prior to the admission of any prospective service user. Assessment information reviewed satisfactorily meets the requirements of the Standard, and included information from placing authorities. Each of the current service users at the home were appropriately placed at the time of the inspection. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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, 7 & 9 The overall quality outcome for these standards is good. Service users assessed needs and goals are reflected in their individual plan. Service users make decisions about their lives with assistance as necessary and are supported to take risks as part of an independent lifestyle. EVIDENCE: A sample of individual care plans was reviewed. These set out care needs clearly, reflect goals or aspirations for service users and are clear as to who is responsible with target dates and review dates incorporated. Care plans also describe strategies and interventions that might be needed to prevent or to manage challenging behaviour. Care plans and associated risk assessments are reviewed at least every six months, with service users representatives are invited to reviews. Records reviewed also evidence that where a change is identified care plans are updated promptly. The manager indicated that an advocate visits the home regularly on behalf of each service user. This was confirmed in review records. Care plans are clear where restrictions are necessary in the interests of safety are recorded and cross referenced with documented risks, and methods of reducing these. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 10 Risk assessments seen comprehensively addressed the balance required to minimise risk and support independence. One exception was the risk assessment for a service user identified at risk at mealtimes that did not incorporate necessary information regarding how food should be prepared to reduce the risk of choking. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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): 12, 13, 15, 16 & 17 The overall quality outcome for these standards is good The home caters effectively for the lifestyle preferences of service users, including providing opportunities for personal development. Links with the community are well supported. EVIDENCE: Service users engage in activities at the home and outside of the home with the support of ‘facilitators’ with dedicated responsibility to support appropriate activities. Where opportunities are limited as a consequence of the cognitive abilities of service users or behaviour in community environments, risk assessments support this. At the time of the inspection service users were observed being supported within the home and into the local community by both carers and facilitators. This included trips to local shops and the taking of lunch away from the home (as was the case at the time of the inspection). Service users are supported to make home visits, including escorting someone home to see their family, and sometimes by remaining with the person to support the family and service user, depending on need and behaviour. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 12 The level of understanding and social skills of service users makes it difficult for them to form and maintain sexual relationships or to give informed consent. There is policy guidance regarding sexuality. Each service user (and their representative) is provided with information that sets out rights and entitlements concerned with privacy, support and responsibilities. Some service users wish to take responsibility for looking after their own bedroom door key, where they do not risk assessments are in place. Care staff at the home prepare meals. Menu setting is also the responsibility of staff based on the preferences and dietary requirements of service users. Lunch menus provide more flexibility with service users evidently choosing different lunch options at the time of the inspection. The assistant manager indicated that food is sourced locally with fresh fruit and vegetables used. Records reviewed evidence that the weight of service users is regularly monitored. The particular needs of service users who experience agitation at mealtimes are catered for and incorporated within clear risk assessment. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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, 20 The overall quality outcome for these standards is good. Service users receive support in the way they require. Their personal and healthcare needs, including medication, are well attended to. EVIDENCE: Feedback from service users reflected that they felt well cared for. Support is provided where service users are able to independently attend to those aspects of their care they are able to. This was supported by individual care plans that contain clear information as to where personal support was required, and how it should be delivered in order to minimise anxiety or agitation. Care plans also reflect individual preferences in routine, including preferred bedtimes and morning routines. Records reviewed indicate that service users health is carefully monitored and that access to community health professionals is supported where necessary. A visiting health professional was seen at the time of the inspection. There is access to psychology services within the providers company. There are no service users accommodated at the home who have responsibility for their own medication. On review of medication records one discrepancy was identified, otherwise records are good. Storage arrangements for medication are good, as were medication administration practices observed at the time of the inspection. There are clear guidelines set out for staff in respect of medications to be administered when required (PRN). Staff with responsibility Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 14 for administering medication confirmed that they had received appropriate training. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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): 22 & 23 The overall quality outcome for these standards is adequate. Arrangements for protecting and responding to the concerns and complaints of service users and staff are satisfactory. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users information leaflet. A service users spoken to appeared clear that if they had a concern or complaint they would either speak with staff or the manager. Advocates visit the home on a regular basis and can play a part in addressing concerns or complaints on behalf of service users. Relatives are actively asked in periodic questionnaires whether their views or requests are listened to, and whether they feel able to make a complaint. Managers are tasked by the proprietor to address relevant feedback from questionnaires. According to information provided by the manager, the home has received six complaints within the last twelve months. Three complaints were substantiated, two were partially substantiated and one was pending an outcome. The latter was referred through the Norfolk Adult Protection Protocol after some delay due to confusion by the proprietor as to their responsibilities within the Protocol. However the matter has subsequently been referred to the proprietor to investigate. A procedure for responding to allegations of abuse is in place. Staff spoken to appeared aware of the procedure and its function, and had received appropriate training. Care plans outline clearly where people may harm themselves (or others), and outline strategies for reducing this. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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, 28, 30 The overall quality outcome for these standards is adequate. A homely, comfortable and safe environment is provided for service users. Staff accommodation is not fully adequate. EVIDENCE: The home provides an environment that is in a good state of repair. There are sizeable grounds and garden areas that were being used by service users at the time of the inspection. The proprietor carries out regular monitoring visits to the home, which focus quite thoroughly on the safety and standard of the environment. Recent improvements include the provision of an extended banister to improve the safety of a landing area, and quotes are being obtained to cover radiators that may present risk. There were no safety issues identified at the time of the inspection. The home has adequate shared space for service users to participate in communal activities, including a large lounge and dining room. Restriction to the dining area (and kitchen) is documented in risk assessments and is due to the behavioural needs and abilities of service users. There is a designated covered smoking area outside. The facilities provided for staff required undertaking ‘sleep in’ duties are not fully adequate. The room and bed are extremely small, and despite the window Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 17 being open in the room it was very hot. It is recommended that an adequate alternative area be identified that will not compromise staff comfort. The general standard of cleanliness and hygiene at the home is good, and assisted by the availability of paper towels and antibacterial soap. Staff have infection control training and guidance. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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): 32, 34 & 35 The overall quality outcome for these standards is adequate. Service users are supported by a competent staff team, and by safe recruitment practices. There are shortfalls in the number of NVQ qualified staff. EVIDENCE: Staff rotas indicate the deployment of sufficient staff to meet service user need. There is a core group of fourteen care staff at the home, supported and overseen by the registered manager. There are staff vacancies, however, extra shifts are currently undertaken by existing or ‘bank’ staff. From discussion with care staff and a review of staff files, it was evident that service users are protected by good recruitment practices. Records of staff training indicate access to appropriate induction (including BILD induction competencies), mandatory and other training. There are three care staff who currently hold a qualification at level NVQ 2 (or above). A further staff member is half way through this training, and three care staff are about to embark on the training. If these staff are successful it will see the home exceed the required 50 . Two care staff have been identified to be registered for NVQ 2 training on completion of probation and BILD induction. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 19 Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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): 37, 39 & 42 The overall quality outcome for these standards is good. Service users benefit from a well run home, although the manager has not achieved the care qualification (or equivalent) set out in standards. Service users interests underpin monitoring review and development. The health, safety and welfare of residents is promoted and protected. EVIDENCE: The manager participates in training offered to care staff, and in additional training where offered to assist with her management skills. She has The Higher Diploma in Care Management NVQ 4 and a Diploma in Healthcare Management and has worked in the social care field for over 30 years – managing Hill House for 11 years. The home has a variety of processes to ensure that it is run in the best interests of service users. These include the role of advocates and key workers (from the care staff team) to represent the interests of service users. They also include monthly monitoring visits by the proprietor, staff supervision, satisfaction questionnaires and a range of audits. Although the manager deals Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 21 with the results of satisfaction questionnaires, it is recommended that the results of this kind of survey information are published and made available to those persons who were asked to contribute. The home demonstrates good practices ensuring service users health, safety and welfare. Relevant health and safety training for staff, including moving and handling, first aid, fire and food hygiene training, support practices. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 22 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 X 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 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Hill House DS0000027489.V301057.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? 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 YA9 Regulation 14(2)(b) Requirement Timescale for action 16/06/06 2. YA32 18(1)(a) The registered person must ensure that risk assessments set out the action required by care staff to meet needs. The registered person must 31/10/06 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained 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. 2. Refer to Standard YA28 YA39 Good Practice Recommendations It is recommended that an adequate alternative staff ‘sleep in’ area be identified that will not compromise staff comfort. It is recommended that the results of this kind of survey information are published and made available to those persons who were asked to contribute. Hill House DS0000027489.V301057.R01.S.doc Version 5.2 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.V301057.R01.S.doc Version 5.2 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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