Inspection on 30/08/05 for Hill House

This inspection was carried out on 30th August 2005.

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

Other inspections for this house

Hill House 10/09/07

Hill House 16/06/06

Hill House 10/01/06

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 IP21 4QT Lead Inspector Judith Huggins Announced 30 August 2005 at 14:00 th 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 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 Stationary 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 I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 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 I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 24th February 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 I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and lasted for four and a quarter hours. The manager, two members of staff, and two residents were spoken to. Other residents were spoken to but find it hard to understand. Written comments were received from three relatives, one professional who arranges placements and the Environmental Health Officer. Some of the things they said about the home have been included in the report. A selection of the records the home needs to keep were looked at, including three plans setting out the care needs of people living at the home. A brief tour of the home was made. What the service does well: What has improved since the last inspection? What they could do better: The way medicines are given to residents and then recorded needs looking into, as the charts do not always show whether tablets have been given, refused or withheld for any reason. There are gaps in the records. Staffing levels are being maintained by use of overtime and staff from other homes in the group. Staff are getting tired and despite there being one post Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 6 under offer, there are still five vacancies according to the manager. If this situation persists the ability of staff to consistently and professionally manage the difficult situations they are often presented with, may be compromised and morale suffer. A part time staff member, who cleans the home, has recently left making further demands on care staff. 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 I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 standard(s) 2 The needs and hopes of people thinking about moving into the home are assessed. EVIDENCE: A range of information was collected before the most recent admission was made. This was extensively reviewed after the person had been receiving care elsewhere and was considering returning to the home, including a very full range of risk assessments. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 Residents (or their representatives) know that assessed and changing needs and goals are reflected in their individual plan. Residents make decisions about their lives with assistance as necessary and are supported to take risks as part of an independent lifestyle. EVIDENCE: Each person has an individual plan setting out how the service is to be successful in supporting the person. These set out specific and consistent interventions that might be needed to manage behaviour. Where people have difficulties communicating, there are plans setting out the kinds of behaviours, sounds or signs that might be used. Plans also include documented strategies for management of aggressive behaviour. The majority of residents are not able to participate fully in drawing up their plans of care. Each has records of the level of involvement they might have, from setting up rooms for the review meeting, whether they are able to be present and under what circumstances, and the efforts made to present information to them in a way which might help them to understand or participate. Many are not able to do so, and keyworkers and an advocate are Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 10 involved. According to the manager, and based on records seen, the advocate visits regularly. Residents representatives are also invited to reviews. Those completing comment cards, and one professional say that they are kept informed of important matters, and consulted about decisions about care. One person is able to participate and to sign daily records. One person participates in meetings and was able to say what their keyworker helped them with. Plans and associated risk assessments show they are reviewed every six months. Documentation also shows that where a change is identified (for example in a particular risk), care plans are updated promptly. There is a clear section in each plan, where restrictions are necessary in the interests of safety are recorded and cross referenced with documented risks, and methods of reducing these. Where one person is able to understand, the risk assessments show the person’s responsibility in the process, and explanation offered. One person is having support to manage finances. Others are not able to do so, and these are accessed by senior staff in accordance with policies. According to the pre-inspection questionnaire, the manager does not act as appointee for any resident. Each has a bank account in their own name, with arranged access. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 standard(s) 11, 12, 13 and 15 Residents have opportunities for personal development, occupation and to participate in the local community subject to their abilities and behaviour. Residents have opportunities to maintain relationships with family members. EVIDENCE: Care plans set out programmes of activities for people to meet development needs. Specialist interventions are supported by interventions from community learning disability team staff, the company’s psychology staff, and the consultant psychiatrist. Where opportunities are limited, for example by behaviour in community environments, risk assessments document this. The cognitive abilities of residents as well as behaviour, limit opportunities for further education and employment. Activities records and risk assessments show people’s opportunities to make use of local facilities. Two residents confirmed making use of shops, people go Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 12 out for lunch or coffee, and one person confirmed via signs, visiting the pub. Notes show people are able to go out for day trips, subject to risk assessments and adequate staff support. A professional making placements at the home comments that residents she places need routine and structure which can limit opportunity to access community resources, but that staff recognise this and make efforts to “balance the need for structure with introducing new and varied experiences”. Staff confirm that they support people to make home visits, sometimes simply by escorting someone home to see their family, and sometimes by remaining with the person to support the family and resident, depending on need and behaviour. Two residents confirmed visits to family members, and using the telephone to keep in contact. One person confirmed via signs that they had seen their brother. The level of understanding and social skills of residents makes it difficult for them to form and maintain sexual relationships or to give informed consent. There is policy guidance regarding sexuality. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 standard(s) 20 There are some minor shortcomings in the management of medication within the home. EVIDENCE: Staff confirm they are trained and supervised in house until competent to give medication. A monitored dosage system is in use. Medication administration record (MAR) charts show some omissions of signatures so that it is not possible to confirm whether medication has been given in accordance with prescribed instructions or withheld or refused. There are no annotations on the reverse of MAR charts to show what has happened on these occasions. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 22 and 23 Residents feel their views are listened to and acted on, and they are safe at the home. EVIDENCE: Two residents able to express a view say that they know who to go to if they have any concerns, identifying the manager, senior staff and keyworkers as important. Keyworkers and advocates support others, with a named advocate visiting every six weeks. Relatives completing written comments are aware of the complaints procedure. The complaints record shows keyworkers have a crucial role in the process. There have been no complaints since February 2004. Staff are trained in abuse awareness when they cover the competencies included in the BILD (British Institute of Learning Disabilities) training package all are expected to complete. Discussion with the manager indicates that staff are aware of issues and would report concerns. Care plans show where people may harm themselves (or others), and outline strategies for reducing this, as well as reducing the risk they may pose to one another from aggressive behaviours. Staff are trained in Breakaway techniques and in physical intervention, with annual updates. Records show that physical intervention was last used at the end of July in circumstances consistent with the explanation given by a staff member. Further records show that staff successfully “de-escalated” events on four occasions after this date, without the need to intervene physically, in order to prevent harm to the person concerned, or others in the vicinity. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 24 and 30 Residents live in a comfortable and safe environment. There was a minor shortfall in cleanliness and a hygiene concern was rectified during the inspection. EVIDENCE: Residents own personal accommodation is homely, reflecting their individual interests and needs. There are necessary restrictions on access to facilities, supported by risk assessments, in the interests of maintaining the safety of residents and staff. Documents show regular audits of safety take place. Not all radiators are guarded, although one in a high-risk location has been shielded. The manager says there are plans to provide guards for all of these. Fire extinguishers in some areas are secured to prevent residents accessing them, as they have been used as weapons. The manager states that all staff carry keys to access these and locations are clearly marked (seen). She has sought advice from the fire safety officer who indicates that the first priority is to detect and contain fires and to evacuate the premises rather than to tackle any outbreak, and says he is aware of the current practice, although not willing Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 16 to confirm in writing. According to the manager, the company’s health and safety officer is actively engaged in discussion and negotiation regarding this issue. No offensive odours were noted during the inspection. Staff have infection control guidance and protective clothing is accessible at relevant points throughout the home. Paper towels and antibacterial hand soap are also provided (although supplies of the former have to be limited as one person blocks lavatories). Faecal incontinence associated with behaviour is noted in care plans, although some staining was apparent on the carpet outside the person’s room associated with this. No requirement is made as care staff took remedial action during the inspection. Elsewhere, the standard of cleanliness was good, although there is some fluff and debris behind the washing machine and tumble dryer. This is difficult to access. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 and 36 Residents benefit from staff who understand their roles and responsibilities. Residents are supported by an effective staff team, although effectiveness may be compromised if vacancies are not soon filled. Residents benefit from well supported and well supervised staff. EVIDENCE: The company’s human resources department is known to supply job descriptions for all grades of staff. Staff interviewed had a good understanding of their roles and those of others with whom they work. Clear accounts were given of the needs of some residents and how these were to be met, and these are consistent with care plans viewed. Staff have a good understanding of the communication difficulties experienced by residents. Training is provided in a range of relevant skills, with staff completing a three-week induction before starting work at the home. Specialist advice is accessed either via the company’s own staff, or by other relevant professionals, and notes show involvement of psychiatry, psychology and occupational therapy professionals. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 18 Staffing levels are being maintained, but this is by virtue of staff working overtime or longer shifts, and also by use of staff from other establishments nearby. This is to cover for 5 current care staff vacancies as well as any annual leave. Staff are clearly highly motivated and committed to the resident group, but are getting tired as a result of working additional hours. Although morale is described as good at present, the situation cannot be sustained in the long term without ill-effect on the staff group, who work with very demanding clients. The manager reports that one vacancy has been offered and a prospective staff member is awaiting clearance. She acknowledges that there have been difficulties and that the home has not been fully staffed for some time. The manager states that there are some concerns regarding working conditions, as staff are expected to sleep-in, and do so in a very small room with no facilities for washing. These are provided with a very small washbasin in a nearby WC, shared with residents. The company’s audit process shows that people receive supervision in accordance with standards, and staff confirm that they are well supported by the manager and deputy. They clearly appreciate the sensitivity and support shown them by the manager, when they may be becoming tired or have had to deal with difficult situations. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 The residents benefit from a well run home, although the manager has not achieved the care qualification (or equivalent) set out in standards. Residents’ views/interests underpin monitoring review and development. The health, safety and welfare of residents is promoted and protected. EVIDENCE: The manager participates in training as offered to care staff, and in additional training where offered to assist with her management skills. She has the equivalent of an NVQ 4 in management and has worked in the field for 30 years – managing Hill House for 10 years. Most of the residents have communication difficulties, so advocates and keyworkers are needed to present their interests. There are regular unannounced monthly visits on behalf of the registered providers, which allow for discussion with those residents who are able to participate, and observations of interactions and behaviours for those who cannot. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 20 There is a monthly audit against service objectives, and quarterly audits of a range of other issues. These have included supervision and appraisal, medication and audit of case notes (providing for cross-referencing where incidents involve more than one resident and more than one type of record needs to be completed). There are documented audits of health and safety issues, and appliances are serviced regularly. Working practices are underpinned by a good range of risk assessments and staff receive training in health and safety as well as fire training. Comment has been made elsewhere about fire extinguishers being secured and the fire safety officer being aware of this. The environmental health officer responsible last inspected the home for compliance with food safety legislation and the health and Safety at Work Act, in May 2004, at which time no concerns were raised. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 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 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score 3 x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hill House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 x I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 22 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 20 Regulation 13(2), 17(1)(a), Schedule 3 Requirement The registered persons must ensure that the administraton of medication, or its refusal or withholding is accurately and contemporaneously recorded. Timescale for action 30/09/05 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 30 33 Good Practice Recommendations The registered persons should ensure that debris behind washing and drying machines is periodically removed. The registered persons should make concerted efforts to recruit to remaining vacancies. Hill House I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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 I55 s27489 Hill House v239684 AN 300805 Stage 4.doc Version 1.40 Page 24 - 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!