Inspection on 05/04/06 for Hill House

This inspection was carried out on 5th April 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 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 26/02/09

Hill House 21/02/08

Hill House 15/10/07

Hill House 01/05/07

Hill House 24/10/05

Hill House 07/04/05

Hill House 22/09/04

Hill House 29/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Hill House Elstree Hill South Elstree Hertfordshire WD6 3DE Lead Inspector Mr Neil Fernando Unannounced Inspection 5th April 2006 10:30 X10015.doc Version 1.40 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 DS0000019427.V288520.R01.S.doc Version 5.1 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 Older People. 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 DS0000019427.V288520.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hill House Address Elstree Hill South Elstree Hertfordshire WD6 3DE 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) 0208 236 0036 0208 236 0944 BUPA Care Homes (AKW) Ltd Care Home 76 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (17) of places Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate 6 older people who require personal care. This home may accommodate 17 people (aged 18-65 years) with physical disability who require personal care. This home may accommodate 53 older people who require general nursing care. 24th October 2005 Date of last inspection Brief Description of the Service: Hill House is a care home situated in the village of Elstree, which offers nursing and residential care to elderly people and residential care to young adults with physical disabilities. The building is a period building with modern additions. All rooms are in excess of the National Minimum Standards for Older People. In the two areas used for the young adults the rooms also meet National Minimum Standards for Young Adults with additional space now available in the ground floor therapy room and the bedrooms are large enough to count towards the day space standard. All rooms have en-suite facilities and there are a variety of day rooms throughout the building. Hill House is situated in a convenient location for links with motorways and routes to London. There are small shops, a post office and a GP surgery nearby. The home has extensive grounds to the rear and off road car parking facilities to the front of the building. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection for the inspection year 2006/7. The last inspection was carried out on 24.10.05. Hill House is one of several BUPA Nursing Care Homes establishments in Hertfordshire. It is registered to accommodate a maximum of 76 elderly people including 17 young adults with a physical disability who require nursing and social care. At the time of the visit, there were 62 service users including 14 young adults in residence. The inspection lasted for over 8 hours during which time 12 service users, 7 staff members including the Head of Care and Manager were spoken to. A number of records were examined and a tour of the premises was also undertaken. What the service does well: The inspection main finding is that most of the Standards assessed on this visit have been achieved. A commendable strength of the staff and management team is their openness and willingness to co-operate and work with the Commission, in order to further improve the quality of service delivery. Prospective service users and significant others receive appropriate assistance and have access to relevant information to enable them make an informed choice about where to live, thus ensuring that their identified needs would be met. Evidence shows that the services offered meet the social and health needs of residents including the young adults, some of whom have complex needs and a range of dependency. The level and variety of social and recreational activities is satisfactory and service users are actively encouraged to maintain contact with family, friends and significant others. A good variety of home cooked nutritious food is served in a comfortable setting and service users have an input in menu planning. They are treated courteously and their privacy is upheld. Service users expressed a good deal of satisfaction regarding the services they receive. The home is clean and comfortable and service users are encouraged to make it their home, through inclusion in decision-making and encouragement to personalise individual rooms. Information on how to raise a concern is well publicised and service users are being empowered to make a complaint if they are dissatisfied with any aspect Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 6 of the service. There are well-established systems in place including staff recruitment to ensure that service users are protected from harm. What has improved since the last inspection? 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 DS0000019427.V288520.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 and 6. Prospective service users, their relatives/friends and significant others are able to make an informed decision about the facilities offered at Hill House. The opportunity to visit the home and meet with staff members and other residents, and being offered appropriate information clearly demonstrates that the participation of service users and their relatives are central to the decisionmaking process. EVIDENCE: The written contract of occupancy/statement of terms and conditions are available in the service users’ case files, which reflect the signature of the service user, next of kin/the Care Manager, as appropriate. Records examined and information gained from service users and staff members including the Manager provides good evidence that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an informed decision about the facilities offered at this establishment is satisfactory. They would spend time looking around, speaking to service users and staff members, and seek clarification on any issue arising. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 9 Service users are admitted on a trial basis to give them adequate opportunity to decide if they want to stay and also to give the home’s staff time to further assess the needs of the new service users. A review meeting is held at the end of the trial period with the service user, relatives and placing authority, and only then the placement is made permanent. Good evidence is available to demonstrate that service users and their relatives are being empowered to participate in the decision making process, on issues that matter to them. The home accommodates up to 2 residents for intermediate care. Staff members appear to have the appropriate skills to support the rehabilitation and discharge planning programmes for service users receiving this specialist facility. Information gained indicates that service users accommodated for intermediate care receive assistance as appropriate, in order to maximise their independence with a view to return to their home. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. All aspects of health and personal care are being delivered appropriately but the monthly review minutes needs improving. The administration and control of medication ensures the well being of service users. Service users felt that they are treated with dignity and respect and their privacy, guarded. The overall impression gained is of a service user group well cared for. EVIDENCE: Information gathered from care plans, service users and staff members indicates that the needs of residents are being identified and addressed satisfactorily. The care plan indicates how the identified needs are to be met. Staff members record the care given, progress made and interactions with service users. All identified health care needs were being met and observations are maintained in order to respond quickly to any change; as noted from the records seen. Residents are encouraged to sign their care plans where this is appropriate. Some service users provided examples of how their key workers assist them daily. Care plans are being internally reviewed each month to reflect the changing needs and objectives for health and personal care. Monthly review notes should however be in greater details, in order to reasonably reflect the Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 11 changing needs/requirements of each service user. Once the above issues are addressed, this standard would be fully met. All service users are registered with a GP and weekly surgeries are held at the home. The Doctor may be called at the home on other occasions as and when required. Residents spoken with expressed a high level of satisfaction in the manner their health care needs are being addressed. The outcome of the Doctor’s visits is also recorded in the care plans. Other professionals that residents have access to include Dentist, Optician, Podiatrist, Psychiatrist and Dietician. The medication policy and practice is comprehensive and this ensures that staff members administer medication in a safe and satisfactory manner. Only professionally qualified and registered nurses, and identified senior care staff members are authorised to administer medication. These staff members have received training in the administration of medicines. Currently, no service user administers their own medicines although this could be arranged following an assessment of any risk involved. Administration of the medication (MAR) sheets for 12 residents were checked are these are noted to be in good order. Service users stated that their care is provided in a dignified and respectful manner. Residents were dressed in fresh and appropriate clothes and staff members were seen to interact with them, in a manner conducive to good practice. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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 and 15. The social, cultural, religious and recreational interests of service users are being addressed satisfactorily. Contact with family and friends is supported and visitors are made very welcome. The frequency of “residents meetings” needs some attention to keep up with their wishes and feelings, and changing needs. Dietary needs of service users are appropriately catered for. EVIDENCE: An Activities Coordinator is available for 37.5 hours weekly to facilitate social and recreational activities for service users. Service users spoken to expressed satisfaction with the level and variety of activities and entertainment programme accessible to them. Activities and entertainments programme are posted on the communal notice board. Staff stated that they remind service users about activities and entertainments as they come close to starting. The new Manager reported that as part of the quality assurance systems, he ensures that a record of weekly recreational activities, which have occurred is also maintained. Staff and service users stated that visitors are always made very welcome and there are no restrictions on visitors, whom the service users are happy to see. The Manager stated that about 10 of the current resident group do not have any contact with family and friends. However, arrangements are in place for an Advocacy Service and Volunteers to visit them whenever possible. Local Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 13 clergy provide religious services in the home and staff assistance is available if any service user wishes to attend the local church or other cultural/religious activities. “Residents meetings” are held every 3 months, in order to seek and discuss the wishes and feelings of service users. Residents stated that they are encouraged to voice their opinions regarding how their expectations and preferences are being met and action will be taken to remedy any dissatisfaction. However, 3 service users suggested that they would prefer it if “residents meetings are held more frequently”. With this in mind, a recommendation is made. The menu seen provided for a nutritious and varied diet. Large windows pleasantly enhance the congenial setting of the dining room. Provision is made for service users to take their meal in their own room if they so wish. Service users are consulted daily regarding the menu and their taste and preference. Evidence indicates that alternative meals are provided if a resident does not like the meals on the menu. Those spoken to expressed a good deal of satisfaction regarding the quality and variety of food offered to them. Snacks and beverages are readily available. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users, their relatives/friends and significant representatives can be confident that their concerns/complaints will be responded to appropriately. There are a number of systems in place, which should adequately protect a resident from abuse. EVIDENCE: The home’s policy and procedures on complaints are available and accessible to all staff members. The Head of Care and the Manager demonstrated a thorough understanding of the procedures and ensuring that any complaint is dealt with quickly and satisfactorily. Information regarding how to make a complaint is also included in the statement of purpose and service users’ guide. Service users spoken with reported that they had no wish to complain but felt confident to raise any concern or complaint they might have about the services they receive. The complaints record indicated that there had been 3 complaints made to the home since the last inspection on 24.10.05. Records examined show that each had been dealt with and responded to quickly and satisfactorily. There were no pending complaints at the time of the visit. The home has a copy of the Hertfordshire procedures on Adult Protection, which include forwarding the names of unsuitable staff for inclusion on the Protection of Vulnerable Adult Register. The “Whistle Blowing” policy is also available to the staff team. Staff confirmed that they are familiar with the above procedures and they have received training on the Protection of Vulnerable Adults, recently provided by the new Manager. This is a subject Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 15 also included in the induction programme for all new staff members and those people undertaking the NVQ assessment. There are currently 2 adult protection matters, which are being dealt with by the appropriate Adult Protection Team in Hertfordshire and Barnet, respectively. The staff team appeared to have responded well to both alleged incidents. The home implements a number of systems, which should adequately protect service users from harm. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Hill House provides good living conditions that are safe and comfortable. The implementation of the last phase of the upgrading work should further improve the physical environment for residents. The standard of cleanliness was high and furnishings are suitable. EVIDENCE: The home employs a maintenance person and a programme of planned maintenance is followed. The numerous and spacious communal areas and bedrooms are decorated and furnished in attractive domestic colour schemes designed to promote a homely appearance. Carpeting and hard flooring has been replaced, which service users said they appreciate. The Manager stated that he has approved the final phase of the upgrading work, which is schedule for completion by June/July 2006. This standard is therefore not fully met. However, the Commission is satisfied that arrangements are in hand to address the shortfall and with this in mind, a recommendation is therefore unnecessary. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 17 Furniture and fittings are of a good standard and bedrooms viewed are comfortable. There is good evidence of residents being able to bring personal items of furniture, pictures and ornaments to personalise their rooms. The structure of the building internally and externally appears satisfactory. Consistent with the last inspection report, there continues to be a high standard of housekeeping throughout those areas viewed during this visit. Given the level of incontinency with the current resident group, there were no mal-odours present – an observation also reported by service users spoken with. This is quite an achievement and the domestic staff team are to be commended for their hard work and achievement. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28. Staffing levels are adequate to meet the needs of the current service user group. Staff recruitment process is robust, which means that residents are in safe hands. EVIDENCE: Staff duty roster for a period of one month was scrutinised and discussion with staff members including the Head of Care and Manager indicates that staffing levels are adequate to meet the needs of the current service users. Information gained indicates that staff members have adequate experience and skills to enable them deliver a good quality care. Service users spoken with stated that staff members are readily available to them and it was observed, during this inspection that the home was adequately staffed. Staff did not appear to be hurried and were observed to approach service users with patience and respect. The recruitment files for 2 new members who have joined the staff team were viewed. Robust recruitment practices are observed to offer protection to service users and in line with legislation; all documentation including CRB and written references are maintained on these files. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38. The health, safety and welfare of service users, and staff are being safeguarded. However, some attention is required regarding the frequency of fire drills and formal staff supervision. Records are maintained as required. EVIDENCE: The Registered Manager left Hill House in January 2006. There is an Acting Manager who is currently managing the home and he is supported by the very able Head of Care. An application from the Manager to become the Registered Manager is being currently progressed by the Commission. He held the Registered Manager post for about 3 years in another nursing home, prior to starting work at Hill House. He is a registered nurse with several years experience in the residential care field. The Manager appears to have the necessary experience and skills, and is able to discharge his responsibilities fully. The management systems are transparent and service users and staff members reported that the management team are very supportive. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 20 Information gathered from staff members including the Head of Care and Manager shows that arrangements are in place for staff members to receive formal one to one supervision. Details of supervision sessions are recorded. However, there is evidence to demonstrate that some members had not received formal supervision within the stated frequency, prior to the new Manager being in post. Formal one to one supervision for all staff should occur once every two months, at minimum. The Responsible Individual when reporting under Regulation 26 to the CSCI each month should also satisfy themselves that this aspect of staff management system is being implemented fully. Although training records were not checked on this occasion, staff on duty indicated that they received specific training to promote safe working practices (first aid, moving and handling, fire safety etc). Risk assessments are in place and updated regularly. The fire alarm system, hot water temperature and portable electrical appliances are checked as appropriate. A requirement has been made for fire drills to be held every 3 months at minimum and for night staff members to participate in some fire drills. All the records checked, including care plans, risk assessments, accident reports, staff recruitment documents, complaints and medication records had been diligently completed, indicating a disciplined approach Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X X X x 4 STAFFING Standard No Score 27 3 28 3 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 2 Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 23 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 OP36 Regulation 18 (2) Requirement The Registered Person must ensure that al care staff members receive formal supervision at least 6 times annually. The Manager must ensure that fire drills are held every 3 months at minimum and night staff members participate in some fire drills. Timescale for action 15/06/06 2 OP38 23 (4) 31/05/06 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 OP12 Refer to Standard OP7 Good Practice Recommendations The monthly review notes should be in greater details, in order to reasonably reflect the changing needs and requirements of each service user. The frequency of “residents meetings” should be increased to suit service users. Hill House DS0000019427.V288520.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 DS0000019427.V288520.R01.S.doc Version 5.1 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. 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!