CARE HOMES FOR OLDER PEOPLE
Hill House Elstree Hill South Elstree Hertfordshire WD6 3DE
Lead Inspector Neil Fernando Unannounced 07 April 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Hill House Address Elstree Hill South, Elstree, Hertfordshire, WD6 3DE 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) 0208 236 0036 0208 236 0944 BUPA Care Homes Limited Rosalind Ben-Edigbe CRH/N 76 Category(ies) of OP - Old Age - registered for 59 registration, with number PD - Physical Disability - registered for 17 of places Hill House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 This home may accommodate 6 older people who require personal care. 2 This home may accommodate 17 people (aged 18-65 years) with physical disability who require personal care. 3 This home may accommodate 53 older people who require general nursing care. Date of last inspection 22 September 2004 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001, the last having occurred on 23.09.04. Hill House is one of many establishments in the Hertfordshire County, which is managed by BUPA Care Homes Limited. 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. On the day of the inspection, there were 64 service users including 16 young adults in residence. The unannounced inspection took place over half a day in early April 2005. It found that a significant majority of the standards assessed on this occasion meet the National Minimum Standards. 10 service users, 2 visiting relatives and 8 members of staff including the Manager were spoken to, in order to seek their views regarding the quality of life at Hill House. What the service does well:
The arrangements to enable service users and their relatives the opportunity to visit and make an informed decision about the facilities offered at this establishment is managed very well. A comprehensive assessment of needs is undertaken prior to any potential resident being offered a place. The health and personal care needs are being identified through a care planning process and monitored through a review system, involving the service user, relatives and professional where appropriate. Good evidence is available to show that service users are treated with dignity and respect. The level and variety of social and recreational activities for the older people is good. Information on how to raise a concern or make a complain is well disseminated and service users and visiting relatives echoed a degree of confidence, in that they would not hesitate to make a complaint if they are dissatisfied with any aspect of the service. There are a number of established systems in place to ensure that service users are protected from harm. Service users and the visiting relatives spoken with expressed a high level of satisfaction with respect to the quality of services offered at this home. A good standard of physical environment is maintained for the comfort of service users. Health and safety issues are being given a high profile. The staffing levels are satisfactory and a good number of qualified nurses are always available during the day and night. All staff members receive mandatory training, which staff members appear to appreciate. A robust recruitment process has been adopted, which protects
Hill House Version 1.10 Page 6 residents from harm. The manager is experienced and competent to manage the home effectively. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hill House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Hill House Version 1.10 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 standard(s) 2,3 and 5. Standard 6 is not applicable as the home does not offer intermediate care. The arrangements to enable service users and their relatives to make an informed decision regarding the facilities offered and suitability of the home are satisfactory. Information available also indicates that they appreciated being given appropriate details and the opportunity to visit the home and meet with staff members and other residents. It is evident that service users are being encouraged and they are involved in the decision making process regarding matters which affect their daily lives. EVIDENCE: A random sample of case files for five service users were viewed and these include terms and conditions agreed and signed by the service user/relatives and Care Manager from the placing authority, a copy of the complaint procedures and details of the room to be occupied. Other evidence includes copies of the completed pre-admission assessment forms for both funded and non-funded placements. Hill House Version 1.10 Page 9 Records examined and information gained from service users, staff members and two visiting relatives suggest that the prospective service user, relatives/friends and the Care Manager where appropriate, would be visiting the home before the prospective resident is admitted. They would spend time looking around, speaking to other service users and a meal is offered. All service users are admitted on a trial basis to give them ample time to decide if they want to stay and also to give the home’s staff time to further assess the needs of the service users. A meeting is held at the end of the trial period with the service user, relatives and Care Manager (where applicable) and a permanent place is offered. Hill House Version 1.10 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 standard(s) 7, 8, and 10. Service users’ needs and requirements, including health and personal care are being identified and addressed through a care planning process and monitored through a monthly review system. Service users and relatives appear to proactively participate in the care planning and review process. Nevertheless, some improvement to the monthly review notes is needed in some cases. Service users are content in the manner their needs are being addressed. Observation of care practice and feedback from residents and relatives suggests that residents are treated with dignity and respect. EVIDENCE: Hill House Version 1.10 Page 11 A random sample of care plans for 10 service users were examined and these were noted to be comprehensive. Information gathered from service users and staff members, and care plans viewed indicate that the needs of residents are being identified and addressed satisfactorily. Each care plan indicates how the identified needs are to be met. Staff members record the care given, progress made and interactions with service users. Service users are encouraged to sign their care plans. A significant majority of service users were able to recall the name of their key worker and provided numerous examples of how they are being assisted to address their care plan. Records show that care plans are being reviewed on a monthly basis to reflect the changing needs and objectives for health and personal care. It was however noted that monthly review notes indicate “No change” or “Maintain as above” in some cases. Monthly review notes should be in greater details, in order to adequately reflect the changing needs and requirements of the service user. Service users see their visitors including the GP, in the privacy of their own bedroom. There is a working pay telephone and some service users also have access to their own mobile telephone facility. Residents confirmed that they are able to make and receive calls in private. One of the ways in which residents’ rights to privacy and dignity are promoted and respected is through staff members always knocking on bedroom doors before entering. The Inspector observed this to be the case on several occasions during the inspection. Mail is delivered unopened and staff members would assist in reading if required. Service users were all well dressed in clean and appropriate clothes and they were observed to be spoken to with dignity and respect by staff members. Hill House Version 1.10 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 standard(s) 12 and 13 Service users’ interests, expectations and aspirations are being sought by staff and fulfilled as appropriate. However, the level of outdoor activities for the younger service users must be improved, in order to provide an adequate level of stimulation for their development and general wellbeing. EVIDENCE: The care plans viewed for ten service users reflect their identified social, cultural, religious and recreational needs, and in the main, these are being addressed. Ministers of different religions visit regularly to suit the needs of service users. Service users spoken to generally expressed satisfaction in this area. Evidence indicates that residents are encouraged to participate in various social and recreational activities to suit their taste and preference. A number of service users reported that there is no pressure to participate and they are free to withdraw from any activity to spend time in the quiet of their own room. An activities coordinator is available to facilitate activities. Whilst the older service users expressed a good deal of satisfaction with respect to the level and variety of recreational activities, five of the residents in the unit for physically disabled young adults reported dissatisfaction with the level of outdoor activities accessible to them. Most of the young adults attended a Day
Hill House Version 1.10 Page 13 Centre facilitated by Barnet Social Services, but this provision has been withdrawn. Whilst it is positive to note that a mini-bus is available to the home, this facility is not being used to its full potential, as there are currently only two staff members including the handy person who are able to drive it. The Manager is aware of the situation and the requirement for improvement, in terms of the level of outdoor activities accessible to young adults. Staff reported and service users, and visiting relatives confirmed that visitors are always welcome in the home. Residents are able to entertain their visitors in private and also choose whom they see and do not see. Some service users are able to go out to visit their relatives and friends. Hill House Version 1.10 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 standard(s) 16 and 18 Information on how to make a complaint is available and service users felt able to raise their concern to the staff team, including the Manager. Information available suggests that complaints are managed speedily and satisfactorily. There are a number of systems in place, which should offer adequate protection to service users against harm. However, essential training on the protection of vulnerable adults should be made accessible to staff to enable them to more effectively protect and promote the welfare of service users. EVIDENCE: The home’s policy and procedures on complaints are available and accessible to all staff members. Staff members interviewed demonstrated a good understanding of the procedures and their responsibilities towards 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 were regularly encouraged to raise any concern or complaint they may have about the services they receive. There is some evidence to suggest that information is also provided to residents for referring a complaint to the Commission at any stage, should the complainant wish to do so. Many service users spoken with echoed confidence, in that they would not hesitate to speak with a member of staff or the Manager, if they were dissatisfied with any aspect of the service they received. The complaints record indicates that there has been one complaint made to the home since the last inspection in September 2004, which is being looked into by the Manager. The complaint is
Hill House Version 1.10 Page 15 from the relative of a respite service user and focuses on some aspect of care practice around physical care needs. The home has comprehensive procedures on the protection of vulnerable adults, which have been updated to reflect that the name of unsuitable staff would be referred for consideration for inclusion on the Protection of Vulnerable Adult Register. The “Whistle Blowing” policy is also available to the staff team. Staff members interviewed demonstrated some understanding of the above procedures. The Manager stated that some staff members have received training on the protection of service users, a subject also included in their NVQ assessment. However, many staff members spoken to felt that they would benefit from training on this subject. Hill House Version 1.10 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 standard(s) 19, 24 and 26 The home appears to continue to provide good living conditions to service users. The accommodation is bright and comfortable. A rolling program of upgrading has improved the physical environment. Once the remaining upgrading work is completed, no doubt, it will further improve the physical environment and the quality of life for service users. The standard of cleanliness was high and furnishings are suitable for the individual and collective needs of the service users. EVIDENCE: Hill House Version 1.10 Page 17 The home is suitable for the use of the service users. An action plan for routine maintenance is in place. The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building. The carpet in some parts of the accommodation has been replaced, which service users appear to appreciate very much. There is some maintenance work including further replacement of carpet identified in various parts of the building – the unit for physically disabled young adults in particular. The Manager indicated that arrangements are in hand for this aspect of the upgrading work to be completed in the next couple of months. Furniture and fittings are of a good standard and bedrooms viewed are comfortable. A high standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. Liquid soap and paper towels are provided in areas where personal care is carried out and in high-risk areas such as the laundry. Staff members are conversant with infection control procedures. There were no health and safety hazards noted. Hill House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The levels and deployment of staff at Hill House are deemed to be adequate on both the day and night shifts. The care needs of the service users appear to be adequately met. The recruitment process for staff remains robust. Staff members are being provided with training to enable them to deliver a good quality service to residents. However, NVQ assessment for care staff should be given a higher profile. EVIDENCE: Information gathered from staff duty rotas for a period of 4 weeks and discussion with the Manager and staff members indicates that the care staffing levels are adequate on both the day and night shifts. Equally, there are sufficient ancillary members in dedicated roles for catering, laundry and housekeeping. The staff members on duty also reconciled with the rotas for the day. The procedures for the recruitment of staff was scrutinised and found to be satisfactory. The recruitment files for 4 staff members who have been in post since the last inspection in September 2004 were examined. These were found to be in good order. All 8 staff members spoken with stated that they had had their CRB checks completed. Information gathered from staff members and individual training profiles evidences that mandatory training has been provided to staff, as appropriate. Whilst NVQ assessment for care staff is being progressed, there has been some delay due to the Assessor’s departure in December 2004. The Manager
Hill House Version 1.10 Page 19 is however aware that 50 of the care staff team excluding qualified Nurses should achieve NVQ level 2 or equivalent. Hill House Version 1.10 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The management of this home remains satisfactory. Policies and procedures ensure that the health, safety and welfare of service users, and staff are safeguarded. Health and safety matters are being attended to. Hill House appears to be a safe home for residents to live in – a view echoed by Members of staff and service users spoken to. Records viewed were maintained in good order. EVIDENCE: The Manager is a registered nurse with several years experience in the residential care field. She has a Certificate in Management Studies. She is aware that a qualification, at level 4 NVQ in management and care or equivalent is required by 2005. There are clear lines of accountability within the home and the Manager appears to be very capable of managing this establishment. Hill House Version 1.10 Page 21 Evidence demonstrates that staff members receive ongoing training that ensures safe working practice. Disinfectant and cleaning materials are stored in locked cupboards and care is taken to ensure that service users are not exposed to any hazard. Up to date risk assessments are in place. Records show that the fire alarm system, hot water temperature and portable electrical appliances are checked as required. There were no health hazards noted during this visit. Hill House Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x x x 3 Hill House Version 1.10 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 OP12 Regulation 16 (2) (m) Requirement The level of outdoor activities for the younger service users must be improved, in order to provide an adequate level of stimulation for their development and general wellbeing. Timescale for action 15.06.05 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. 3. 4. 5. Refer to Standard OP7 OP18 OP19 OP30 Good Practice Recommendations Monthly review notes should be in greater details, in order to reasonably reflect the changing needs and requirements of each service user. Essential training on the protection of vulnerable adults should be made accessible to staff. The remaining upgrading work should be completed. NVQ assessment for care staff staff should be given a higher profile. Hill House Version 1.10 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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