CARE HOMES FOR OLDER PEOPLE
Hill House, Combe Raleigh Combe Raleigh Honiton Devon EX14 4UQ Lead Inspector
Michelle Oliver Unannounced Inspection 09:30 18th June 2007 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, Combe Raleigh DS0000021951.V331355.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 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, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hill House, Combe Raleigh Address Combe Raleigh Honiton Devon EX14 4UQ 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) 01404 46694 01404 46694 Abbeyfield East Devon Extra Care Society Limited Mrs Patricia Joan Crisp Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age of places (25) Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th September 2005 Brief Description of the Service: Hill House is a care home providing personal care to a maximum of 25 older people who may also have a physical disability. It is a large detached, extended property, standing in its own grounds in the village of Combe Raleigh, near the town of Honiton. Bedroom accommodation is on the ground and first floors. Each is designed for single occupancy with en-suite W.C. and wash hand basin. There is a vertical lift and a stair lift between floors, a large sitting room and a dining room on the ground floor and a library/lounge on the first floor. There is also a dedicated hairdressing room. Local G.P and community nursing services serve the home and there is regular structured support by volunteers. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Monday 18thth June 2007 over a period of 8 hours. The manager was present throughout the inspection. During the inspection plans of care for 3 people living at the home were looked at in detail. This helps us to understand the experiences of people using the service. A number of other people were met and spoke with during the course of the day. A considerable time was also spent observing the care and attention give by staff. Several staff were spoken with during the day, including care staff, cook, the manager and her deputy. Prior to the inspection questionnaires were sent to all residents to obtain their views of the service provided; 13 were returned. Comments were in the main very positive. Surveys were sent to 26 staff in order to hear their confidential views; 14 were returned. Five health and social care professionals were also contacted prior to the inspection 3 of who replied. We also received responses from 12 relatives. During the inspection we toured the premises and a sample number of records were inspected including care plans, medication records, staff recruitment files, record of complaints, fire safety records and a record of accidents. What the service does well:
Prospective new residents and their relatives/representatives are given good information about the home before any decision to move in is made. Trial visits are encouraged. A representative from the home will also carry out a careful assessment before anyone is admitted to the home to ensure their needs can be met. People interviewed during the inspection talked about the process of choosing and moving into Hill house, and they all expressed complete satisfaction with the outcome. The home has drawn up care plans covering all aspects of care needs. Risk assessments have also been drawn up on all aspects of health and personal care and clearly show how the home identifies potential health risks and puts Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 6 preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. Medications are stored safely and only experienced staff carry out the administration. Records of medicines administered have been generally well maintained. Evidence was obtained in various ways through this inspection to show that people living at the home are treated in a dignified manner and their privacy is upheld at all times. People expressed complete satisfaction in the way they are treated by the staff. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. People talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a good range of activities to suit people’s interests. Excellent arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. Access to the community is ensured through the provision of a minibus. People praised the standard of meals provided. Those who have specific likes and dislikes talked about how the cook makes sure they have exactly what they want. The menus are balanced, varied and nutritious meals and suit individual dietary needs. The home has an excellent range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, safe and hygienic. The home employs sufficient staff to meet people’s needs. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. Excellent quality assurance procedures are in place. People’s financial interests are safeguarded. Excellent systems are in place to safeguard the health and safety of those living at the home and staff. Relative comments in response to questionnaires include: “The care at Hill House is of a very high standard and they have been really kind to my mum while she has been convalescing. We are very pleased with the care my mother received”. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 7 “Staff are not only respectful and caring but are also friendly and welcoming towards me when I visit. I am never led to feel I am a nuisance or taking up their time- I think they are saints”. “They make every effort to create a real sense of community and respect the dignity of each resident”. “They know their clients well and can make them as comfortable as possible” “They make the family welcome” “The clients always look well cared for” “Nothing is ever too much trouble”. “Staff just give that extra bit to make the residents feel at home”. “Treats people sensibly and ask their opinions”. “Dedicated care staff supported by an excellent manager who cares for the residents and their family making visiting a pleasure”. And from a resident: “The staff are fantastic, this is now my home and I am very happy here”. What has improved since the last inspection?
The home has developed a system to make sure that ointments and creams are not used beyond their expiry date and that items prescribed for a person are only used for them and not others The home ensures that all staff supplied through agencies have had appropriate safety checked carried out and that they have been suitably recruited. This is to ensure that people are protected by having only suitable staff working at their home. A copy of the home’s “Whistle Blowing” policy is now displayed in the entrance hall to enable all staff to refer to. The home has worked hard to achieve more than 50 of the staff achieving a nationally recognised qualification. This means that people living at the home are cared for by qualified, competent staff. The home has complied with requirements made following a visit by the local fire service, prior to the last inspection, when some areas of concern that needed to be addressed were identified. This means that people live in a safe well maintained home.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 9 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, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. EVIDENCE: During this inspection we looked at the admission records of three people. We talked to them about how they chose the home, about the information that was shared, and about the discussions and agreements that were reached on the care they need. The manager had visited them to carry out an assessment of their health and social care needs and to give them information about Hill House before a decision was made to move to Hill House.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 11 The assessment records showed that comprehensive information had been gathered to form the basis of a plan of care, which means that all care staff know how the person wants to be looked after. Copies of comprehensive assessment and plans of care for people who are not privately funded and are admitted through care management are obtained. All prospective residents and/or their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make it their home. Two people said that they knew about the home as they had lived locally and were aware of its reputation. All residents spoken to confirm that the home had provided ample information about the home before they decided to make it their home and the home had lived up to their expectations. One person said: “All details dealt with by my relative ” “ Two friends have enjoyed their stay here. I was given a preview.” All of the people living at Hill House were sent questionnaires before this inspection to help gather information about their life at the home. Thirteen were returned all of which confirmed they had received enough information about the home before they moved in. The home does not provide intermediate care. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,&10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning provides staff with an overview of people’s individual health needs but do not always act as an indicator of changes of these needs. All medicines are stored securely and policies and systems provide for safe administration but staff do not follow some policies EVIDENCE: Plans of care are developed with the resident or their family. They are based on an up to date assessment covering all aspects of their health, welfare and social care needs. Plans focus on individual’s strengths, abilities and wishes. This means that staff will have the information to encourage people to lead purposeful fulfilling lives as independently as possible. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 13 Three peoples’ files were looked at in detail. Plans of care were well written, clear and easy to understand and included information to ensure that staff are aware of how to meet most people’s daily health and social care needs. Some plans of care lacked detail relating to specific health issues such as what care was to be carried out, why, by whom, outcomes of this plan and any subsequent changes as a result of the monitoring. For instance it had been noted by a member of staff that a resident was uncomfortable because of a skin problem. A district nurse was consulted about this who recommended treatment. Although details had been written in a daily record it was difficult to monitor the treatment and its effect. An entry was made two days after the start of treatment stating that the problem had resolved however five days after this entry a member of staff had recorded that there was still a problem. There were no further details about this issue. Detailed planning, recording and reviewing peoples’ care makes sure that staff are up to date with changes, people receive appropriate care to achieve positive outcomes and care given is person centred. All staff said that they refer to the plans daily and record information to keep them up to date. There are also daily notes written by care staff that show how people’s personal and social care needs are being met. Plans of care are reviewed regularly, however there was no evidence that people are involved in this review of their care. Those people spoken to could not remember being involved in this but were confident that they are well cared for and their needs are met by the home. People living at the home said that the standard of personal care provided was excellent and staff felt that good care was their main achievement. People benefit from regular opportunities to make their changing needs known. The home monitors peoples’ dental and optician checks and chiropodists are used according to people’s needs. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. People felt that their privacy was respected and staff were seen to knock on doors and wait to be invited in before doing so and were also seen offering personal care in a discreet manner. Medication is generally well managed at the home. Medicines are stored securely and records were generally accurate, up to date and indicated that medication is generally appropriately administered. We noted that hand written directions are not sufficiently detailed to ensure that people are kept safe. For example, on one chart only the name of a pain
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 14 reliever had been recorded, no directions or suggested dosage, another did not have the name of the medication recorded: and staff were instructed to give “drops to both ears twice daily”. Hand written instructions must include the amount received, date received, name of the medicine, strength and times to be given and should be witnessed and signed by two members of staff to make sure that residents are given the correct medicine at the correct times. The home has developed a system has been put in place since the last inspection to make sure that ointments and creams are not used after their expiry date. This means that products at risk of being ineffective are not used. All staff that handle medicines have received training in the safe handling of medication, which ensures that people living at the home are cared for by competent, well trained staff Comment received from some relatives in response to questionnaires included, “ The staff at Hill House have been excellent at keeping me informed”, “ If there is a change in my relatives care they always contact me”, “ They do their best to meet the needs of the residents but this can be difficult when some of them are very demanding”, “I cannot fault the care my mother gets in her care home, it is exceptionally well run “ Usually support people to live the lives they choose although sometimes they encourage my mother to be more independent than she would like but they have the full support of the family”. “ My [relative] needs encouragement to drink but often the jug and glass are left on the other side of the room” during this visit drinks were available and within reach in all rooms. At the time of this visit we saw staff replenishing water jugs in people’s rooms and taking great care to make sure that drinks were within reach. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, &15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Everyone living at the home is offered good choices in all aspects of daily living. Social activities are very well managed. They provide daily variation and interest for individuals and create opportunities for increasing their independence. Meals are nutritious and balanced and provide individuals with choice and variety. EVIDENCE: During this visit we spoke to ten people who live at the home, all were very complimentary about the care and support they receive. We also spoke to the manager and staff who confirmed that the aim of the home is to make sure that people who live there are able to enjoy a full and stimulating lifestyle with a variety of options to choose from.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 16 Plans of care include details of individual preferences in relation to daily routines such as getting up, going to bed, social activities, contact with the community and interests and hobbies. A comment in response to a questionnaire stated: “[My relative] is able to make own choices however is not very assertive. Suggest newsletter emailed to inform about things so that relative can talk things through and encourage [them] ”. All people living at the home said that there is always something going on at the home that they can take part in if they wish and that their individual interests are also met. One person told us that how they had been encouraged and supported to continue a hobby since living at the home. During this visit several people took part in a quiz. The home has its own mini bus and some people said they enjoy going out on trips. In response to a questionnaire comments were made including: “ I tend to do my own thing, reading. knitting and keeping my room tidy”,“ Always activities to take part in, outings, afternoon activities, quizzes, handicrafts, taken around garden” “ I am a bit nervous about going on outings and I sometimes forget they are on”. A programme of activities is prominently displayed on a notice board in the hall so that people can choose to take part or not. A relative commented, “They provide numerous opportunities for outings and activities in house and make the residents feel part of a family”. Several people spoke about how their relatives/ visitors are made to feel welcome at the home. Visitors are offered drinks and “are made to feel part of the family”. We looked at the visitors’ book and it was clear that many people received visitors and they came at different times of the day. Comments in questionnaires included: “ Good at respecting privacy and visitors are always made to feel welcome”. People moving into Hill House are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. Most of the rooms seen during this inspection Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 17 were personalised and people spoke about the pleasure having their own things around gave them. We discussed with the manager how the interests of people who have no family or do not wish to involve them are met at the home. The manager was not familiar with contacting outside agencies as the situation had never arisen; people usually had family or legal advisors to act on their behalf if needed. We discussed the importance of being aware of the details of how these could be contacted if asked by a resident or relative. The manager said that details were included in the home’s residents’ handbook which is available to all residents and their relatives. This helps to encourage people to exercise choice and control over their lives. Most of the people spoken to during this inspection said that the food served was very good. Some said that it was not an easy job cooking for a number of people and “ you can’t please all of them all the time”. Meals served at the home are generally well balanced, nutritious and varied. The home has a four weekly rotating menu, displayed in the hall and on individual dining room tables, and a choice of meal is always offered. We spoke to one of the two cooks during this visit. They confirmed that they were well informed about peoples’ individual food likes and dislikes and were given information about dietary needs and preferences when they moved into the home. The cook was able to discuss different diets such as sugar free. The home has a 4 weekly rotating menu that is. The home has a summer and winter menu to take advantage of fresh seasonal vegetables, which are always served with meals. People living at the home benefit from having a light, spacious dining room where all meals are served; they may choose to have their meals served in their rooms or one of the sittings areas if they wish. In response to questionnaires one person commented: “ Sometimes likes the meals, the soups are not good, poached eggs on toast are as hard as bricks” “ Don’t enjoy the meals as much as when first moved to the home. Menu rotates 4 weekly and a little more could be done to give greater variety” “ The home is sensitive to likes and dislikes including food and diet”. These comments were shared with the manager. Provision is made for residents to make suggestions or comments in the form of a post box in the dining room and a recent quality assurance survey did not include any complaints about the quality of meals served at the home.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 18 Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: The home has a detailed, clear and simple complaints procedure, which is prominently displayed for all those living at the home and visitors to see. The home maintains a detailed record of complaints received. One complaint has been made to the home since the last inspection. This complaint had been taken seriously and acted upon by the home. We saw a record of the action taken and response to the complainant. People living at the home said that they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or deputy manager. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 20 Response included in questionnaires from residents stated: “Can’t remember how to make a complaint but I feel confident I could ask the manager to remind me” “In 3 years we have had no reason to complain to the manager, minor problems are sorted out quickly and efficiently. Day to day problems are dealt with as they arise”. In response to a questionnaire a relative stated: “Know how to make a complaint but have never needed to”. Records were seen showing that staff have received training in Adult Protection issues. A procedure for responding to abuse is available and staff were aware of this. They were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the home’s ‘Whistle-blowing’ policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is excellent providing a comfortable, clean and safe environment for those living in, working at and visiting the home. EVIDENCE: Residents said they were very comfortable living at Hill House. During this inspection we walked around the building, visiting many bedrooms, the sittings rooms, dining room, hairdressing room, bathrooms laundry and kitchen. The home was clean, fresh, well maintained, with the lounge areas especially homely and very comfortably furnished. Bathrooms are well equipped and the home has a good provision of equipment to aid peoples’ independence.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 22 People have the choice of communal areas both inside and outside the home, this means that people have a choice of place to sit quietly, meet with family and friends or to be actively engaged with other people living at the home. They also said how much enjoyment they get from the gardens, and surrounding countryside, at Hill House. Decoration, fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a very high quality. Fresh flowers and plants are placed around the home, people also spoke of the pleasure these give. All bedrooms have ensuite facilities, and all bedroom doors being fitted with locks promote peoples’ privacy. At the time of this inspection the home was extremely clean and fresh. People said the home was always like this. Feedback from all questionnaires confirmed that the home is always clean and one person living at the home stated, “Scrupulously clean”. The home’s laundry was clean and well organised. Staff described good infection control practice that ensures that people are protected from the risk of cross infection. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. EVIDENCE: The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. We looked at three recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training, evidence of identity, police checks and references. This procedure means that people living at the home are protected by the home’s recruitment procedure. At the time of this inspection the manager, senior carer, four carers, an administrator, domestic and two cooks were on duty. This level of care staff changed to a deputy manager or senior carer and three carers during the afternoon and two throughout the night. Staff and residents felt that there was always enough staff on duty to meet their needs. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 24 People who responded to questionnaires and those spoken to during this inspection said that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Comments from residents included: “Some staff try to do a good job others not” “Staff listen and act on what is said but more staff would be welcome” Relatives’ comments: “Senior staff are excellent, agency staff are varied” “Could improve the home by having more permanent staff and less agency. Questionnaires completed by staff included comments such as: “Would like to spend more time with people on a one to one basis”. “To spend more time with residents and not so much time cleaning at night which should be done in the day”. A rota has recently been developed at the home that provides dedicated time for staff to spend with residents during the afternoons to make sure that people do not experience social isolation. The manager discussed problems associated with recruiting staff at the home. Some staff find transport a problem and some leave because they find other places of work more convenient. Management is considering ways of improving recruitment including looking at methods of transport. The manager said that the home does use agency staff and are aware of the problems associated with this, people not knowing staff and staff not knowing them. This means that people are at risk of their individual needs not being carried out by familiar staff they know and trust. Since the last inspection the manager has developed a system of being notified that agency staff working at the home have been appropriately checked and recruited by the agencies. The manager also requests that only agency staff who are familiar with the home and people living there are provided. This means that people can feel safe and secure with familiar staff to care for them. Training is a priority at Hill House. Individual staff files include confirmation of all training undertaken and all planned. This means that all staff are kept up to date with current good practice. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 25 Newly employed staff all undertake a period of induction training. This introduces them to the home’s policies and procedures, the layout of the home, health and safety issues and conditions of employment. They also undertake an induction course covering care specifically related to health and social care needs of the people they care for. During the last 12 months staff have undertaken training in the management diabetes, continence, safe handling of medicines, first aid update, protection of vulnerable adults and infection control with updates planned for the following year. Four care staff are currently undertaking a Nationally recognised qualification [NVQ] at level 2 or above qualification and two are completing a Registered Manager Award. This means that people living at the home are cared for by well trained competent staff. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed, run in the best interest of residents, and their health and safety are properly attended to. EVIDENCE: The manager is a registered nurse with a current registration, has many years experience of running homes, has a supervisory management certificate and has completed the Registered Managers Award. She attends managers’ workshops run by the Abbeyfield Society and 6 weekly meetings of the Executive Committee responsible for the running of the home. Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 27 Comments received from those living at the home and relatives included: “ The home is exceptionally well run”. “ We have a very high opinion of the manager. She is popular not only with the residents but also with the staff who like her and respect her. She is always available if we need to discuss any aspect of our mothers care and keeps us informed at all times” People are consulted regularly about the running of the home and how they are being cared for. The home undertakes surveys annually asking relatives, visitors, and other interested people to give their views about the home. The results of the surveys are collated and action is taken to deal with any issues raised that could improve life at the home. Currently the result of the surveys are made available to residents, relatives, staff and the Executive Committee but are not made public to enable people deciding whether to make it their home to be aware of the results. Staff, and residents, meetings are held regularly, providing an opportunity for the manager to give and receive information about the home. This means that standards of health, social care and welfare needs will be maintained and a programme of continuing improvement developed at the home. People will benefit by being assured that the home is working towards delivering high standards of care. Some people living at Hill House choose to have personal money dealt with by the home. This means that a “float” is kept so that day-to-day items such as toiletries, hairdressing, papers and magazines can be bought as people wish. We saw records and receipts kept by the home; these were accurate and up to date. The money of two people was checked and was correct against the home’s records. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Only records of fee payments are kept on computer. Records are kept in lockable filing cabinets, and those seen were up to date. Records required by regulation for the protection of people living at the home are maintained. Training records confirm that staff are up to date with manual handling, fire safety, safe handling of food, first aid and infection control. Records confirm that fire alarms and emergency lighting tests have been carried out regularly. An assessment of identified hazards and associated risks relating to the environment, including fire hazards, has been undertaken. Information received before this inspection indicated that all equipment is well maintained regularly, all of which contributes towards ensuring that Hill House is a safe place for people to live.
Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 4 Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 OP7 OP7 Good Practice Recommendations Care plans should include details of care given, outcomes and actions taken as a result of this monitoring. People should be involved in reviews of their individual plans of care and told of any changes made. This means that people will be involved in the way they wish to be cared for at the home. When staff hand write instructions for giving medicines on the record it should be witnessed and signed by another member of staff. This means that people will be kept safe from receiving the wrong medication. Outcomes of quality assurance surveys should be made available to all interested parties and a copy should be sent to the Commission. 3 OP9 5 OP33 Hill House, Combe Raleigh DS0000021951.V331355.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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