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Inspection on 02/06/05 for Hill House Nursing Home Limited

Also see our care home review for Hill House Nursing Home Limited for more information

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users speak highly of this home, and the CSCI confirmed that the home provides a spacious and comfortable environment. The home has a motivated staff team who are very caring. Visiting professionals such as Occupational Therapists confirm that clinical care is also competently managed. This home provides rehabilitation for short stay service users and again they found the home most helpful in preparing them to return home.

What has improved since the last inspection?

The home has confirmed the arrangements for admitting all service users, including those referred by the local PCT [Primary care Trust]. This will ensure only appropriate admissions take place in future.

What the care home could do better:

In respect of the care of service users, the CSCI recommends the re-evaluation of a service user`s care needs - which appear very complex and possibly outside the registration categories of the home. To ensure the privacy of service users a lock needs to be replaced in a bathroom door. The home is also reviewing suitable door locks for bedrooms. A number of safety requirements are made one of which is outstanding but underway (radiator covers in ensuite facilities). Fire exits were blocked with wheelchairs and other items; a number of wheelchairs were seen to be lacking their footrests. `Multiplug` (electrical) adaptors were seen in use but these are not as safe as extension leads with a fuse or additional wall sockets.

CARE HOMES FOR OLDER PEOPLE Hill House Nursing Home Limited Hill House Nursing Home 48-50 Park Road Kenley, Surrey CR8 5AR Lead Inspector Michael Williams Unannounced 2nd June 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 Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hill House Nursing Home limited Address 48-50 Park Road, Kenley, Surrey, CR8 5AR 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) 020 8660 9336 020 8668 0210 Hill House Nursing Home Limited Mrs Elana Pamela Follwell Care Home 65 Category(ies) of Old Age, not falling within any other category registration, with number (65), Terminally ill (10) of places Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11/1/05 Brief Description of the Service: Hill House provides personal care, including nursing care, to older people but does not provide care in other categories such as dementia care or people with mental illness. Its services include “Intermediate Care” and care of the “Terminally ill”. Both of these specialist services are supported directly by the relevant Health Authority agencies. The hotel-style home comprises 35 single rooms and 15 shared rooms. There are 4 dayrooms plus bathrooms, showerrooms and toilets throughout the home. There is a library, a hairdressing salon plus the usual facilities, including a laundry, offices and staff rooms. There is a garden to the rear plus an enclosed courtyard and to the front off-street parking is available. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This care home continues to achieve high standards throughout. The Directors of this care home can be satisfied they are maintaining a very good service. Only a small number of requirements arose and the CSCI is confident any outstanding matters will be addressed. The purpose of the visit was to undertake an unannounced inspection of key standards. What the service does well: 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 Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 6 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 Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 7 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) 3, 6 Service users’ needs are being assessed prior to admission to ensure their needs can be appropriately met. When service users are admitted without such an assessment the nursing staff in the home assess service users’ needs immediately after admission to ensure they have been appropriately referred. Service users that are admitted for intermediate care are offered appropriate support to enable them to return to their homes. EVIDENCE: The arrangements for assessing service users prior to admission were discussed in some detail and the manager confirmed that the home will in future assert its right to admit only service users within its registration category and has the right of veto to not admit service users out of category. This was a previous requirement and is now met. Service users’ case files were examined and found to contain the necessary assessments and service users advised the inspector that their needs were made known to the home before they were admitted. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 8 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, 9, 10. Care Plans are in place for each service user to ensure their health and personal care needs are being fully met. However the frequency of which care plans are review needs to be reassessed for those service users whose needs are complex and may well have changed since admission. Medication procedures and policies ensure that service users are protected. Service users are treated with respect and dignity at all times by the staff. EVIDENCE: Individual plans of care, ‘care plans’, are in place for all service users. A standardised format is used for all service user documentation, this makes the information about service users’ needs readily available for all staff. These personal case files for each service user include the initial assessments from which arise the goals designed to meet the specific needs of service users. Medication is administered in most instances by the nursing staff. The service users admitted for intermediate care hold and administer medication themselves with the support of nursing staff. Service users confirm that they are treated with respect and dignity. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 9 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 to 15 The lifestyle of service users is much as they expected when they entered the home and this home supports and encourages them to exercise they of choice whenever possible. The meals are varied, nutritious and service in pleasant and enjoyed by the service users. EVIDENCE: In discussion with staff and service users it is clear that the home attends to the social, cultural and emotional needs of service users. They are supported in maintaining contact with family and friends and in some cases will be returning to their own homes and are therefore encouraged to maintain community links. Various social, recreational and therapeutic activities are offered in this home and on the day of inspection an art class was underway; quizzes are also very popular. Choice in nursing homes depends upon the capacity of the service user to make choices but every opportunity to make choices is offered, for example with respect to their admission, with a range of meals, how they will spend their day and so forth. The service users commended the chef for the very nice meals provided. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 10 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, 18. Complaints are dealt with in a sensitive and professional manner this ensures service users and their representatives feel free to make their concerns known and they will be acted upon. Policies, Procedures and training are in place for the safety and wellbeing of service users. EVIDENCE: The record of complaints was examined and it shows that the home deals with complaints in a timely and helpful manner. No complaints arose during the course of the inspection but one service user did make observations about a range of issues concerning her care and in order to ensure her needs can still be met in this particular care home a recommendation is made under the provisions of standard eight (about assessing and meeting service users changing needs). Staff are aware of their responsibility to protect service from abuse and to report untoward incidents to the correct authorities. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 11 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, 26. Service users live in a safe, clean, well-maintained and comfortable environment. This large domestic style property extended to meet the needs of service users and is subject to ongoing refurbishment. EVIDENCE: Communal areas are pleasantly decorated and individual rooms are spacious and each bedroom has a shower or wash hand basin and a range of suitable bedroom furniture and fittings. Minor damage noted in some areas such as a missing bathroom door lock. In most areas the use of tasteful colour schemes make this a large but homely environment. The home was clean and tidy and free of unpleasant odour when visited. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 12 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 Staffing levels are adequate for the home’s stated aims and objective enabling staff to meet the wide range of service users’ needs. EVIDENCE: Staffing levels are based upon the home’s existing Staffing Notice issued under previous guidance. The staff rosters indicated that staffing levels are frequently above these minimum levels. In addition to the Nursing and Care staff, the home employs a large ancillary staff team including a professional chef and assistant in the kitchen plus catering assistants; housekeeper and domestics and gardener/maintenance persons. The CSCI is therefore satisfied that staffing levels in this home can meet the current needs of service users. The inspector was reminded that the staff team is large enough to allow shift leaders on each of the three floors to vary the deployment of staff, between floors, depending upon variations in service users’ dependency. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 13 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) 33, 38 This is clearly a well managed care home, that is run in such a manner as to ensure the health and well being of the service users. A number health and safety hazards were identified and need to be addressed to ensure that safety of service users. EVIDENCE: The registered manager has been assessed by the CSCI as competent and fit to manage this home and has been doing so for several years an a series of excellent inspection reports testify to the competency of the management team including the directors and the on-site manager. Once again only a small number of matters require attention so service users can be assured their interests, their safety and their comfort is paramount in this home. A number of matters do however require attention including materials to be cleared from fire exit routes and unlocked chemical cupboard. Whilst the home has embarked on an assessment of hot surfaces that may pose a risk it has yet to deal with heated towel rails in service users’ ensuite facilities. Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 14 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 15 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 38 Regulation 13(4)(b) Requirement Management: The home must risk assess hot surfaces, including radiators and towel rails and must take steps to reduce those risks by reducing the temperature to 430C or fitting protective covers. This remains an outstanding requirement from 30/3/05 Fire safety: It is required that all fire exits routes be kept clear at all times; materials such as carperts rolls and wheelchairs must be removed from exit routes. Chemical Hazards: it is required that hazaradous chemical be stored in a locked cupboard. Aids and adaptations: Wheelchairs must have their footrests in place when in use. Electircal hazards: Multiplug adaptors should not be used; either increase the number of wall-mounted sockets or use fused extension units. Timescale for action 30/7/05 2. 38 23(4)(c) 30/7/05 3. 4. 5. 38 38 38 13(4)(a) 23(2)(n) 13(4)(a) 30/7/05 30/7/05 30/7/05 Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 16 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. Refer to Standard 8 Good Practice Recommendations Assessments: it is recommended that the mental health of a be re-assssed to enure her needs can be met and that she remains appropriatley placed in this home (NMS 8:7). Hill House Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 17 Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Nursing Home Limited G53-G53 S19029 hill house V230568 060605 stage 0.doc Version 1.30 Page 18 - 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. 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