CARE HOMES FOR OLDER PEOPLE
Hill Top Care Home Colliery Road Church Gresley Swadlincote Derbyshire DE11 9LU Lead Inspector
Vanessa Davies Unannounced Inspection 17th December 2007 09:00 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 Top Care Home DS0000067538.V355411.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 Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hill Top Care Home Address Colliery Road Church Gresley Swadlincote Derbyshire DE11 9LU 01283 550354 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) Mrs Judith Dena Griffin Stewart Westley Barker Audrey Phyllis Ramsell Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability over 65 years of age (2) of places Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 23 places for OP. 3 places for younger people PD aged 50 and over, either sex, included in the above total. 1 day care place. Total Registration not to exceed 23 places. Date of last inspection 23rd July 2007 Brief Description of the Service: Hill Top Care Home Limited is a 23 bedded home, providing nursing and personal care to persons aged 65 years and over, including 2 places for people aged 50 years and over with physical disabilities. The home is a purpose built, single storey building, located in Church Gresley, and close to local shops and a bus route. The home has 21 single rooms and 1 shared room. Service users have access to two lounge areas and a dining room which can be partitioned from the lounge Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report was written with evidence gathered before and during a visit to the home. A relative and two residents were spoken with. The new Manager, both providers and the new operations manager were there throughout the visit. What the service does well: What has improved since the last inspection?
Staffing levels have improved to ensure that residents are supported to participate in activities and to ensure that their dignity is preserved when meeting their needs. A detailed activities programme has been implemented and provides information relating to what the activity was, how long it took place and who was involved. Medication is administered ensuring that the cabinet is never left unattended whilst unlocked.
Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 6 All staff have up to date training in Safeguarding Adults. All staff have a completed POVAFirst check and a Criminal Records Bureau check prior to commencing work at the home to ensure residents are not placed at any undue risk. A window restrictor has been fitted on the window highlighted at the previous visit. The lock on the front door has been replaced with something more suitable and which now meets with fire regulations. The providers have implemented audits, including sending questionnaires out to relatives and visiting professionals. 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 Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. Detailed assessments of need ensure that staff are given the information to ensure that the needs of the residents are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 2 residents files were examined on the day of the visit. Each file had a completed assessment of need, a nursing assessment tool and a completed continence assessment. The files also included pressure sore risk assessments, slips trips and falls risk assessment and various other risk assessments as necessary. From these detailed assessments care plans have been implemented to address the needs highlighted. It was evident within all files examined that the family or the residents had input with the preparation of the assessments and the care plans and this was confirmed when speaking with a relative during the visit. All care plans were reviewed on a regular basis and there was evidence of Social Services care reviews.
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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. Detailed assessments, input from other relevant professionals and contact with families and friends ensures that the health and social needs of the residents are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The health needs of the residents are highlighted in a variety of assessments. There was evidence of input from a range of other professionals; optician, GP, dentist and speech & language therapist. Dietary needs are assessed, as are continence needs. It was evident that health needs of the residents are met. Relatives and friends visit without restriction and this was confirmed by a relative during this visit. Although staff record accidents accordingly they do not currently make a record of an incident. In one file examined the medication had been increased by the GP to lessen the aggressive behaviour, however there were no records of incidents to evidence the need to increase the medication. The manager was
Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 10 made aware of this and the need to keep clear records and stated that an incident form would be introduced. The Activity Coordinator now details every activity in a great deal of detail including who is involved and how involved that person is. Staffing levels improved at keys times of the day. Medication is stored appropriately. All medication received and administered at the home is documented accordingly. Medication is administered by staff trained to do so, no issues were evident. The home has a policy and procedure in place for the safe storage and administration of medication. Staff were observed throughout the visit speaking appropriately with residents and relatives, knocking on bedroom and bathroom doors before entering and offering choice. A relative spoken with stated that the staff are always polite and welcoming when she visits. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 11 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 good. Suitable activities, additional staff and positive changes to the attitudes of staff helps to ensure that residents privacy and dignity are met and therefore making them feel valued. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident throughout the visit that relatives and friends visit the home on regular occasions, without restriction. The Activity Coordinator now documents all activities in great detail including what residents do, who takes part and what involvement they have. Staff were observed speaking with residents appropriately. Staffing levels have increased at peak times during the day and staff spoken with stated that this had made a difference and they were now able to spend more valuable time with the residents. The New Manager and provider are still working with the staff to change their views and encourage them to sit with the residents and talk to them without thinking that it is not acceptable. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 12 The home offers a choice of menu to all service users. Special dietary needs are catered for and well documented. The manager and staff complete nutritional assessments and regularly review them. Staffing levels are increased at mealtimes to ensure that the dignity of residents is respected and that changing needs are met. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 13 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. Suitable policies and procedures in place help to ensure that residents are safe and able to voice opinions without fear. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure was available to all residents and this was included in the service user guide. The residents spoken with felt able to speak to the staff and manager if they were not happy about anything to do with their care as did the relative spoken with. The home has a rigorous recruitment procedure in place which is now followed by the new Manager and the providers. There was a safeguarding adults policy in place. All staff have now completed Safeguarding adults training. Staff spoken to had a basic understanding of the action to be taken if an allegation was made. All staff files examined contained 2 written references, 2 forms of identity and a Criminal Records Bureau check. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 14 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 good. A clean and well maintained environment helps to ensure the safety of the residents and promotes an easily accessible environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment is clean although the carpet in the lounge had a strong malodour, the providers stated that a new one had been ordered. A window restrictor has been fitted as required at the previous inspection. Bedrooms are personalised. Wheelchairs are stored more appropriately therefore no longer causing a health and safety hazard.
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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. Appropriately trained staff in sufficient numbers at key times helps to ensure that residents needs are met and that they are safe and feel safe, promoting a positive environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was apparent on the day of the visit, by observations, speaking with staff and the manager, that staffing levels had been increased at peak times to meet specific needs. The record of activities was very detailed. Adult Protection training for many staff had been completed and the new manager did state that further training was being arranged. The home has a rigorous recruitment procedure to ensure that all staff have 2 written references, job history and a Criminal Records Bureau check in place prior to starting at the home and staff files evidenced this. The manager intends to delegate supervision responsibilities to other qualified staff to ensure that all staff receive regular 1:1 supervision. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 16 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): 31,33,38 Quality in this outcome area is good. Positive Management changes and improved quality monitoring helps to ensure that the changing needs of the residents continue to be met by a qualified and enthusiastic staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous Registered Manager had resigned and left the home prior to our visit. A new manager was appointed, with great deal of experience and is due to start the Registered Managers Award. There appeared to be a difference within the staff team, morale appeared much improved. The manager had organised a Christmas party, which was much appreciated by the residents and relative spoken with.
Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 17 Staff had purchased cards and gifts on behalf of the residents unable to do so to give to their relatives and again this was much appreciated by the relative spoken with. The provider and manager have developed a quality audit and forwarded it to relatives and other professionals and are awaiting a response. Care plans and risk assessments are reviewed on a regular basis. The fire alarm and electrical equipment are tested on a regular basis Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 18 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 X X X 3 Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? NO 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. Refer to Standard OP7 Good Practice Recommendations The manager should ensure that incident forms are completed and monitored for all incidents. Hill Top Care Home DS0000067538.V355411.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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