CARE HOMES FOR OLDER PEOPLE
Hill Top Care Home Colliery Road Church Gresley Swadlincote Derbyshire DE11 9LU Lead Inspector
Vanessa Davies Unannounced Inspection 23rd July 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.V341230.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.V341230.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.V341230.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 12th July 2006 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.V341230.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. During the visit the inspector spoke with all staff, the Registered Manager, one of the Providers, a relative and residents. The information was gathered whilst observing how staff worked and spoke with the residents. What the service does well: What has improved since the last inspection?
The Manager now has a number of quality audits in place and it was evident that these are completed on a regular basis. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 6 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.V341230.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.V341230.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. This judgement has been made using available evidence including a visit to this service. Detailed assessments of need ensure that staff are given the information to ensure that the needs of the residents are met. EVIDENCE: 3 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 the manager has implemented care plans 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. This was confirmed by a relative on the day of the visit. All care plans were reviewed on a regular basis and there was evidence of Social Services care reviews.
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 9 The home does not offer intermediate care. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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, however staffing levels meant that the manager was attempting to do two jobs at once, potentially putting residents at risk. 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. There was little evidence of activities taking place, the manager stated that the Activities Coordinator had recently left, however there was little evidence of activities taking place whilst she was there. There was no evidence of activities taking place during the visit.
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 11 Medication is stored appropriately. All medication received and administered at the home is documented accordingly. Medication is administered by staff trained to do so, on the day of the visit medication was being administered by the Manager, during lunchtime, the manager was administering medication and attempting to feed a resident, leaving the medication trolley open, although she did remain quite close to the trolley it must not be left open. 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.V341230.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor staffing levels potentially prevents social expectation of residents being met and compromises the dignity of the residents. EVIDENCE: As stated previously the manager ensures that detailed assessments of need are completed, these include detailed information of life prior to moving into the care home. It was evident throughout the visit that relatives and friends visit the home on regular occasions, without restriction. The was no evidence of activities taking place recently and this was confirmed by the staff and manager and evident on the day of the visit. There was little evidence of activities taking place when there was an Activities Coordinator. Staff were observed speaking with residents appropriately, however poor staffing levels prevented the staff from socialising with residents and undertaking any activities. Staff spoken with felt that they had the time to meet basic care needs but nothing further and this was evident on the day of
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 13 the visit. There were 3 care staff on duty and 1 registered nurse; who was the Registered Manager. 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. However due to the staffing levels the dignity of the residents was compromised, 1 staff member was attempting to feed 3 residents in their beds and the other 2 were trying to feed 4 residents at the meal table at the same time. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Timely responses to complaints ensures that residents and families feel listened to. Employing staff without a Criminal Records Bureau check and POVAFirst check potentially puts residents at risk. EVIDENCE: The home has a detailed complaints procedure and the manager documents all complaints and responses, the CSCI have received 2 complaints, evidence for both were examined on the day of the visit. Complaints are dealt with by the home in a timely fashion. Some staff have completed training in Safeguarding Adults, the manager stated that further training had been planned. A selection of staff records were examined, 1 was examined in connection to a complaint received, 1 member of staff had worked at the home between 07.05.07 and 13.07.07 without a Criminal Records Bureau check and a POVAFirst check. All other files examined held 2 written references, 2 forms of identity and a Criminal Records Bureau check. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, however the lack of storage space, the need for a window restrictor on a first floor window and the lock on the front door, potentially put residents at risk. EVIDENCE: The environment is clean, however as stated in previous inspections the manager needs to arrange for suitable storage areas for wheelchairs and other equipment; Toilets 1 and 3 are not accessible as they are used as store rooms. They are also wheelchairs stored in lounge areas. In addition to using toilets and lounges to store equipment, damaged wheelchairs are stored outside, a note in the diary stated that one had been found ‘down the lane’ the manager stated that they do have problems with local children taking them. A window restrictor is needed on the window highlighted on the day of the visit, this was highlighted at the previous inspection in 2006, although the staff
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 16 stated that only 2 of the residents are able to mobilise currently, the window is within easy reach and there is a severe drop outside. An immediate requirement was left for this to be addressed, the provider contacted the inspector following the visit and stated that the restrictor had now been fitted. There are no radiator covers on a large number of radiators throughout the home and there are no risk assessments in place. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. Insufficient staff, employing staff without a Criminal Records Bureau check and not providing up to date Safeguarding Adults training for staff, potentially places residents at risk of harm and prevent staff from meeting their holistic needs. EVIDENCE: It was apparent on the day of the visit, by observations, speaking with staff and the manager, that there were insufficient staff on duty to meet the needs and respect the dignity of the residents. The last record of activities taking place was 9th July 2007; board games and skittles but no names of the residents participating and for how long. There was no evidence of activities taking place on the day of the visit and when asked all of the staff stated that they did not have the time anymore, there were 3 care staff on duty and the Registered Manager. On the day of the visit there were 5 residents who were bed fast, 14 residents unable to mobilise, all needing to be hoisted and 1 resident able to mobilise. During lunchtime, the staff were trying to feed residents around a dining room table 2 at a time and another member of staff was feeding the residents who were bed fast, in doing so the dignity of the residents was not taken into consideration.
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 18 Adult Protection training for many staff is out of date, the manager did state that his was being arranged. The staff spoken with stated that they did not think that they were paid to attend training since the new provider had started, this should be clarified with staff. 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, however on one occasion the home employed a member of staff for a number of weeks without a Criminal Records Bureau check, this was discussed with one of the providers on the day of the visit. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home is managed by a competent and confident manager who has previously received good inspection reports, lack of Regulation 26 visits, lack of specific management allocated time and failing to address fire officers recommendations, would indicate that she is not receiving the necessary support from the providers and therefore could potentially put residents at risk. EVIDENCE: The manager is a competent, well-qualified Registered Nurse who has managed the home for a long time. She achieved her NVQ 4 Management award in 2004 and keeps up to date with changes relating to her profession.
Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 20 She works 5 days per week and as she is counted in the staffing numbers on each shift, this takes her away from the day to day care of the residents, leaving 3 care staff without a Registered Nurse when she has management tasks to undertake. Fire alarm checks, drills and training were all up to date. The fire officer visited the home and highlighted a problem with the locking of the front door, the door was still being locked and the key kept in a locked office only accessible via a key-coded lock, this adds unnecessary time into unlocking the door in the event of a fire. The Provider contacted the inspector after the inspection to state that this issue was being resolved. The Providers do visit the home, however there was no evidence of a Regulation 26 report being completed, the manager stated that she had not received one and none have been received by CSCI. The Manager forwarded the required information requested by CSCI prior to the visit, however the date for the homes electrical circuit checks had not been completed, when asked on the day of the inspection she said that the Provider was supply her with the information but to date had not done so. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 1 Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 2. Standard OP19 OP19 Regulation 13.4 a 23.2l 13.4 c Requirement All areas of the home must be free from hazards. (previous date 31/10/06) Unnecessary risks to residents health and safety must be eliminated as far as possible. (previous date 18/07/06) A programme of activities must be arranged, having regard for the needs of the residents. Unnecessary risks to the health and safety of the residents should be identified and eliminated. Residents must be supported to engage in local, social and community activities. Staff must have a Criminal Records Bureau check in place prior to commencing duties at the home. Appropriate staffing levels must be maintained to prevent unnecessary risks to residents. Providers must undertake audit visits to the home and provide written reports to the manager. Adequate means of escape must be provided.
DS0000067538.V341230.R01.S.doc Timescale for action 23/07/07 23/07/07 3. 4. OP7 OP9 16.2 (n) 13.4(c) 31/10/07 30/09/07 5. 6. OP12 OP18 16.2 (m) 7,9,19 Sch 2 (7) 12.1 12.2 13.4(c) 18.1 (a) 26 23.4 (b) 31/10/07 15/09/07 7. 8. 9. OP27 OP33 OP38 23/07/07 30/09/07 23/07/07 Hill Top Care Home Version 5.2 Page 23 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. Refer to Standard OP19 OP30 OP30 OP31 Good Practice Recommendations The manager should ensure that radiators are fitted with covers or risk assessments are completed. The manager should ensure that all staff complete the Safeguarding Adults training as arranged. The Provider should clarify which training the staff are paid to attend, as Health & Safety legislation states that staff should be paid for attending Health & Safety courses. The Registered Manager should arrange for supernumerary days for herself to ensure that when she is on duty she is not taken away from working with the residents. Hill Top Care Home DS0000067538.V341230.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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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