CARE HOMES FOR OLDER PEOPLE
Hill View 46 St Judiths Lane Sawtry Cambridgeshire PE28 5XE
Lead Inspector Don Traylen Announced 07 June 2005 @ 10:00 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 View Version 1.10 Page 3 SERVICE INFORMATION
Name of service Hill View Address 46 St Judiths Lane Sawtry Cambridgeshire PE28 5XE 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) 01487 831709 01487 831709 OakHouse Homecare Ltd Julie Boardman Care Home 16 Category(ies) of Dementia over 65 years of age (DE(E)) 1, registration, with number Old age not falling into any other category (OP) of places 16, Hill View Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 08/11/2005 Brief Description of the Service: Hill View is registered to provide care to 16 older people including one older person with age-related mental health impairment. The home is set in its own gardens in a quiet location on the outskirts of the village of Sawtry and approximately five minutes walk from the village centre shops and public house. Huntingdon, Cambridge and Peterborough are within a radius of approximately 20 miles. Originally a domestic bungalow, the building has been extended to offer ground floor accommodation in single bedrooms all of which have en-suite facilities. There is a large lounge at the front of the home, a dining room with an open plan kitchen, a conservatory as well as adequate bathing and washing facilities. Hill View has an enclosed and sheltered garden with ponds and flower beds. Hill View Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector considered it a priority to spend time to meet and talk to service users. 6 service users a relative and a district nurse spoke to the inspector on the day of inspection. The inspector stayed for a significant amount of time in the lounge, the dining area near the kitchen and with service users who remained in their rooms so that observations and discussion with service users were facilitated. The manager was available throughout the inspection. 13 service users’ comment cards sent to the home were returned and these had been completed by staff on behalf of service users but did not contain any comments. 2 relatives’ comment cards were completed. What the service does well: What has improved since the last inspection?
4 of the 4 requirements made at the last inspection have been met. Training arrangements have been given greater attention by the registered providers who have recently employed a training manager to co-ordinate training for all care staff in the three homes and domiciliary care agency they own. As a consequence, additional training in Dementia care has been provided.
Hill View Version 1.10 Page 6 The return of the manager from a period of sick leave has consolidated the daily functioning and running of the home. The home has employed an exceptionally efficient and conscientious cleaner who has brought a high standard of cleanliness to the home. New carpets have been laid in three bedrooms and in the hallway and corridors. Radiator covers have been applied to radiators that required low surface temperatures or covers. New kitchen units have been fitted and the dining area adjacent to the kitchen has been redecorated in a light-enhancing colour. One service user remarked that she approved of the colour of the painted wood. Although the home has never previously appeared under lit, the home felt brighter and lighter because parts of the home have been redecorated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Hill View Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hill View Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, Service users move into the home only after their needs have been assessed and their care needs agreed by the manager. EVIDENCE: The statement of Purpose and Service Users Guide were read. It is recommended that specific review periods for these documents are made to ensure that these documents are updated. Intermediate care is not provided. Two service users’ files contained Care Management assessments that had been made prior to admission plus an assessment conducted by the home. The manager stated she would not admit any service user unless she was satisfied the home were able to meet their needs. Service users are issued with contracts either by the local authority or by the home, if privately funding. Hill View Version 1.10 Page 9 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) 7,8,10,11, Service users have adequate Care Plans that includes appropriate support from community health services. EVIDENCE: One relative wrote in a comment card, “staff care for my mother above the call of duty”. One service users stated that, “it is excellent…the girls are marvellous” and “most are humane”, when asked about the home. Another service user described his visits to hospital and the visits to him in the home by District Nurses and his GP. He described the social and physical care and attention that he and other service users experience as “good” and that as far as he could tell, staff treat other service users with respect. Another service user stated, “they are very nice here”, when asked how staff treated her. A visiting District Nurse informed the inspector that she visits daily to administer insulin and attend to four diabetic service users. She considers the manager and staff of the home have a good working relationship with the Health Service group practice. She added that she notices each day the high standard of cleanliness within the home and that she sees service users in their own rooms. Two Care Plans contained assessment detail and adequate care planning information. The manger and the assistant manager stated how they would
Hill View Version 1.10 Page 10 both like to improve Care Plans by making them more descriptive of the person. They have hopes that staff will be involved in creating these new person-centred plans. One service users’ plan was in the process of being written and the manager added that this was going to be written in a the new style. 6 service users told the inspector they were treated respectfully and were pleased with their care arrangements made by the home. Service users stated they were able to receive visitors at any time. One visiting relative stated she was able to visit whenever she chose and felt that the home had kept her involved in the care planning for her mother. She added that the staff were, “very friendly”. The manager discussed with the inspector the ‘Heatwave Plan’ published by the Department of Health in June 2004 (and again in June 2005) that she is mindful of high temperatures by providing extra drinks and other measures to assess service users. The manager has developed a Temperature risk assessment and action plan that should be considered as good practice and as a policy to be used to protect service users from dehydration. Hill View Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15, Service users enjoy a lifestyle that meets their expectations. EVIDENCE: The 6 service users who spoke to the inspector said they were happy with their lifestyles and daily routines and felt they had control and choice in their life. One service user stated they enjoyed bingo, church service and musical evenings in the home. One other service user stated there was not enough social events planned for the evenings. One other service user goes out frequently to the local shops by himself. A pipe-smoking service user stated he was content with living in the home and enjoys sitting outside. Meetings for service users are encouraged and attended by some of the service users, but some expressed a desire not to take part. Hill View Version 1.10 Page 12 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, Service users are protected from abuse by the policies and practices of the home. EVIDENCE: All staff have received training in adult abuse and should therefore know how to recognise and report abuse. The inspector and manager discussed that some, if not all staff would benefit from a repeat or refresher course about abuse. Service users stated they felt confident about reporting abuse or raising any concerns with the manager whom they considered to be easy to talk to and available to talk to. All staff have received satisfactory Criminal Records Bureau checks and other appropriate checks on their employment history and qualifications. Three CRB disclosures were seen by the inspector during the inspection. The home has a Whistle Blowing policy. Two staff who spoke to the inspector had a sound knowledge of protecting vulnerable people from abuse. Hill View Version 1.10 Page 13 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) 19,20,21,22,23,24,25,26, Service users live in a very clean, comfortable and well-maintained home. EVIDENCE: It was observed that the home was very clean and tidy. Toilets, bedrooms and communal rooms are cleaned every day. A nighttime routine for cleaning duties has been established as well as a daytime routine. The cleaner employed by the home has brought about a high standard of cleanliness and has a wide knowledge of service users habits that she sensitively considers when managing her responsibilities. The cleaner explained to the inspector how she strives for a high a standard and revealed her skill and knowledge when describing how she communicates and interacts with service users needs. The cook stated that she organises the kitchen to be cleaned each day although she did not have a written plan to show the inspector, she stated that she would write a cleaning routine for these tasks.
Hill View Version 1.10 Page 14 The kitchen has been refitted with new units and the adjacent dining area has been repainted in a pleasant colour scheme. The changes were discussed with service users who said that they liked the colour scheme. The manager stated that she would like the same pleasing colour scheme applied to other parts of the home and has brought her ideas to the attention of the registered providers. New carpeting has been fitted to three bedrooms, the hallway and the corridors since the last inspection. The main lounge is a popular area for most service users, although a number of service users choose to sit in their own rooms, or use the chairs and tables of the dining room. One service user who is in his nineties, regularly sits outside in the enclosed gardens that are interesting, well kept and easily accessible at the rear of the home. A maintenance person is employed by the home on a regular basis to maintain the garden and attend to daily matters and any planned decoration. The manager stated she expects to identify the maintenance and decoration necessary for the home. A number of service users stated that the home is clean and has an environment that pleases them. It was discussed with the manager that the shower room has a radiator sited close to the shower seat where it might cause injury. The removal or refitting of the radiator must be considered. The paintwork to the door surround of the shower room must be completed. The manager stated that the home has planned for the bathroom and shower room to be improved. Hill View Version 1.10 Page 15 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) 29,30 Service users are protected by the home’s recruitment procedures and through appropriate training for staff. EVIDENCE: The home’s recruitment policies continue to be rigorous and meet the same standards as they have in the past. The home employs 12 care staff, two assistant managers, a manager, a cook, two cleaners and a handyman. The organisation also employs a training manager who has responsibility for arranging and providing appropriate training for staff. The home arranges for 2 care staff to be on duty between the hours of 7.30am and 10pm plus the manager who works from 9am to 4pm Mon-Fridays and an assistant manager who works 9am to 3pm every day. 3 Staff have NVQ level 2 awards and a further 4 staff are undertaking this qualification. Hill View Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38, Service users interests are the focus of management at Hill View. EVIDENCE: The manager is competent and suitably qualified to manage Hill View. The manager conducts supervisory arrangements, for all staff, every two months. The use of Care Plans, risk assessments, the record of complaints, the staff recruitment procedures and the company’s policies for preventing abuse and whistle blowing were read and these were considered to protect service users’ best interests. Records of fire drills, fire training and weekly fire equipment checks are maintained. This comment is extracted from section ‘Health and Personal Care’, “The manager discussed with the inspector the ‘Heatwave Plan’ published by the Department of Health in June 2004 (and again in June 2005) that she is
Hill View Version 1.10 Page 17 mindful of high temperatures by providing extra drinks and other measures to assess service users. The manager has developed a Temperature risk assessment and action plan that should be considered as good practice and as a policy to be used to protect service users from dehydration”. Hill View Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x 3 3 3 Hill View Version 1.10 Page 19 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 19 Regulation 23(2)(a)( d) Requirement The shower room must be the subject of preventative action to ensure the edges of a radiator that is fitted close to the shower does not cause injury, and the same room must be painted to the same high standard that has been created in the rest of the home. The bath taps in the bathroom must be maintained and be treated for corrosion and if necessary be replaced. Timescale for action 01/09/05 2. 19 23(2)(c) 01/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations The home should make specific arrangements to keep the Statement of Purpose and Service User Guide under review. These arrangements should be periodic and each document should bear a date and indicate when it is to be reviewed. A cleaning schedule for the kitchen should be prepared and managed by the cook as was discussed with her during the inspection.
Version 1.10 Page 20 2. 19 Hill View 3. 4. 30 33 The training matrix shows a range of subjects for training and these should be completed to indicate whether these topics are being arranged or have already been achieved. Regulation 26 reports that are being carried out regularly, should be sent regularly to the CSCI, as indicated in the Care Homes Regulations 2001. The manager has developed a Temperature risk assessment and action plan that should be considered as good practice and a policy or procedure to be used to protect service users from dehydration. 5. 38 Hill View Version 1.10 Page 21 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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