Inspection on 10/08/05 for Hillbeck

This inspection was carried out on 10th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillbeck 16/04/09

Hillbeck 18/04/08

Hillbeck 17/12/07

Hillbeck 31/01/07

Hillbeck 06/12/05

Hillbeck 23/02/05

Hillbeck 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN Lead Inspector Debbie Sullivan Unannounced 10 August 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. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hillbeck Address The Roundwell Bearsted Maidstone Kent ME14 4HN 01622 737847 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) Charing Healthcare Mrs Louise Jayne Beaney CRH Care Home 40 Category(ies) of DE(E) Dementia - over 65 (40) registration, with number of places Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Two double rooms 14 and 19 currently used as single rooms of 31 March 2002 continue to be so. Bedroom 9a is to be used as a double room for married couples, siblings or friends that can be evidenced, wish to move into the home together. The home registration is restricted to provide care to one service user diagnosed with dementia whose date of birth is 12 July 1949. Date of last inspection 23 February 2005 Brief Description of the Service: Hillbeck is a care home for older people with dementia situated on the outskirts of Maidstone in a semi rural area. The town centre is approximately two miles away and there is easy access to the M20. The home is near to local shops, bus routes and a station. The home has undergone substantial extension and refurbishment over the past two years which has enhanced the facilities and increased the number of bedrooms. There are now 40 places and a new sun lounge, kitchen, laundry and sluice room. A safe, secure and attractive patio area leads off the lounge. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. Due to the nature of the service much evidence was gained from discussion with the manager and deputy manager, other members of staff and a number of relatives who were visiting. Evidence was also gained from direct observation, some individual discussion with residents and from reading of documentation. A tour of the premises took place and the midday meal partially observed. Activities sessions were also partially observed and the visit offered the opportunity to see a part of the staff recruitment process in operation and the process of offering choice of home to prospective residents. The registration condition allowing the home to accommodate a resident with the date of birth 12.9.1949 will be removed, as it no longer applies. What the service does well: Hillbeck provides a safe, clean and comfortable environment for older people with dementia. Staff exhibit good understanding of specialist needs and a genuine interest in and positive attitude towards the resident group. The atmosphere in the home is open, friendly and welcoming with plenty of activity and evidence of staff interaction with residents. Communication within the home and between staff is effective and staff are well supported. Refurbishment has increased the size of communal areas and bedrooms are decorated to a good standard with rooms individualized to varying degrees. There are plenty of signs throughout giving information to residents, visitors and staff. Signs are used to good effect especially in the laundry /sluice/medication room area to remind staff to adhere to procedures for health and safety and hygiene. Meals are well planned, cooked and presented. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 6 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. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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) 1,3,4 and 5. Prospective residents have access to information about the home, the assessment process is thorough and the home welcomes visits so that all can be sure needs can be met on admission. EVIDENCE: During the inspection clear evidence was available that prospective residents and their relatives have every opportunity to gather information regarding the home and that a full assessment of needs take place prior to admission; the process could be very clearly tracked. Phone calls were received in the office by the manager with enquires about vacancies; information on the position given and requested on the prospective resident and relatives or others were invited to visit. One prospective resident was at the home for assessment and later another came to look round with a relative. The manager is very clear that no resident is admitted if his or her needs cannot be met by the home. Pre admission assessments undertaken by the manager or deputy manager were sampled on care plans; they were comprehensive and the information clear. A number of relatives were visiting throughout the day varying from relatives of well-established residents to those of a relatively recent admission. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 9 All confirmed that assessment had taken place and they had had opportunity to view the home, one relative stated that it had met expectations. Relatives who had considered alternatives chose Hillbeck due to the nice atmosphere. One resident very recently admitted stated that he and relatives had viewed the home prior to making a choice. The service users guide is clearly displayed in the entrance hall; it contains the necessary information and is clear and easy to read. The home does not offer intermediate care. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. Residents care plans are well kept, comprehensive and reflect individual care and social needs. Medication procedures are good and measures to enhance them will be put into place. EVIDENCE: Care plans follow the organisational format, the sample read were up to date, easy to read and the information found in clearly marked sections. There are separate sheets for each aspect of residents’ care needs such as communication, risk assessment, mobility and nutrition. There was clear evidence of medical appointments and contact with GP’s and other professionals and that when a health concern is identified other professionals are promptly contacted. The manager gave a verbal example of a situation where a large amount of support from CPN’s was needed and of the good relationship they had with the home. Some care plans had gaps in sections such as ‘dentist’ if such a service had not been accessed; it is recommended any gaps be filled in. Relatives said that they were happy with the care given and that any care issues they mention to staff are addressed satisfactorily. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 11 Throughout the inspection care and other staff were observed to be treating residents with respect and dignity and personal care needs were attended to discreetly. Residents do not self medicate. Medication procedures were inspected a requirement was made that the controlled drug cabinet be bolted onto the wall; this was actioned during the inspection. Recommendations are made regarding the night storage of the drugs trolley and temperature in the medication room. Again decisions on measures to address these issues were agreed on the visit. The lunchtime medication round was partially observed, a senior carer and the deputy manager were attending the trolley at all times and medication was seen to be correctly administered. Wishes regarding death are recorded on care plans. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,and15. Residents individual preferences are recorded and contact with friends and family maintained. Choices are offered and respected and activities provided. Meals are well balanced, cooked and presented with plenty of choice. EVIDENCE: The individual preferences of residents regarding interests are recorded on care plans and a range of activities provided in the home. An activities coordinator is employed three days a week, time was spent with the coordinator who keeps a record of residents worked with each day, their interests and activities undertaken, these include recognition work, reading and artwork. One resident was proud that with encouragement she was able to read short sentences. A prebooked musical entertainer arrived during the morning, residents participated in the session and those most interested were enthusiastically assisted by staff to join in singing and dancing. The atmosphere was one of real enjoyment on the part of residents and staff. If residents did not wish to join in this was respected. Several visitors arrived during the day and contact with friends and family is promoted. One resident returned from a walk, which he had enjoyed, this had been risk assessed. Others were choosing to access the patio area, as it was a warm day. Examples of opportunities for residents to make choices were choice of location to access in the home, residents can move around freely and safely within Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 13 communal areas, choice of décor and furnishing in bedrooms, choice of meal and activity. Lunchtime was partially observed and time spent with the cook. The meal was well presented with appropriate sized portions; two choices were offered and other options available on request. Pureed food is presented well and items on the plate separate. The mealtime was unhurried with staff assisting residents as needed. Comments from relatives and residents about the food were complimentary. A visitor of a resident on a pureed diet said that the resident enjoyed the meals. The menus are drawn up monthly by the organisational catering manager and checked by a nutritionist before distribution to the home. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Residents’ concerns and complaints are acted upon and the home has a clear accessible complaints procedure. Staff are aware of adult protection issues and policies and procedures are in place to protect residents. EVIDENCE: The home has a clear complaints procedure, which is displayed in the reception area; there had been no formal complaints since the last inspection. Relatives spoken with were aware of the procedure and said that any matters could be referred to the manager, deputy manager or senior staff and would be dealt with promptly. Examples of this were given. Relatives felt that communication within the home was good. One relative had queried a funding issue with the organisation and had subsequently met with a senior manager although knew this was an organisational matter and could not be resolved at home manager level. Response at the homes’ level had been good. One resident was able to state that they were aware of the procedure and although they had not complained formally had raised a matter regarding their bedroom that had been addressed. Staff receive adult protection training during induction and care staff spoken with had core understanding of adult protection issues and procedures. Update training is provided. Staff were aware of whistle blowing and complaints procedures and said they would feel confident in using them if necessary. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,23,24,25 and 26. Residents live in a safe, comfortable, clean and well-maintained environment. Individual bedrooms meet personal needs and reflect personal taste in decoration as far as possible. Independence is promoted by the availability of equipment. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 16 EVIDENCE: Hillbeck is well decorated and maintained, additional communal space is available following the refurbishment. Furnishings are of good quality and the home is cleaned to a high standard. Residents are free to access bedrooms and communal areas safely, areas of risk such as the laundry and kitchen are isolated by the use of keypads. Access to the patio is via the dining room and an unobtrusive ramp, the patio and pathway around part of the building is secure with gates at each end. A number of individual bedrooms were inspected; all were clean, light and well decorated. If residents bring personal furniture an inventory is drawn up of items. Bedrooms had been personalised to varying degrees with the addition of pictures, ornaments and photographs. The majority have en suite facilities, communal bathrooms are available on each floor, and the two upstairs bathrooms are newly refurbished. The downstairs bathroom had an odour; this may have been due to the flooring that is scheduled to be replaced. Grab rails are located throughout the building and evidence of personal equipment was seen in bedrooms. Visitors spoken with all said that their relatives were happy with their rooms and one commented on “the lovely room” which had been redecorated before admission. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 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) 27,28,29 and 30. The needs of residents are reflected in the staffing compliment, care and other staff are well supported and relate very well with residents. Staff are confident in their roles, further training is required so that the so that the correct ratio of NVQ 2 or above qualified care staff are employed. EVIDENCE: The home has a clear staffing structure in place; the organisation’s area manager supports the manager and deputy. Both the manager and deputy are on duty during the week and on call at weekends with senior carers then in charge. There is a staffing compliment of carers and senior carers, cook, kitchen assistant, maintenance man, two domestic staff and a laundry assistant. There were five care staff on duty at the time of the inspection and they were clearly confident in their role and attentive to residents’ needs. An interview for a member of care staff took place during the inspection with a positive result. All staff are CRB checked and those recruited from abroad via an agency have checks and references taken up by the agency. Staff are expected to pay personally for CRB checks, a recommendation from the last inspection was that the organisation revise this procedure. The file of a member of staff recruited from abroad was inspected and included references, CRB documentation and a copy of a work permit. The ratio of 50 of care staff with NVQ 2 or 3 in care or equivalent is not yet achieved, six care staff have gained NVQ 2 and others will commence the course in September. It is recognised that although the Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 18 target will not be reached this year, there is a clear commitment to achieving it as soon as possible. Care and other staff spoken with felt well supported and were happy working at the home. This was reflected in the level of interaction and empathy shown to residents. Comments from residents and relatives regarding care and other staff included, “staff are excellent” “she’s always been good to me” and “nothing is too much trouble”. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 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) 31,32,35,36,37 and 38. The home is well run in the best interests of residents and staff. Residents benefit from the ethos and welcoming atmosphere and they can be confident that their rights, safety and security are protected by the homes’ policies and procedures. EVIDENCE: Throughout the inspection it was evident that the home is run in the best interests of residents and that the atmosphere is friendly, open and inclusive. Residents were seen to be supported by an interested and attentive staff group who are well managed and enjoy their work. Comments from staff and relatives were complimentary about the way the home is managed, and residents and staff interacted in an easy relaxed way. Staff receive regular supervision and staff meetings are held monthly. One relative state that the home was chosen due to its atmosphere. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 20 The manager and deputy manager are currently undertaking the NVQ 4 in care. A sample of the homes’ maintenance records were inspected and evidence seen that regular safety and maintenance checks take place. Some documentation in place to safeguard residents was inspected such as fridge and freezer temperature charts, recording of food deliveries and storage and cleaning schedules, all seen were up to date and raised no concerns. The home does not manage the finances of residents. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 4 x x 3 3 3 3 Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 22 Yes 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 OP9 Regulation 13(2) Requirement The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that the controlled drugs cabinet be secured to the wall by a bolt and the temperature in the medication room be monitored and measures put in place to cool it if necessary. Timescale for action Immediate. A bolt was fitted to the controlled drugs cabinet during the inspection and a fan will be placed in the medication room if it is too warm. Action plan to be received by CSCI by the end of October 2005. The manager advised that the flooring is already scheduled for replacemen Page 23 2. OP 26 13(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. In that the flooring in the downstairs communal bathroom be replaced. Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 t. 3. OP31 9 The registered person must ensure that the registered manager has the qualifications, skills and experience necessary for managing the care home. In that Mrs Beaney attains a qualification at NVQ level 4 in management and care by 2005. This was a requirement at the last inspection, Mrs Beaney has commenced the NVQ 4 qualification along with the deputy manager. Ongoing and to be reviewed at the next inspection. 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. Refer to Standard OP7 OP9 OP28 Good Practice Recommendations It is recommended that gaps in care plan recording be filled in or marked as unknown or not applicable. This remains a recommendation from the last inspection. It is recommended that a senior member of night care staff sign that the medication trolley has been put in the medication room at night. It is recommended that the home continue to work towards achieving a minimum of 50 NVQ or above trained care staff. This was a recommendation at the last inspection, it is now acknowledged that this target is not realistic in 2005 but should be aimed for at the earliest possible date. It is strongly recommended that the organisation fund CRB disclosures, this was a recommendation at the last inspection and remains a good practice issue to secure the safety and protection of residents and staff. 4. 0P29 Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Hillbeck H56-H06 S39699 Hillbeck V242057 100805 Stage 4.doc Version 1.30 Page 25 - 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. 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