Inspection on 16/04/09 for Hillbeck

This inspection was carried out on 16th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillbeck 18/04/08

Hillbeck 17/12/07

Hillbeck 31/01/07

Hillbeck 06/12/05

Hillbeck 10/08/05

Hillbeck 23/02/05

Hillbeck 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN 01622737847 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ian@charinghealthcare.co.uk Charing Hill Ltd care home 40 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 40 The maximum number of service users who can be accommodated is: 40. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Hillbeck is a residential care home providing accommodation, personal care and support for up to forty older people who have difficulty managing aspects of their comprehension. The registered provider is a private company and has other similar homes in the region. The home is a property with accommodation on the ground and first floors. There is a passenger lift that gives access to the first floor and step-free access around the building. There are four double rooms although most of these are being used as single rooms at present. Each bedroom has a private wash hand basin. Most bedrooms have en suite facilities and one has its own bath. There is a call bell system that helps people summon assistance when needed. There is a main lounge that leads onto the Care Homes for Older People Page 4 of 25 Brief description of the care home dining room. There are bathrooms and toilets on both floors. Hoists and other equipment are in place to assist those people who have difficulty need assistance to move. The home is currently being extended to provide additional bedrooms and communual areas as well as two wet rooms. The older part of the home will then undergo a refurbishment programme which will include a clinical room and better staff facilities. Outside there is ample car parking to the front of the home. There are gardens to the rear of the home. These gardens are currently being landscaped to provide a safe outside area with seating for residents. The home is situated in a quiet residential area approximately a mile from the centre of Bearsted village. There are two pubs, a small number of shops and a railway station in Bearsted. The county town of Maidstone is about three miles away. A bus route runs past the home and there is easy access to the M20 motorway. Further information can be obtained by contacting the manager for the home. The weekly fees range from £420 to £620.00. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit formed part of the annual inspection process of the Commission under the Care Standards Act. This report uses information that we gathered prior to, and during, this visit. This includes the homes quality assurance self assessment (AQAA) document; notifications about significant incidences; the views of visiting health and social care professionals; and the views of people using this home and their supporters. As a result of this inspection a judgment about the quality of the home has been made. The visit was made in conjunction with the Safeguarding Adults Coordinator from Kent Social Services, Mrs Felicity Elvidge. During the visit we spoke to five of the residents and observed the interaction of others with staff. We examined relevant documentation Care Homes for Older People Page 6 of 25 such as care plans, staff files and medication records. We made a tour of the home and spent time in discussion with the area manager and the registered provider for the home. The term, residents, is used throughout this report to refer to the people who live in the home. this is the term that their supporters told us they would prefer us to use. The residents, their relatives, the staff, the area manager and the registered provider are all thanked fro welcoming us to the home and for their assistance throughout the visit. The quality rating for this home is 1 Star. This means that the outcomes for the people who live here are judged to adequate. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives prospective service users and their supporters good information about the home. this means that informed decisions can be made about moving into the home. There are sound admissions policies and procedures that ensure only those people whose needs can be met and who are suitable for the home are offered a place in the home. Evidence: The home has a comprehensive Statement of Purpose, Service User Guide and plenty of additional information about the home. There is a large notice board in the foyer of the home with a guide in pictorial form as well as a copy of the last inspection report. There have been no new admissions in recent months as there is extensive building Care Homes for Older People Page 10 of 25 Evidence: work being carried out. In addition there have been changes in management arrangements and a high staff turnover. There are sound admissions policies and procedures and a comprehensive preadmission assessment format that includes the Bartel and Waterlow assessments. However the home is looking at improving the way in which is assesses dependency levels as the Bartel score does not always give an accurate picture for people with dementia. The home does not offer intermediate care. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst basic care needs are met there is room for improvement in the care planning process to ensure that all individual needs are met. Nutritional monitoring is unsatisfactory and does not identify the action that should be taken if residents lose weight. This puts them at risk of malnutrition and may mean that underlying medical conditions are missed. There have been improvements in the way medicines are managed and administered in the home but continuous and closer monitoring is needed Evidence: Four care plans were examined. Whilst these contain very good information about the needs of each person who uses this service there was no evidence that the care plans are being used appropriately. There are a lot of new staff and, on occasions, it has been necessary for the home to use agency staff. The care plans contain a great deal of information but this information is not in a format that can be easily used by staff Care Homes for Older People Page 12 of 25 Evidence: who may not know the person or the home very well. Observation of the interaction between staff and residents showed that staff are kind, cheerful and caring. Staff treated the service users with respect and understood the need for confidentiality. The home is currently working to improve the care plans and the way they are used. A new, simplified format for care planning has been produced and a copy of this was seen during this visit. Staff training in care planing has been stepped up and the area and an experienced mamber of staff from another home in the company is now working at the home, full time, to provide more leadership and training for staff until new staff appointments are taken up. Nutritional monitoring needs to be improved. Currently the residents are weighed regularly but there was no evidence to show that the home takes appropriate action when significant weight loss is noted. The care plans of two residents who had lost weight were examined but there was no record of any action taken. The residents were also indirectly observed at lunchtime. Staff were not recording their food intake and did not offer alternatives when they ate only a very small amount. There have been errors in the administration of medicines since the last inspection. The home informed us about these in accordance with Regulation 37. Since these errors there have been a number of changes in the home, including the management arrangements. More training has been given to staff and a senior members of staff have reviewed the systems and there has now been a complete review of medication in conjunction with local general practitioners (GPs). However, during the inspection we found that there were still deficiencies in the way medicines are managed and administered in the home. For example, the Medication Administration Records showed that there were a number of occasions when medicines were not administered because the resident was asleep and one occasion when a tablet had been dropped and therefore not given. No record had been made of any action that had been taken. There were no instructions for staff as to what action they should take in these circumstances and the daily record did not reflect that medication had been missed. Since this visit we have been told that the home has introduced a simplified guide for staff about the administration of medicines and a book in which staff must record any missed medication and the action taken. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life in the home needs more thought so that there is a more stimulating environment. Whilst there is a generous food budget, there should be more consideration of individual needs in respect of nutrition Evidence: There is an activities co-ordinator who spends time with individual residents. However, there seems to be little in the way of organised activities. Staff interact well with the residents and were seen to be kind. There was plenty of fresh produce in the home and meals were seen to be of generous portions. Special diets are catered for and there was a good choice of food on offer on the day of this visit. However, some residents seemed to be put off by these large portions. Nutritional monitoring is not well established in the home and the manager told us that they are planning to introduce a more rigorous system in the near future. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has improved the way in which it responds to concerns, complaints and safeguarding issues but further staff training is needed. Evidence: The home has sound policies and procedures for managing concerns, complaints and safeguarding. However, we found evidence that these had not been followed on two occasions. Since the last inspection three serious concerns had been raised by relatives. Two of these concerns were subsequently directed to Social Services as the complainants were not satisfied with the response from the home. These concerns resulted in Adult Protection Alerts being raised. Currently the home has a Level 3 contract suspension placed by Social Services and there is a voluntary agreement not to admit any new residents until the new management arrangements have had time to make the planned improvements. Staff files show that staff receive training in safeguarding and those spoken to understood the need to report any concerns in the proper way. The area manager told us that she is now dealing with the complaints and concerns and that staff are to receive further training in complaints and safeguarding. Care Homes for Older People Page 15 of 25 Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is currently undergoing major improvements. Once complete the environment will be greatly improved. Evidence: A tour of the home was made. Over the past year there has been a lot of building work going on at the home. A large extension that will provide six new bedrooms, two wet rooms, a managers office, a large patio area and a new day room. Once complete this will be a great improvement to the accommodation, however, the work has impacted on the lives of the residents. It has meant that part of the communal area is very dark and that there has been restricted access to outside space. The home was clean and hazard free on the day of this visit although some furniture in the day room was stained. We were told that there are plans for refurbishment of existing rooms and the communal areas once the building work is complete. The work is expected to be complete by early summer. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are kind and caring and staffing levels are adequate. However, clearer lines of responsibility and leadership on some shifts are needed. Recruitment procedures are sound and ensure that all any staff offered a post at the home will have been carefully vetted. Evidence: Although there appears to be adequate funding to ensure that there are enough staff on duty to meet the needs of the resident there has been a significant staff turnover. This has led to recruitment of a significant number of new staff but there is still a lack of experienced senior staff. This has meant that the home has lacked appropriate leadership on some shifts. The area manager is aware of this shortfall and is currently reviewing staffing structures and advertising for additional staff. She is also looking at more innovative ways of using the domestic staff to provide more support at times, such as mealtimes, when care staff are under more pressure. Recently a very experienced member of staff who works at other homes in the Charing Health group has been asked to work at the home to provide additional supervision and training for staff. She is making good progress with this and staff said that she has helped them a lot in developing their roles as carers. Care Homes for Older People Page 18 of 25 Evidence: Staff spoken to were positive about their work in the home and appeared committed to providing good care for the residents. Staff were observed to treat the residents with respect and kindness and to be cheerful and friendly. Recruitment of new staff has been encouraging. A sample of staff files was examined. These confirmed that there are sound recruitment procedures in place. The home makes stringent checks on all prospective staff. Criminal records checks, written references, health check forms and detailed application forms are all in place. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is improving and there is a clear vision for the way in which the National Minimum Standards will be achieved. Evidence: Until two weeks prior to this visit there concerns about the way the home was being managed. For example, relatives expressed concern about the way complaints were dealt with, there was a high staff turnover and a lack of leadership. These shortfalls are now being addressed. In the two weeks she has been based at the home, the area manager has spent all her time managing the home. She told us that she would remain as acting home manager until a new manager can be recruited. The registered provider told us that he intends to be on site more often and that he would look at ways of covering the area manager role so as to allow the area manager to devote as much time as possible to managing the home. Discussion with the area manager and the owner showed that they have now clearly Care Homes for Older People Page 20 of 25 Evidence: identified the changes that are needed and are beginning to address these. They are trying hard to recruit a new home manager who will meet the requirements for registering with the Commission. There are sound quality assurance policies and procedures in place. Until the last two weeks, when she began to provide the management cover for the home, the area manager carried out regular checks on the home to make sure that all areas are safe and that the needs of the residents are being met. These checks are now being made by the registered provider. The home has sound written health and safety procedures. However, lack of experienced staff and some lack of training have led to a number of significant incidences such as medication errors and challenging behaviour that have not been well managed. In addition, there is extensive building work at the home and, although good precautions are in place, this has posed a higher health and safety risk to residents. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 The service to ensure that 01/06/2008 there are adequate numbers of suitable trained staff on duty at all times Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 27 18 The home must ensure that 30/06/2009 staff numbers and qualifications are sufficient to meet the needs of the service users. We found that adequate funding for staff but that there was lack of leadership and some inexperience amongst staff. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must ensure all procedures and practices in respect of the management and administration of medicines in the home are safe and that staff receive the appropriate training. There were a significant number of medication errors since the last inspection. Some of these were made by staff who had not received the required training. During the visit it was found that there were no clear directions for offering medicines later 26/05/2009 Care Homes for Older People Page 23 of 25 should a resident have refused them or been asleep at the time they were offered. 2 15 12 The home must improve the way it monitors nutrition and ensure that individual needs are met We found that some residents were given food they did not like and in large quantities that made them feel unable to eat. There was no record made of this and the amount of food was not noted despite some residents appearing underweight. 26/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 31 The company makes every effort to recruit a new home manager who will be able to meet the requirements of the Care Quality Commissions registration process. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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