Inspection on 31/01/07 for Hillbeck

This inspection was carried out on 31st January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN Lead Inspector Helen Martin Key Unannounced Inspection 31st January 2007 12:00 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 Hillbeck DS0000039699.V316733.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. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillbeck Address The Roundwell Bearsted Maidstone Kent ME14 4HN 01622 737847 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) Charing Healthcare Post Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 it can be evidenced, wish to move into the home together. Care is restricted to one service user under the age of 65 whose date of birth is 15 November 1948. 6th December 2005 Date of last inspection 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 train station. The home underwent substantial extension and refurbishment during 2004 and 2005 that has enhanced facilities and increased the number of bedrooms. There are now 40 places and a new sun lounge, kitchen, laundry and sluice room. A safe and secure patio area surrounding the building leads off the lounge. Current fees for the home range from £401.00 to £570.00 per week. Additional costs include hairdressing, personal toiletries, chiropody and newspapers/magazines. Full information about the fees payable, the service provided and the home’s Statement of Purpose are available from the manager. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 31st January 2007. The inspection included talking with the manager, deputy manager, one carer and two people who live in the home. Some judgements about the quality of life within the home were taken from observation and conversation. Some records were looked at. A tour of the premises was undertaken. The home has given the CSCI a completed pre-inspection questionnaire and this information has been used within this report where appropriate. Postal surveys from one resident, twenty-four relatives and two health and social care professionals have been received by the CSCI and have been used within this inspection process. Currently there are thirty-four residents accommodated with six vacancies. There are four shared rooms of which presently one is used for single occupancy. Comments made by residents spoken with at the time of this visit included: ‘I enjoy living here’, ‘The home is very clean’, ‘I like my room’, ‘We have activities occasionally’, ‘I like knitting and quizzes’, ‘I like the food, I get a choice’ ‘Visitors come to see me’. Numerous comments were received through postal surveys, a selection of these include: ‘I find everything very satisfactory…’ ‘I have found all the staff…to be very caring people, both to the residents and their families, my relative is in good hands.’ ‘My relative has only been at Hillbeck for 6 weeks but so far we have been very impressed with the staff and care provided.’ ‘I think that the home has improved enormously…’ ‘We are pleased with the care my relative receives. The staff are always very kind and helpful both to us and the residents. They are very good at dealing with sometimes very difficult residents. A well run home in our opinion’. ‘My relative is very happy here and feels satisfied with everything’ ‘My relative is very happy at Hillbeck’ ‘Hillbeck has been a good place for my relative. The only thing I am unhappy about, they lost their bottom false teeth 4 weeks ago, they’ve lost weight and Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 6 are not eating well. I have had to ask nearly every day about getting a new set. Nobody seemed to know what to do. Still waiting.’ ‘I have on numerous occasions made my feelings known where I have felt that the standards of care have not been adequate. The response has generally been positive.’ ‘A chair design is needed to enable residents to drop off to sleep without risk to their necks. ‘I would like to see residents involved in active and interesting daily activities instead of being idle and bored.’ ‘The number of night staff is not enough and even the day staff seem very busy but all staff are very kind and helpful to the residents in the time they have been allocated.’ ‘My relative chooses to spend quite a lot of time in her room and on occasions…she didn’t appear to be receiving mid morning/mid afternoon refreshments. There is always a friendly and welcoming atmosphere…and I believe that my relative is being well looked after. I was slightly concerned to hear…that there is to be a change of manager…for the second time this year. The team of senior carers seems constant.’ Staff are helpful and friendly. Home is warm and welcoming. Teeth cleaning and oral care intermittent. ‘The staff…are very professional and caring. The whole home runs well.’ What the service does well: What has improved since the last inspection? Since the last inspection a new manager has been appointed and has been in post for two months. It is evident that the manager has undertaken a substantial amount of work since they have been in post and is aware of continued improvements that could be made. There are no offensive odours within the home noted. Tiles have been replaced in a bathroom. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 7 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. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 8 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 Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information they need in order to decide whether to move into the home, although their rights could be better protected by a review of terms and conditions of accommodation. EVIDENCE: The home’s statement of purpose and service users’ guide give comprehensive information on the service and are available to prospective residents and their representatives. The manager said that each resident has a contract regarding the terms and conditions of the home. Although this includes comprehensive responsibilities of the resident and/or their representative, only some of their rights are mentioned. Contracts do not include the room number to be occupied or any information regarding the sharing of rooms or the provision of food. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 10 Although information was evident from local authorities, no pre-admission information or assessments undertaken by the home were available at the time of this visit. The home does not offer intermediate care. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect. Arrangements are in place to maintain their privacy and dignity. Residents’ personal, health and social care needs could be better reflected in care plans. Some improvement to medication procedures and a review of weight and dental care would better protect residents. EVIDENCE: The home uses Charing Healthcares’ organisational care plan. This is holistic in nature and provides the format for recording a wide range of issues. Four care files were looked at, including those of residents recently admitted. Documentation included care plans, risk and dependency assessments, daily report sheets, health records, information on contacts and other professionals involved and personal information. Some care plans are detailed, whilst others contain some gaps in information. Although documentation from the local authority was present, no pre-admission assessments undertaken by the home were available. Residents’ activities are recorded in a designated log, although these would benefit from reflecting the relevant care plans more Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 12 comprehensively. Daily notes are detailed, although it was noted that one event recorded as an incident was not included. There continues to be no agreement for the sharing of rooms within the care plans. Monthly reviews of needs take place, although these are not recorded in detail, many of which state only ‘no change’. Health care professionals and specialists are involved when necessary. A GP visited during the day of inspection. The home has taken appropriate action regarding a condition affecting some residents. Residents’ nutrition and weight is monitored and food and fluid charts are maintained for those identified as at risk. Food supplements are prescribed for some residents; these are monitored and signed for by senior staff. Weight records are kept, although one resident’s care plan had not been updated. Although being weighed monthly, one resident’s nutritional assessment identified the need to be weighed weekly. The manager said that this would be addressed immediately. Discussion took place regarding oral hygiene and the availability of dental care; within postal surveys received, relatives of residents had mentioned this issue. The manager assured the inspector that, since they had been in post, they had put in place a system, which now ensures that all residents have improved oral hygiene and access to dentists. Two residents with tooth and/or gum problems have seen dentists, although their care plans did not contain any information about the issues or the visits from the dentist. Arrangements are in place for the administration of medication. Although the medication room is locked, the medication fridge and cupboards inside are unlocked. The manager explained that they had ordered locks for the cupboards. A monitored dosage system is used. Oral, topical, regular and ‘when required’ medication is stored together. Records for the administration of medication are appropriately maintained. Staff demonstrated a good understanding of individual residents’ medication, including when to administer on a ‘when required’ basis, although guidelines for the latter are not recorded. Reference material is available. It was said that the GP was due to review all residents’ medication shortly. Throughout the visit staff were observed to be assisting and aiding residents in a respectful and dignified manner and to be attending to personal care needs discreetly. Residents spoken with were happy with their care. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice over their lives. They benefit from activities and meals that they enjoy and are able to keep in contact with their family and friends. EVIDENCE: Residents are able to make choices within the constraints of group living and their own capabilities. Residents spoken with said that they were able to choose whether to spend time in their rooms or in the communal areas. At the time of this visit, some were in the lounge watching television, in the dining room, in their rooms or going to and fro. The routines of the home are flexible. Staff spoken with demonstrated a good understanding of residents’ choices within the home. Residents spoken with enjoyed the activities that the home provided such as knitting and quizzes. The home employs an activities coordinator for three days a week, who offers activities such as memory puzzles, life story work, board games, jigsaws, skittles, books and pictures. In addition there is a regular motivational group session. It was said that events such as coffee Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 14 afternoons, clothes parties and monthly musical entertainment took place. There is a trip to a pantomime next week. Group and individual activities take place. The home keeps fish and budgies and it was said that there are plans for the garden. Residents’ activities are recorded in specific records. Residents are encouraged to keep contact with their relatives and friends if they wish. Visitors are welcome in the home at any reasonable hour. Residents spoken with said that they enjoyed visits from members of their family. The conservatory provides a pleasant room for residents to see relatives away from the main lounge. Residents are asked for their meal choices by staff and records are kept. Pureed diets are catered for and food supplements are provided for those who require them. Drinks are available at all times, such as tea and coffee, orange juice and Ribena. The manager assured the inspector that those residents who needed it, are prompted to eat and drink appropriately by staff. This was observed at the time of this visit. Fresh fruit was seen to be available for all residents. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. residents are not protected from potential abuse due to inadequate recruitment procedures. EVIDENCE: The home has a complaints procedure available for residents and their representatives. There are five complaints recorded appropriately, with the exception of one, which does not contain sufficient detail. The manager explained that this was undertaken before they were in post and that they would ensure that all such issues were recorded appropriately in future. The manager described how some issues, highlighted in relatives comment cards to the CSCI, as part of this inspection, had been addressed. Comments included within postal surveys from relatives of residents stated that where a complaint was made, the response from the home was generally positive. Procedures are in place to protect residents from potential abuse. The home has an organisational adult protection policy. Staff recruitment checks are mentioned elsewhere within this report. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, tidy, well-maintained and comfortable environment, although the quality of life of those in shared rooms could be improved by a review of the home’s procedures. EVIDENCE: The home is comfortable, warm and well maintained. All the areas seen were clean and tidy and this was confirmed by comments from residents. Decoration and furniture were of a good quality. Since the last inspection some bedrooms have been redecorated and have new furniture. The manager explained that continued refurbishment is planned. There is a dining room and lounge on the ground floor. The conservatory provides a pleasant room for residents to access or to see relatives away from the main lounge. Communal areas contained high backed chairs; the manager stated that some cushions had Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 17 been provided to support some residents’ necks. A hairdressing room is available. Residents have access to safe and secure outdoor space in terms of a patio than runs around part of the building, and that has gates at each end to prevent access to areas outside the property. A number of bedrooms were seen, all had personal items that residents had brought with them, and were attractively decorated. Most are ensuite and there are sufficient communal toilet and bathing facilities. There are four shared bedrooms of which one is specifically for the use of a married couple and presently one is used for single occupancy. In the case of the other two rooms, agreement to sharing continues not to be recorded in the care plan. Discussion took place regarding the nature of the needs of residents sharing rooms and their capacity to express a positive choice to do so; the manager was unclear as to whether this had taken place on their admission. Following an incident, one resident was recently moved from one shared room to another. The manager said that residents in shared rooms are not offered single rooms as they become vacant. A shaft lift provides easy access to all floors. There is level access into the house. Aids and equipment to give increased confidence and support are provided as necessary. Grab rails are fitted throughout areas accessed by residents and equipment for personal or communal use was in evidence. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Responsive staff care for, understand and anticipate residents’ needs and wishes. A review of staffing numbers would improve residents’ quality of life. It was not possible to evidence that residents are fully protected by appropriate staff recruitment and training procedures. EVIDENCE: Numerous comments have been received from relatives of residents through postal surveys, which said that they were happy and satisfied with their relative’s care and praised the professional, friendly, helpful and caring qualities of staff. Subsequent to this visit comments have been received from one individual who stated that staff were rude when they were trying to access the home and arrange an activity for residents; it was said a complaint would be made to the organisation. Staff spoken with at the time of this visit were committed to their role and knowledgeable about the running of the home. They were seen to be responsive to residents’ needs; there was good interaction between staff and residents. Comments within nine postal surveys from relatives of residents indicated that they did not think that there were sufficient staff on duty. There are usually between five and six care staff on duty during the day with between three and four waking night staff. It was said that as two staff had left recently, the Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 19 home was currently in the process of recruitment and when this had been completed, six staff would be on duty during the day. The manager stated that although the home was not short staffed, they were in the process of reviewing staffing numbers with the aim to increase these to seven during the day; it was said that, if this was the case, more could be done with residents and it would improve their quality of life. The manager explained that current staff absence was covered within the existing team and that there was a senior present at all times. The files of two care staff were seen. Although it was clear that preemployment procedures were in place, not all checks could be fully evidenced. Files contained a Protection of Vulnerable Adults (POVA) check, health questionnaire, employment history and interview questions and answers. One file did not include any proof of identity; the manager explained that this would have been checked at the time of applying for a Criminal Records Bureau (CRB) check; no evidence of the CRB check was available; the manager stated that they had not yet received this from the organisations head office. A CRB log was seen for all staff, although there were gaps in the record, which needed updating. Both files contained only one written reference. The manager said that when they started in post, recruitment records had not been maintained appropriately. It was said that staff received induction training and two records were seen. The manager mentioned that they intended to ensure that this complies with Skills for Care. The manager assured the inspector that staff received appropriate ongoing training, some of which was indicated within the home’s pre-inspection questionnaire. This also stated that seven staff had obtained an NVQ qualification. However courses could not be evidenced, as no documentation was available. The manager explained that when they started in post, there were no staff training records; they have developed documentation and a staff training matrix format, which is awaiting approval from head office. The manager assured the inspector that staff, including the activities co-ordinator had received training in dementia. It was mentioned that no staff had received training in providing activities for people with dementia. The manager stated that they intended to review staff recruitment and training files as soon as possible to ensure that the documentation was in place to evidence appropriate procedures within the home. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a friendly and supportive home with appropriately supervised staff, which is run in their best interests. Residents would be better protected by the qualification and registration of the manager, a review of policies and procedures and gas safety checks. Residents may be put at some risk by the continued lack of attention to the last fire safety inspection. EVIDENCE: The new manager has been in post for two months. They are in the process of applying for registration with the CSCI. The manager has previously been registered with the CSCI and has had many years experience of working with older people. Although this has not been with people with dementia, it was said Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 21 that they had undertaken appropriate training. It is evident that the manager has undertaken a substantial amount of work since they have been in post and is aware of continued improvements that could be made. The manager is in the process of undertaking a Registered Manager’s Award. Throughout the visit it was clear that the management style is open and inclusive and that residents and staff benefit from a friendly and supportive atmosphere. Comments from relatives of residents included in postal surveys stated that the home has a friendly and welcoming atmosphere and is well run. Previous inspection identified that an annual questionnaire regarding the service is circulated. It was said that this would take place later this year; the manager indicated that this would include relatives of residents and health and social care professionals. The manager explained that evening meetings had been held for residents’ relatives to meet night staff. Previous inspection identified that staff receive regular supervision and staff meetings are held. The manager is in the process of providing formal supervision for all staff. They have developed new methodology and recording formats for supervision and appraisal. The home has the facility to hold small amounts of cash on behalf of some residents, which is stored individually and securely. Transaction records are maintained, which are held with receipts for expenditure and receipt. These were last audited in November 2006; the manager said that this was due to be done shortly. It was noted that no receipts are kept for hairdressing or chiropody. The practice of cutting up some shop receipts, for items purchased for more than one resident, and placing the parts in individual records means that full accountability is not possible as not all the necessary information is available. Two residents’ cash balances were checked against their accounts, one of which tallied and the other was slightly over. Records of accidents and incidents are recorded appropriately, although documentation should be able to evidence that the manager has reviewed and audited these. The manager stated that all appropriate accidents and incidents are notified to the CSCI. Other records looked at as part of this visit have been mentioned previously within this report where appropriate. The home provides a comprehensive range of written policies and procedures, which are available for staff. The home’s pre-inspection questionnaire stated that these were last reviewed in 2005. The manager said that they and the organisation were currently in the process of updating these. It was mentioned that the staff call system was serviced on the day of this visit with the boiler booked for the coming week. The manager is unaware of when the latest gas safety or central heating checks were undertaken; it was stated that this would be looked into and the appropriate action taken if necessary. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 22 The kitchen was maintained in a hygienic manner and refrigerated food was stored appropriately. The manager said that fridge, freezer and hot food temperatures were checked and recorded. The laundry room was clean and tidy and appropriate procedures are in place for infection control. The fire logbook is maintained appropriately with the exception of staff fire training records, which need updating. The home’s fire risk assessment and policy and procedures are in need of updating. The manager explained that not all the recommendations from a fire safety inspection undertaken on 23rd February 2006 had been addressed before they started in post; it was agreed at the time of this visit that the remainder of these recommendations would be fully addressed within two weeks. Radiators seen were guarded. Previous inspection strongly recommended that signs and a barrier be put in place on and in front of the wall outside the bedroom facing onto the car park to prevent cars emitting fumes into the room. The new manager was unaware of this and said that they would look into the matter as soon as possible. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 23 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 3 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 2 3 3 3 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 3 2 2 Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 24 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 Standard OP3 Regulation 14 Requirement The registered person shall not provide accommodation to a service user…unless…their needs…have been assessed by a suitably qualified or suitably trained person; the registered person has obtained a copy of the assessment;…the registered person has confirmed in writing to the service user that…the care home is suitable for the purpose of meeting their…needs in respect of…health and welfare. In that, as no pre-admission information or assessments by the home were available at the time of this visit, it was not possible to evidence that these had been undertaken appropriately. A recommendation that a letter should be sent to prospective residents and their relatives to confirm that a place can be offered at the home was made during previous inspection dated 6th December 2005. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 25 Timescale for action 07/03/07 2 OP7 OP37 15 …the registered person shall…prepare a written plan…as to how the service user’s needs in respect of their health and welfare are to be met. In that, care plans must be reviewed to ensure that they contain all the updated information necessary to meet all the health and welfare needs of all residents. 07/03/07 3 OP8 OP23 12(1)(a) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. In that, residents identified through assessment, as needing weekly weight monitoring must be provided with this on a weekly basis. A review must take place to confirm that all residents have access to appropriate dental care. A review must take place regarding the sharing of rooms by residents who do not have the capacity to express a positive choice to do so. 07/03/07 4 OP9 13(2) The registered person shall make 07/03/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, the cupboards and fridge storing medication must be kept locked. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 26 5 OP28 OP30 OP37 18(1)(a) The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that, the manager must complete their stated intention to review staffing numbers to ensure that all the health and welfare needs of residents can be met at all times. Appropriate and up to date staff training and qualification courses must be provided for all staff. The manager must review their stated intention to review staff files in order that appropriate training and qualifications can be evidenced. Issues regarding the number of NVQ trained staff have been repeated from previous inspection dated 6th December 2005. 07/03/07 6 OP18 OP29 OP37 19 The registered person shall not employ a person to work at the care home unless the person is fit to…do so and…they have obtained in respect of that person the information and documents specified in…Schedule 2. In that, the manager must complete their stated intention to review staff files, which must contain documentation regarding all the necessary preemployment checks. This must include proof of identity, CRB 07/03/07 Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 27 and two written references, in order to evidence a sound recruitment procedure within the home. 7 OP31 8 The registered provider shall appoint an individual to manage the care home where the registered provider is an organisation…or does not intend to be, in full-time day-to-day charge of the care home. In that, the manager must complete the process of application for registration with the CSCI. 8 OP38 23(2)(c) The registered person shall…ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order. In that, the manager must complete their intention to review the maintenance and services of the central heating system and gas safety checks, and take appropriate action if necessary, to ensure they are up to date. 9 OP38 23(4) …the registered person shall 14/02/07 after consultation with the fire and rescue authority take adequate precautions against the risk of fire, provide adequate means of escape, make adequate arrangements for detecting, containing and extinguishing fires;…warnings of fires;…the evacuation of all persons in the care home…;…maintenance of fire equipment;…reviewing fire DS0000039699.V316733.R01.S.doc Version 5.2 Page 28 07/04/07 07/03/07 Hillbeck precautions…, for staff to receive suitable training in fire prevention and to ensure, by means of…drills and practices…, that staff and… service users are aware of the procedure to be followed… In that, suitable fire training must be provided for all staff and records must evidence this. The home’s fire risk assessment and fire policy and procedure must be updated. All of the recommendations made during the last fire safety inspection of the home on 23rd February 2006 must be addressed as a matter of urgency. It was agreed at the time of inspection that these issues would be fully addressed by 14th February 2007. The manager must send a copy of the fire safety inspection, together with written evidence that these issues have been addressed to the CSCI. Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 29 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 OP2 Good Practice Recommendations It is strongly recommended that the terms and conditions of accommodation for residents should be reviewed to include the room number to be occupied, the provision of food, information regarding the sharing of rooms and greater detail regarding the rights of the resident. It is recommended that agreement to sharing double rooms is recorded in the care plan. In that, there continues to be no agreement for the sharing of rooms within the care plans. This recommendation has been repeated from previous inspection dated 6th December 2005. 3 OP9 It is recommended that, with regard to medication: 1. Oral, topical, regular and ‘when required’ medication should be stored separately. 2. Detailed written guidelines for the administration of ‘when required’ medication should be available for staff. 4 5 6 OP23 OP27 OP31 It is recommended that residents in shared rooms should be offered single rooms as they become vacant. It is strongly recommended that the manager should investigate the complaint regarding staff. It is recommended that the manager complete their stated intention to obtain the Registered Manager’s Award as soon as possible. It is strongly recommended that, with regard to residents monies: DS0000039699.V316733.R01.S.doc Version 5.2 Page 30 2. OP7 7 OP35 Hillbeck 1. Receipts should be provided for hairdressing and chiropody. 2. Shop receipts should be kept whole in order to be fully accountable. 3. Residents’ cash balances should be kept exact. 8 OP37 It is recommended that accident and incident records should be able to evidence that the manager has reviewed and audited these. It is recommended that the manager and the organisation should complete their review of the home’s policies and procedures as soon as possible in order to provide up to date guidelines for staff. It is strongly recommended that signs and a barrier be put in place on and in front of the wall outside the bedroom facing onto the car park to prevent cars emitting fumes into the room. In that, the new manager was unaware of this and said that they would look into the matter as soon as possible. This recommendation has been repeated from previous inspection dated 6th December 2005. 9 OP37 6. OP38 Hillbeck DS0000039699.V316733.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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