CARE HOMES FOR OLDER PEOPLE
Hillbrow House Hillbrow 1 Park Road Crediton Devon EX17 3BS Lead Inspector
James Rose Unannounced Inspection 25th October 2005 09:30 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 Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 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. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hillbrow House Address Hillbrow 1 Park Road Crediton Devon EX17 3BS 01363 773055 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) Hillbrow Residential Care Home Ltd Mrs Rosemarie Joan Olive Heard Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th July 2005 Brief Description of the Service: Hillbrow House is based in an original two-storey 18th century building with a modern ground floor extension. It is situated in a residential area towards the outskirts of the town, and on a main bus route. GP surgeries and other services are reasonably close by, and the shops are within one mile. The older part of the building has one double bedroom on the ground floor and seven single bedrooms on the first. There is a shaft lift between floors. The older part of the building also contains one of the lounges and the dining room. The extension has fifteen single bedrooms and a lounge. Both of the lounges and the dining room have been decorated to a high standard. On the ground floor there is a step down into the dining room with grab rails at either side. There is also a step between two parts of the corridor, which has been ramped. There is an attractive, well-maintained and sheltered garden to the rear of the building with flowerbeds and pond. A patio area has been paved and a small fountain added. There is also a good-sized car park. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours on 25th October 2005. A complete tour of the building was undertaken and samples of the care records were examined. Five residents were consulted individually in private during the inspection process, who were well able to express their opinion and the district nurse was asked for her views. Two carers were also interviewed and the way care was delivered was observed. The proprietor and the registered manager assisted throughout the inspection. What the service does well: What has improved since the last inspection?
A requirement was raised in the last report that called for all the information needed in personnel files to be included and this has been achieved or the home is in the process of waiting for a response from the authorities.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 6 The home has been able to adopt the two recommendations made at the time of the last inspection one concerning the administration of medication and the completion of a policy and procedure for the protection of residents from abuse. 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.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 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 the following standard(s): 3 and 6 New residents can not be confident that their social needs will be met. EVIDENCE: Five assessments were examined during the inspection process that had been completed prior to the home offering a service, detailed health and personal needs were evident but little information was included of a residents social needs. In order to produce a comprehensive care plan of all the needs of a resident it will be necessary for the social needs element of the assessment to be developed further. Standard 6 refers to a service not provided at Hillbrow House. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Residents can be assured that their health and personal care needs will be met because the care planning process at the home contains comprehensive details of a resident’s health and personal needs. EVIDENCE: An individual plan of care was available for each person receiving a service at the home. The recording of health and personal needs were detailed and the plan demonstrated how carers met these. Five care plans were examined at the time of the inspection. Social needs were not well recorded and in some cases the social element of the plan was missing. This was discussed with the registered manager who was able to demonstrate that although the needs were not recorded they were well known by the home. A recommendation has been made in this report for the social elements of residents to be developed further to ensure that all their needs are met at the home. The district nurse was consulted during the inspection and she advised that the home consulted them appropriately and met residents’ health needs, no concerns were expressed.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 10 Residents that wished were able to self medicate at the home subject to a risk assessment process to ensure that they were capable. All the records kept by the home of the administration of medication were examined and were in general well maintained. However, no record was available to demonstrate that medication had been checked and booked in when received; this deficit has the potential to put residents at risk. A requirement has been raised to ensure that carers administer the medication in the home according to the policy and procedure available. It is acknowledged that on previous medication administration sheets a record was available. Five residents were consulted during the inspection, they were interviewed individually in private and were well able to express their views. They all stated that they were very happy with the lifestyle at Hillbrow House and were well cared for. One resident said, “ This is the next best place from my own home” and another remarked, “ I feel happy here and there is always someone available to help me if I need it”. From observations made during the inspection it was clear that residents were treated with respect and care was taken to maintain their privacy at all times particularly when toileting. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The lifestyle in Hillbrow House satisfies the needs of the residents and met their expectations. Residents were able to maintain their contact with family and friends. Service users were assisted to exercise choice and control over their lives and they received a wholesome balanced diet. EVIDENCE: As previously stated five service users at Hillbrow House were interviewed individually in private and they were all well able to express their views. They advised that they liked the lifestyle at the home and were well supported and assisted by the care team. Residents were given the opportunity to join arts and crafts groups in the home twice weekly and once a month an entertainer is retained to provide music. Arrangements are made for residents to have access to religious services and monthly trips out are available. When asked none of the residents could suggest additional activities they would like to have provided. The home has an unrestricted visiting policy and procedure and residents confirmed that they could have a visitor at anytime. Residents that are able and wish to make visits or undertake trips of their own are able to do so.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 12 During the inspection observations were made of carers helping residents to make decisions about events that affected them, time and space was given to help a resident make their own decision. Residents confirmed in conversation that they felt in charge of their own lives. Residents are consulted daily about what foods they would like to eat and where they would like to have their meals served. A wholesome balanced diet is provided with choice always available to residents they are also offered fortified wine at the main meal of the day. A wide range of choice is always available that includes a full cooked breakfast in the mornings. The residents consulted advised that the food available at the home was to their liking and was of good quality with portions served to their choice. The meal served on the day of the inspection was of good quality and was clearly appreciated by the residents. On the day of the inspection the meat portion was plated up in the kitchen with vegetables available at the table for residents to help themselves, assistance was readily available if required. One resident said, “You can’t do better than this” no complaints were received. Visitors are able to have a meal with their relative/friend and no change is made by the home. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 and 18 Residents were confident that any issue raised by them would be resolved to their satisfaction. Service users are protected from abuse. EVIDENCE: The home has a clear complaints policy and procedure that is readily available and a copy is provided in the hall of the home. Residents consulted were confident that if they raised an issue it would be taken seriously and quickly resolved to their satisfaction. Clear confidence was expressed in the manager and the proprietor. No complaints were received during the inspection process. The home has a clear adult protection policy and procedure and carers are trained in its use. Two members of the care team were interviewed individually during the inspection and both were clear and confident about what constituted abuse and what action should be taken if abuse was discovered in the home. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19 and 26 Hillbrow House provides comfortable, safe residential accommodation. Good access is provided to the garden. The home is clean and pleasant with good standards of hygiene apparent throughout. EVIDENCE: A complete tour of the home was undertaken as part of the inspection process, all rooms were seen including the kitchen, cellar and laundry. The home was clearly well maintained and a comfortable environment was provided for the residents. Level access was provided to the garden area where additional seating had been provided and a small courtyard. The residents consulted liked their rooms, which displayed ample evidence of personalisation and said the two lounges were to their liking particularly the furniture. Bathrooms and toilets were equipped with appropriate aids to ensure residents were always safe.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 15 The home was clean throughout with high standards of hygiene evident. No malodour was found. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 There are always sufficient numbers of staff on duty to ensure that residents’ needs are met. Appropriate recruitment procedures are undertaken and carers are trained and competent to do their jobs. EVIDENCE: The staffing levels at the home remain at their previous level and there are always sufficient carers to ensure that residents’ needs are met. The registered manager and the proprietor of the home, plus kitchen and domestic staff are not recorded as being part of the care team provided. It was clear from observations made and from what residents had to say that good relationships exist between carers and residents. The home has a comprehensive recruitment procedure that ensures that appropriate references are in place and that all checks are completed before a new member of staff is able to work unsupervised. Hillbrow House has a comprehensive training programme in place, which includes a detailed induction programme and further NVQ training for carers. Clear recording is maintained of training completed for each member of staff. Two carers were interviewed during the inspection; they both demonstrated appropriate knowledge to enable them to provide a good service to residents. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Hillbrow House is well managed by an experienced person. The home is run in the interest of the residents and is not involved with residents’ finances in any way. Health and safety issues are given a priority; there was a deficit in the risk assessment approach taken by the home. EVIDENCE: The registered manager of Hillbrow House has worked in the care industry for sixteen and half years, she has also obtained the registered managers award and during the inspection she demonstrated detailed knowledge of all aspects of the service provided. Residents and staff expressed confidence in the management processes of the home. Apart from the day to day enquiries made by the staff team to ensure residents welfare the home also conducts a questionnaire process, when this has been completed the results are made available to everyone in the entrance hall of the home. The five residents interviewed were clear that their needs took priority over the routines of the home.
Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 18 Currently all residents or their relatives manage their own personal allowances. The management of the home demonstrates that health and safety issues are seen as important with equipment being regularly serviced and appropriate checks being undertaken. Appropriate storage was in place for all cleaning chemicals and reports were made of events covered by legislation. However, one deficit was apparent in the risk assessment approach covering the use of hot water where residents have access. A requirement has been raised to ensure the safety of residents that a risk assessment should be completed where there is unrestricted access to hot water that is not controlled by a locally fitted thermostat. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A x 3 2 Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO 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 OP 9 Regulation 13 Requirement The registered manager must ensure that staff adhere to the policy and procedure for the administration of medication. The registered manager must undertake appropriate risk assessments to all hot water outlets that are not controlled by a locally fitted thermostat. Timescale for action 28/10/05 2 OP38 23 09/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered manager should develop the social element of the care plans to ensure all needs are addressed. Hillbrow House DS0000036439.V257937.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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