Inspection on 28/07/05 for Hillbrow House

This inspection was carried out on 28th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillbrow House 24/01/07

Hillbrow House 25/10/05

Hillbrow House 21/10/04

Hillbrow House 28/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hillbrow House 1 Park Road Crediton Devon EX17 3BS Lead Inspector Louise Delacroix Announced 28 July 2005 10:00hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hillbrow House Address 1 Park Road Crediton Devon EX17 3BS 01363 773055 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hillbrow Residential Care Home Ltd Mrs Rosemarie Joan Olive Heard Care Home 24 Category(ies) of OP Old age (24) registration, with number of places Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21 October 2004 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 the 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 redecorated 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 D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over a day, during which eleven residents and two members of staff contributed to the report, by sharing their views on the home and the service provided. Twenty-two people were living at the home with a prospective resident due to move in shortly. During the day, residents were observed spending time in their rooms or in communal areas, and enjoying the garden. Throughout the day, visitors were seen coming and going, and the home had a friendly, welcoming atmosphere. As well as talking to people living, working and visiting the home, records were looked at, which included care plans, medication charts, staff files, visitors’ comment cards, maintenance files, quality assurance responses and fire checks. What the service does well: What has improved since the last inspection? There were no requirements made on the last inspection. Five recommendations were made and four of these have now been met. The quality of the information in care plans is improving and storage has been provided for controlled drugs. The home has a homely medicines policy and information about the retention of medication has now been recorded. Uncovered radiators have been risk assessed and the outcome of the residents’ feedback questionnaires have been collated and the outcome shared. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 6 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 D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,4,5,6 The standard of the home’s statement of purpose and service user guide, plus the option of visiting, enables prospective residents to make an informed decision about if the home is right for them. The home has an experienced and skilled staff team. EVIDENCE: There is a detailed and informative statement of purpose and service user guide. The tone is friendly and welcoming. These are both available in large print, if necessary. Comments from residents’ families can be found in a publicity brochure for prospective service users. The home’s statement of purpose recognises the diversity of older people and states that the home will meet the needs of the residents. A communion service is held once a month and other denominations also visit the home. Staff have been trained in the core caring skills and attended some specialist training. For example, caring for people with challenging behaviour. The manager explained how she uses supervision sessions to identify training with staff. Two members of staff confirmed they received supervision and training was discussed. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 9 The manager told the inspector that she visits residents. The statement of purpose also details that residents can visit for the day or that day care may be able to be arranged to assist them in making up their minds. She said that prospective residents could also come for lunch. A resident confirmed that they had visited before moving in and two other residents said that they had been too unwell to visit but their family had looked around on their behalf. The home does not provide intermediate care. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The recording within the care plans has improved and there is evidence that the health needs of residents are well met, with good links with health professionals. Medication is well managed with only one amendment needed to improve practice. Personal support to residents is offered in a way to promote and protect the privacy and dignity of people living in the home. EVIDENCE: Three care plans were looked at. The manager explained how the content of care plans are overseen and this was reflected in the improved quality of the information recorded by staff. Monthly reviews are in place. Residents have also signed their care plans. Care plans include pressure assessment charts, regular weights are recorded, visits from health professionals and there was evidence that residents have a choice of GPs. A resident explained how it was arranged for them to see the GP or a district nurse, who they could see in private. The staff communication book held information about the health needs of residents, which could be audited and showed clear outcomes. A resident confirmed that they had been helped to see a dentist. Another said they were ‘well looked after’. One resident, who is at risk of falling, completes exercises with staff twice daily as advised by a physiotherapist. The manager said that the home was well supported by the local surgeries, especially when residents are dying. A Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 11 resident was visited who was very frail. She was being cared for on a pressurerelieving mattress and appeared comfortable. A staff member was encouraging her to drink and the room was light and clean. The manager and owner acknowledged that the home receives referrals for people with high care needs. They were clear about the need for careful assessment and balancing the needs of existing residents, as well as the skills and capacity of the staff team. The manager explained that the pharmacist linked to the home trains staff and then staff members are overseen with their medication practice, which is built up over time. Medication charts were looked at, which showed that they were well completed with no gaps, and linked with comments in care plans and the home’s communication book. The controlled drugs book is appropriately double signed in a bound and numbered page book, and the home now has secure locked storage for controlled drugs. The manager confirmed that items such as eye drops are signed once opened and the contents of the medication fridge were checked. However, amendments to the medications administration records have not been double signed, which is best practice. Residents were spoken to individually, both in communal areas and in their own rooms. They spoke about how they were treated with respect by staff. For example, by staff knocking on doors before entering and calling them by their chosen names. People also commented on how well their clothes were looked after and that help with having a bath was done in a way, which respected their dignity. One resident confirmed that they received their mail unopened and had access to a telephone and that they could make phone calls in private. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,15 The atmosphere of the home is welcoming and staff appreciate the role of visitors. The meals in this home provide choice and quality, and are prepared by a skilled staff team. EVIDENCE: Two visitors said they felt welcomed and in their comment cards five visitors said they could see their friend/relative in private. Residents confirmed that they could see their visitors in private or in communal areas. Observations during the day, confirmed the friendly and welcoming atmosphere of the staff towards visitors. All residents spoken to were positive about the quality of the food and the choice offered. The main hot meal is three courses. There is a menu board in the dining room and residents are asked about their preferences the day before the meal is served. On the last inspection, the cook and the kitchen assistant demonstrated a detailed knowledge of the likes and dislikes of residents, and could evidence that a range of food is served. They appeared to work as a good team and are still working at the home. The kitchen is clean and has been refurbished, as well as food being well stored. Food hygiene certificates for staff involved in food preparation were seen. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 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 standard(s) 16,18 The home has a clear complaints policy, which is accessible to residents and visitors. Training in the protection of vulnerable adults is provided for staff but refresher training and an adjustment to the home’s policy is needed to increase staff knowledge. EVIDENCE: The pre-inspection questionnaire and the manager confirmed that there had been no complaints. Five visitors’ comment cards said that they were aware of the home’s complaint procedure. The complaints policy is clearly displayed in the entrance hall. A copy of the complaints procedure is included in the Service User guide. The home has the ‘No Secrets’ policy, Devon County Council’s Alerter’s Guide and video. There is also a whistle-blowing policy. Staff confirmed that they had received training in this area but from discussion need to revisit organisations that abuse could be reported to. Currently, the home has a generic Adult Protection policy, which does not contain with local contacts and numbers. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 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 standard(s) 19,20,21,23,24 The standard of the décor and furnishings is high, with evidence of a rolling maintenance programme to improve and maintain the attractive environment. This includes both communal and residents’ individual areas of the home. EVIDENCE: The home has a programme of routine maintenance, which ensures that the home is maintained to a high standard. The grounds are well kept, including a small courtyard, and are accessible to residents. The communal rooms consist of two lounges and a dining room. They are all tastefully decorated with a high quality of furniture and furnishings. Residents said they had been asked about the colour scheme and given their views. A fireplace has been added to the dining room and seating, which allows it to be used as a quiet room. There is also a range of ornaments, pictures and plants. Residents spoke with appreciation about the standard of the décor and appeared relaxed in their environment. There are three communal bathrooms, two with assisted baths and one with a new walk in shower, which also has facilities for the hairdresser. Two in Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 15 particular have been refurbished to a very attractive level. There are five ensuite rooms. The remaining rooms have wash hand basins and the use of a number of communal toilets throughout the home. At the time of the inspection, the double room was being used as a single. Eight bedrooms were spot-checked. Five of which had been redecorated with good quality carpets, furniture and curtains, including lamps. Residents said they had been consulted about colours. The manager advised that extra chairs could be provided for visitors in rooms where the layout made a permanent second chair difficult. One resident commented that since the owner had bought the home he had ‘created a very pleasant atmosphere’. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There are positive relationships between staff and residents and the staffing levels meet the residents’ needs. Whilst training is promoted and staff show an enthusiasm for their work, current recruitment practices have the potential to put residents at risk. EVIDENCE: As the quotes in the summary convey, residents were very positive about their relationship with staff. On the day of the inspection, four care staff were on duty in the morning, which included a senior, and three care staff in the afternoon from 1.45pm until 8pm. After 8pm, there are two waking night staff. The manager and the owner were also present, plus domestic staff and kitchen staff. This was reflected on the staff rota. This level of staffing provides a good level of support to residents. The manager confirmed that nobody under the age of twenty-one is left in charge of the home and nobody under the age of eighteen is employed as care staff. Three staff records were looked at. The content of these files needs to be improved. For example, on all three application forms there were gaps in employment histories and no record of the reason for this. For two members of staff there was no written confirmation that the staff members’ POVA check was clear. However, the umbrella body had not provided the latter to the home. During the inspection, the owner and a representative of the umbrella body reached agreement that this would now happen. The manager said that the CRBs for these two members of staff had been applied for. One file had no photo of the staff member and no reference from their last care position. However, ID was seen for staff, interview checklists and staff contracts, plus Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 17 written confirmation that staff had received the General Social Care Council’s code of conduct. The manager has put together a clear record of staff training, which enables her to audit the skill mix and where training needs to be refreshed. She demonstrated during the inspection that she has a good overview of the staff team’s capabilities. Staff described how they felt training was encouraged. One person said they were waiting to start their NVQ 2 and had recently undertaken moving and handling training. They spoke about their induction as being well supervised. Another member of staff said that they had recent training in moving and handling, as well as health and safety. A resident said they felt reassured by the competency of the staff. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,38 The home is well managed with regular safety checks and a supportive environment for staff. The systems of service user consultation are good and the feedback presented in a clear manner. EVIDENCE: Staff spoke to said that there was a good staff team, who worked well together and therefore residents benefited from a ‘friendly’ atmosphere. They both commented that there was good communication between staff and management. A handover was seen during the inspection as different shifts came on duty. The manager was described as supportive and ‘professional’ in her approach. The manager as acted as a role model for staff and recently completed her NVQ level 4. Two residents said that they had completed the residents’ survey about the home. The results are on display in the hallway. The survey is detailed and covers a wide range of topics, and had a response rate from seventeen residents. The outcome of the feedback is very favourable. All five visitors’ Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 19 comment cards said that they had access to the latest CSCI inspection report and residents were aware of the inspection and the role of the inspector. The manager and owner said that the home does not manage residents’ personal allowances. Fire records were up to date. The manager confirmed that all the staff team had received fire training in the last six months. The home has a maintenance man, who staff and residents spoke favourably about. For example, he has created raised beds in the garden so that one resident can plant vegetables. There is a maintenance book for staff to report concerns and the maintenance man’s role is also to check that bed rails are fitted accurately. The manager said that she has trained staff to also check the fitting. Risk assessments were seen for call bells and unguarded radiators. Accident records are well kept and bathing temperatures recorded. Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x 3 3 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 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 4 3 x 3 3 x x STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 x N/A x x 3 Hillbrow House D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 17,19,Sch edule 2 Requirement The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person the information and documents specified in 1 to 9 of Schedule 2. ( Staff files must contain written evidence of all the required checks and information i.e. references from previous care positions and gaps in employment history explored) Timescale for action 31/10/05 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. 2. Refer to Standard 9 18 Good Practice Recommendations Any ammendments or handwritten entries to the MAR chart should be double signed by two staff and checked against the medication. The generic Adult Protection policy should be written specifically for Hillbrow with local numbers and contacts included. Staff training in this area should be revisited so that staff have knowledge of external organisations to contact if they have concerns about abusive practice. D54 D06_s36439_hillbrow_v225415_280705 stage 4.doc Version 1.30 Page 22 Hillbrow House Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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