Inspection on 12/01/07 for Hillcrest

This inspection was carried out on 12th January 2007.

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

Hillcrest 09/01/09

Hillcrest 23/01/06

Hillcrest 05/09/05

Hillcrest 04/11/04

Hillcrest 19/05/04

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

CARE HOMES FOR OLDER PEOPLE Hillcrest Elliott Street Tyldesley Wigan Greater Manchester M29 8JE Lead Inspector Kath Smethurst Unannounced Inspection 12th January 2007 09:00 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 Hillcrest DS0000005740.V315525.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. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Address Elliott Street Tyldesley Wigan Greater Manchester M29 8JE 01942 891949 01942 876393 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) Caring Alternatives Limited Ms Margaret Joyce Elizabeth Swanson Care Home 17 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (17), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (2) Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 17 service users to include:up to 17 service users in the category of DE(E) Dementia over 65 years of age up to 2 service users in the category of DE Dementia aged between 55 and 65 years of age up to 2 service users in the category of MD(E) Mental Disorder over 65 years of age One named service user (WF) in the category of MD(E) (Mental Disorder over 65 years of age) may be accommodated within the overall number of registered places. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. The Registered Person must ensure that all staff working in the home have dementia and mental disorder awareness and training, which equips them to meet the assessed needs of the service users accommodated, as defined in the individual plan of care. The service should at all times employ suitably qualified and experienced members of staff, in sufficient numbers, to meet the assessed needs of the service users with dementia and mental disorder. Work on the external grounds of the home, to make the area safe, attractive and accessible to service users must be completed by 1.11.05. 23rd January 2006 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Hillcrest is situated on the outskirts of Tyldesley town centre and is close to local amenities and is on a main bus route. St George’s church is adjacent to the home. Hillcrest is a converted vicarage and provides private accommodation on the ground and first floor. The home has recently had an extension to the property providing two additional bedrooms with en-suite facilities and an additional lounge and a lift has been installed. Three bedrooms are shared rooms, the rest are single bedrooms. All bedrooms have a hand washbasin and three rooms in total have en-suite facilities. Toilets are close to resident’s bedrooms and the lounge and dining areas. The home has extensive grounds, which the manager is in the process of arranging to have landscaped and made private and secure. The home offers accommodation and care for up to seventeen residents over the age of sixty-five years, who Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 5 have dementia, including up to two residents under sixty-five but over the age of fifty-five, who have dementia and two designated residents who are over sixty five years of age who have a mental disorder. Fees range from £340 to £365 per week. Additional charges are made for hairdressing, outings and entertainers. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection at Hillcrest took place over 7 hours by two inspectors. The home had not been told that the inspectors would visit. The inspectors looked at records the home holds on residents (care plans) and other records the home needs to keep to ensure the home is being run properly, for example activity records, menus, staff files and staff training records. The inspectors also looked around the building. To find out more information the inspectors spoke to a number of residents and two visitors. The manager, a senior carer, two care staff, the cook and maintenance person were spoken with. A social worker visiting the home was also spoken with. Staff were also watched as they went about their work. Comment cards, asking residents and relatives and other visitors to the home for example doctors and the district nurses what they thought about the home and the care provided were sent out prior to the inspection. Five residents and five relatives returned comment cards. All were satisfied with the care provided. What the service does well: From speaking to residents and visitors and the information residents and relatives gave in the comment cards, it was clear that they were happy with the care provided. One resident said, “It’s friendly here. Very good. They are all nice girls. They do anything for you. It’s very comfortable and clean”. One relative who returned a comment card wrote, “I am very happy with the care my mother receives”, a second “All staff are have been kind and friendly-my mother is well cared for and seems settled and happy”, while a visitor spoken with said, “It’s excellent here. I would have no qualms about recommending Hillcrest to anyone”. Before people come to live at the home staff visit residents, either at home or in hospital, to make sure the care needed can be provided. The records kept on residents (care plans), includes a lot of information about the things residents need support with and the things they like to do. This means staff have the information they need so they can make sure residents get the care and support they need. Relatives spoken with and those who returned comment cards said they could visit at any time and staff always made them feel welcome. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 7 Residents were very satisfied with the food stating they got enough, that they were given choices at each meal was home cooked. One resident said, “Foods really good. They will make anything you want and there is a good choice”. The home makes sure that before staff starts work they are properly checked to make sure they are suitable to care for people living in the home. All staff spoken with indicated they enjoyed working at the home. One member of staff said, “It’s brilliant I enjoy working here” a second, “I love it. I don’t wake up thinking I don’t want to go to work”. What has improved since the last inspection? What they could do better: Although risks are looked at, more detailed nutritional risk assessments need to be completed when concerns are raised about the amount of food residents are eating. The type of social activities for residents with special needs (such as dementia) needs to be increased. Staff should have regular training on what to do if they think a resident isn’t being treated properly. To help residents with memory difficulties to find their way about the home more signs and aids should be provided. The garden would be improved if there were raised flowerbeds and more paths. To make sure staff move and handle residents safely training needs to be arranged on an annual basis. Whilst the manager is very experienced she needs to obtain a formal management qualification. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 8 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. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 9 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 Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 10 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): 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are properly assessed prior to admission in order to ensure the home is able to meet any identified needs. EVIDENCE: Senior staff complete assessments. If possible prospective residents are visited prior to admission at home or hospital, whether they are paying for themselves or the local authority funds their care. Residents and their families are also welcome to visit Hillcrest prior to deciding to come to live at the home. The majority of residents have lived in the home for over a year. Inspection of the most recently admitted residents file showed a full assessment of physical care needs had been completed and where applicable social work assessments had been taken note off. The assessment document was detailed and included information relating to physical and social care needs. The assessment included information relating to current medication, personal care and Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 11 wellbeing, mental state/cognition, communication, sight, hearing, dietary preferences, weight, oral health, sleeping patterns, mobility, foot care, history of falls, continence, social interests, personal safety and risk, family and significant relationships. Good practice was noted in that the pre-admission checklist contained details of the allocated key worker, whether the key worker has spent time speaking with the resident and if the resident had been shown around the building. Many of the residents have dementia so were unable to describe the admission and assessment process. Nevertheless feedback in returned relative comment cards indicated they had been provided with sufficient information prior to their relative coming to live at the home. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 12 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, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and care needs were well met and care plans provide clear guidance to staff in each area of residents care needs, providing staff with the information they need when delivering care. Residents were treated with dignity and respect and their right to privacy was upheld. EVIDENCE: Three care plans were examined. All contained comprehensive information relating to residents personal, social and health care needs. Supplementary information includes personal care record and weight. Daily entries in care notes were completed in all the plans examined and gave a good indication of the care provided and residents well being. The plans were easy to read, had been regularly reviewed and set out clear guidance for staff to take when providing care. There was written evidence that the plans had been signed and agreed by either the residents or their representatives. The care plans examined contained some very good information in respect to resident’s needs, likes/dislikes and chosen lifestyle. For example one plan Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 13 instructed staff to “Explain slowly and clearly what they mean and what they are doing” and “Sociable so staff are to talk to her about events in the home and media”. A checklist was in place, which identified areas of risks to residents. It was noted in two records examined concerns had been identified regarding nutrition. Staff had sought medical intervention and these residents had been prescribed food supplements. In such instances more comprehensive nutritional risk assessments would need to be completed. Discussion with the manager indicated this was an area she had identified and was going to address. Drinks were given out mid morning but those residents that were sleeping still had a cold drink at the side of them when it was time to go in for lunch. Staff need to be mindful of this in order to ensure residents fluid intake is sufficient. Feedback from residents (able to comment) was very complimentary about staff and the care provided. One resident said, “It’s friendly here-very good. They are all nice girls. They do anything for you” a second, “I like everything about it. They are like my daughters”. Relatives spoken with and those who returned comment cards were also pleased with the standard of care. One visitor said, “It’s excellent here. I would have no qualms about recommending Hillcrest to anyone”. A visiting social worker spoken with indicated that the care and support provided was very good and staff had a very good understanding of the residents needs. The health care needs of residents were satisfactorily met. Individual care records inspected showed evidence of visits from general practitioners, chiropodist, optician etc. A pharmacy inspection was carried out by Stephanie West (CSCI Inspector) on the 8th August 2006. Some weaknesses were found in record keeping. It was also noted that in some instances when residents were prescribed the same medicine it was not always administered from their own supply. During this inspection the requirements made following this inspection were looked at. The requirements made were followed up and it was found that all had been addressed. Procedures are in place that described safe medication handling. Trained carers are responsible for the administration of medication. A separate facility is provided for the storage of medication (on each unit). A lockable drug trolley is provided which when not in use are secured to the wall. Currently none of the residents have been prescribed controlled drugs, but if the need arose a separate system for recording the administration of controlled drugs is in place and separate storage is provided. Medication storage was Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 14 orderly with no evidence of overstocking. Accurate records were in place for the receipt and disposal of medication. The home uses a monitored dosage system supplied by a local pharmacist. Medication Administration Records (MAR) are supplied by the pharmacy except for example when additional medication is provided mid month. Samples of MAR (Medication Administration Records) were examined and were found to be clear and up to date. Those residents who were able to comment and feedback in returned relative comment cards, indicated staff respected their privacy and dignity. During the inspection, staff were observed to treat residents with respect and consideration. Residents were observed to be dressed in clean well maintained clothing. Staff were observed knocking on doors before entering rooms and toilets. One resident said, “The girls always knock”. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 15 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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s interests and links with visitors are encouraged, to ensure residents live as normal a life as possible, but improvements to the range of specialist activities provided for residents with dementia is needed to ensure they lead a stimulating life. Meals are good and the needs of residents are well catered for with a balanced and varied selection of food provided. EVIDENCE: Staff spoken with said the manager encouraged them to spend quality time with the residents and this was observed on the day of the visit. For example staff were seen spending time talking and sitting with the residents and they appeared to know the residents really well. The cook and domestic also popped in and chatted to the residents and one member of staff not on duty called in to say hello to some residents as she was passing. Care staff are responsible for organising and delivering activities. Staff spoken with indicated they had sufficient time to undertake this responsibility. Staff were asked what type of activities they undertook. One member of staff said, “We do picture bingo, dominoes, throwing beanbags and I sometimes read to Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 16 some of the residents”, a second, “we play bingo, do sing a longs and sometimes entertainment comes in. An organist comes in once a month”. Information provided in the pre-inspection questionnaire indicated activities provided included TV, video’s, music, records, tapes, CDs, board games, skittles, quizzes, entertainer, shopping, church visits and trips out to local places such as garden centres. The individual activity records of three residents were examined. The activities undertaken by these residents included, dancing, music, sing-a-long and one to activities (shopping). It was noted that in some records information in regard to the type of one to one activities undertaken was not recorded. This is recommended in order to provide evidence of the range of recreational pursuits recorded. Most residents living in the home have communication and memory difficulties (dementia). These residents are able to take part in most of the activities arranged. However some consideration should be given to further developing the range and frequency of specialist activities for these residents. For example sensory activities such as baking, painting, planting bulbs/flowers, massage etc. This was discussed with the manager who advised this was an area that had been identified for further development. The manager said she had interviewed a prospective member (a qualified occupational therapist) who would she hoped would develop more specialised activities. The home has an open visiting policy. There are no restrictions on the time people visit evidence of which was highlighted in the visitor’s book, where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Anecdotal evidence from residents indicated staff encouraged links with families to be maintained. One resident said, “I can have visitors anytime”. Feedback in returned relative comment cards and visitors spoken with indicated they were always made welcome when visiting. Residents who were able to comment expressed satisfaction with the care provided. Residents said they had choices where they wished to sit, when they got up, when they went to bed and what clothes they wore. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practice indicated residents could make some choices for example in regard to meals and where they spent their day. Resident’s rooms are personalised and residents are able to bring personal items in the home. There is a 4 weekly menu cycle, which offered a varied choice of nutritional food. Meat and fish were offered on a daily basis, as well as a good Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 17 assortment of vegetables. Menus offer a cooked breakfast or porridge, toast and preserve. Lunch is the main meal of the day, there is always a choice of meals served with vegetables and potatoes. The evening meal offers a hot meal or soup or sandwiches. Records of choices made by residents are maintained. A detail of special diets, meal preferences and assistance residents may need is documented. Staff speak to residents to ask them about their choice of meals. However if residents change their minds regarding their preferred meal option this is not a problem. The lunchtime meal was observed. On the day of the visit lunch consisted of battered or steamed fish, chips or mashed potatoes and peas followed by cherry sponge and cream. Residents were given time to enjoy their meal and support was given in a discreet and individual manner. Discussion with the cook indicated there were sufficient funds made available to her. She said, “If I ever need anything I only have to ask. I have a budget each week to buy fresh foods- I have a company credit card and use it when I need anything”. Very little convenience food is used with all meals being home cooked. The cook said, “We only use the best, free range chickens, eggs, fresh vegetables and meat”. The cook also said she “likes to spend time in the dining room seeing who likes what, I always ask the residents what they want each day. I know who likes what by observing”. This was also observed during the inspection. All residents spoken with and who returned comment cards were very complimentary about the food served. One resident spoken with said, “ The foods really good. They will make anything you want and there is a good choice”. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 18 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, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a policy and procedure on complaints and the protection of vulnerable adults, which ensures residents rights and well being is protected. EVIDENCE: Hillcrest has a comment and complaints policy showing how complaints were responded to and within what timescales. The address and contact details of the CSCI were in the leaflet. The policy was also printed within the service user guide and both of these were displayed in the entrance to the home. A complaints/compliments file was seen. No complaints had been received since the last inspection. Forms used to document complaints were clear and showed what action would be taken to resolve the problem and what was done to improve the service. Compliments in the form of letters and cards were seen on the file but these were not dated it would be good practice to date these on receipt and when fed back to staff in staff meetings. The three residents whose care was looked at were unable to indicate if whether they could speak to staff about any problems. However other residents spoken with and relatives who returned comment cards confirmed they knew whom to approach if they had a concern or complaint. One resident said, “I would just tell them if I wasn’t happy”. None of the relatives who returned comment cards had made a complaint but all confirmed they knew whom to approach if the need arose. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 19 Adult Protection and Prevention of Abuse policy are in place. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before they commence work. Training in the signs and recognition of abuse is covered during induction and in NVQ (National Vocational Qualification) training. No recent POVA (Protection of Vulnerable Adults) investigations have taken place. In conversations, staff were able to confirm that they understood what “abuse,” meant, and what they would do if they saw abuse taking place. When staff were asked if they were aware of abuse procedures and what they would do if they suspected abuse, one member of staff said, “I’ve covered what to do if I suspect abuse as part of my NVQ. I would talk to the senior on duty or the manager” a second “Talk to my manager”. Protection of Vulnerable Adults training is covered during induction and NVQ training. It was however noted that updated training in this area is not routinely undertaken. This was discussed with the manager who agreed to look into this issue. To ensure staff are fully conversant with abuse procedures it is recommended updated training in this area be provided every two years. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 20 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, 21, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained and safe environment. EVIDENCE: Hillcrest is situated on the outskirts of Tyldesley town centre and is close to local amenities and is on a main bus route. The home is a converted vicarage set in its own extensive grounds. Car parking is provided at the front of the home. Communal areas comprise of two lounges and a dining room. Both lounges were nicely decorated and furnished. All the bathrooms had been refurbished since the last inspection and redecorated in warm colours giving these rooms a homely appearance. It was noted that the wallpaper in the corridors was damaged. This had been identified by the manager and was being decorated the following week. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 21 The dining tables and chairs are showing signs of wear and tear and while functional plans should be made to replace these items. While some landscaping has been undertaken with the planting of tress, hedging and bulbs. Consideration should be given to be made to undertaking more landscaping in the garden. The provision of raised flowerbeds and paved paths should be considered. This would greatly enhance this area and make more accessible and attractive for residents to use. Consideration should also be given to improving orientation aids in home given a high proportion of residents have dementia. The provision of signage would be useful to residents including personalised plaques, or memory boxes, which would help with identification of bedrooms. These areas should be considered in order to ensure residents with dementia have a supportive environment in order to compensate for any cognitive difficulties they have. On the day of the visit the home was clean and odour control was good. The laundry was sited away from food preparation areas and was seen to be clean and orderly. Sufficient and suitable equipment was provided. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 22 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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory ensuring consistency of care for people living in the home. The residents were cared for by staff that were safely recruited, suitably experienced and trained to meet the residents care needs. EVIDENCE: All staff spoken with indicated they enjoyed working at the home. One member of staff said, “It’s brilliant I enjoy working here” a second, “I love it. I don’t wake up thinking I don’t want to go to work”. Staff also indicated management appreciated the work they did. For example one member of staff said, “If I do an extra shift I will get a text or phone call thanking me”. On the day of the visit staffing levels were sufficient to meet the needs of the residents. A written rota is maintained and showed when staff were on holiday or sick leave, were covered. Domestic and catering staff support care staff. Two members of staff cover a waking night shift. Staff spoken with indicated staffing levels were sufficient. One member of staff said, “Yes definitely enough staff”, another, “Yes I think there are enough staff. I would be happy for a family member to live here”. The atmosphere in the home was very relaxed and friendly. Interactions between staff and residents were frequent, natural and warm. During the visit Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 23 staff were observed to respond speedily to requests for assistance made by residents and also spent time socialising with them. The files of three staff employed looked at showed all necessary recruitment checks had been undertaken. All contained: written application forms, 2 references, Criminal Records Bureau (CRB) check and verification of identification. Staff spoken with said they had been interviewed prior to being offered a post. The cook said, “I had an interview then had to do a trial day. As part of that day the residents that could answer were asked what they thought of the food I’d cooked. I wouldn’t have got the job if they hadn’t liked it”. A staff development programme is in place and records of training are maintained. Samples of training records were examined. There was evidence that new staff undertake induction training following which foundation training is undertaken. Staff spoken with were asked to describe their induction to the home. All confirmed they had undertaken induction training. One member of staff said, “I worked with other staff and over a few weeks completed a workbook”. Mandatory training needs were in the main met. Training undertaken by staff includes first aid, food hygiene, medication, fire safety, moving and handling and dementia care. It was however noted that moving and handling training was due now. This is an area, which needs to be addressed. Although staff have undertaken dementia care training the manager advised further training in this area was planned for the coming year. Currently 9 of the 18 staff are in receipt of NVQ (National Vocational Qualification) level 2. The remaining 9 staff are registered to undertake training. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 24 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, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent ensuring the home is run in the best interests of the residents. Regular maintenance and fire safety checks were carried out, promoting the health and safety of both residents and staff. EVIDENCE: The manager has extensive experience in running care homes for older people. She has continued her professional development and is currently undertaking the NVQ level 4 registered managers award, which she hopes to complete in the near future. There is a clear line of accountability in the home. Record keeping is in the main good and residents and relatives indicated they continue to be satisfied with the care and organisation of life in the home. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 25 Internal and external quality assurance systems are in place. Staff spoken with confirmed regular one to one meetings with the manager and staff meetings take place. The manager said that in the past satisfaction questionnaires had been sent to relatives and that she intended to send them out again. The manager said that she makes an effort to meet with relatives on a regular basis. Relatives who returned comment cards confirmed they were kept well informed by the home. Opinions are sought from residents on a one to one basis rather than a group, as the manager thinks this is more effective in gaining residents views. Evidence of this was seen in regard to meals and decoration. The cook regularly speaks with residents and observes mealtimes to ensure they are enjoying the meals. Residents preferences in regard to food are also documented. Residents were also consulted when one of the lounges and dining room was re-decorated. For example one of the residents likes to spend her day in the dining room and she chose the colour scheme for this area. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. Hillcrest takes part in the scheme. As part of the rating process an annual audit of quality is undertaken. This includes consultation with residents and staff. The home has a satisfactory accounting system in place. Staff could determine exactly how much money the home was holding for each resident. The Home looks after small amounts of resident’s personal allowances. Detailed records are held of all transactions. All monies held for safekeeping are kept individually. A record is kept of monies credited and debited and receipts were obtained for financial transactions. Health and safety policies and procedures were in place. The staff team have completed health and safety training. Although as previously noted moving and handling training needs to be updated. Accidents have been recorded appropriately. With the pre-inspection materials, the manager provided a list of maintenance and associated records. A number were checked on the site visit on the 12th January 2007, including the electrical, gas and water treatment service records. All were up to date. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. Staff have undertaken fire safety training and a fire risk assessment is in place. Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 26 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 14 (2) (a) (b) Requirement To ensure resident’s health is maintained and staff have the guidance they need comprehensive nutritional risk assessments must be completed where residents have lost weight or have been prescribed food supplements. To ensure the health and safety of residents and staff updated moving and handling training must be provided annually. Timescale for action 28/02/07 2 OP30 13 (5) 01/04/07 3 OP31 9 (1) The registered manager must (2) (a) (b) complete the NVQ level 4 registered managers award to ensure she has the necessary qualification to run the home. 30/04/07 Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 28 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 OP12 Good Practice Recommendations In order to provide evidence residents social care needs are being met staff should record specific detail of the type of one to one activities they undertake with residents. To ensure residents living with dementia lead a stimulating life consideration should be given to providing more sensory activities such as baking, painting, planting bulbs/flowers, massage. To assist residents with memory difficulties find their way around the home consideration should be given to improving signage and orientation aids in the home. To ensure the home is well maintained and attractive for the residents the dining table and chairs should be replaced. To ensure staff are clear about the steps they must take in the event of an allegation or suspicion of abuse updated abuse training should be provided. In order to make the outside space more attractive and accessible for residents consideration should be given to the provision of raised flowerbeds and pathed walkways. 2. OP12 3. OP19 4. OP19 5. OP18 6. OP19 Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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. Extracts may not be used or reproduced without the express permission of CSCI Hillcrest DS0000005740.V315525.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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