Inspection on 19/02/07 for Hillcrest

This inspection was carried out on 19th February 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillcrest 06/02/06

Hillcrest 06/09/05

Hillcrest 12/01/05

Hillcrest 02/06/04

Hillcrest 29/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Hillcrest Hillcrest Harrowden Road Wellingborough Northants NN8 5BD Lead Inspector Ms Helen Abel Key Unannounced Inspection 19th February 2007 13.15 Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 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 DS0000012813.V316120.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 Adults 18-65. 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 DS0000012813.V316120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Address Hillcrest Harrowden Road Wellingborough Northants NN8 5BD 01933 272281 01933 272281 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) Tebmar Ltd Mrs Susan Tebbutt Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users accommodated within the home will have a condition that falls within the spectrum of Autism. 6th February 2006 Date of last inspection Brief Description of the Service: Hillcrest provides long term residential care for up to five young adults. This is a specialist service, providing 24hour care for younger people aged 22 to 33 years of age with Autism. The home is a five bedroom (1960’s) detached property situated on the outskirts of Wellingborough town centre, close to a local bus route. There is a separate large activity room for educational sessions and leisure activities and the home also provides a sensory room for relaxation. There is an attractive, well-maintained garden to the rear of the property, providing a secure outdoor recreation area. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 1.15 and 6pm. Prior to the inspection the inspector spent preparation time reading the homes service history, previous inspection report, a pre-inspection questionnaire submitted by the registered manager. This information informed the planning of the areas to be inspected. Three residents were closely case tracked to check how their care needs had been assessed and how their care is planned and supported. The Inspector met all five residents in the home introduced by the registered manager. The Inspector spoke with the registered manager, and staff and observed routines, staff practice and interactions between staff and residents throughout the inspection. Due to communication difficulties and the anxiety experienced by people with autism when routines change, or when faced with new people such as an Inspector visiting unannounced their views were not asked on this occasion. Observations of general well-being and reactions to staff were used as a guide to assess their comfort and safety in the home. Documents relating to staff training and recruitment, health and safety, medication and quality assurance processes were examined and a full tour of the home made. What the service does well: The home specialises in the care of young adults with autism and staff demonstrate a clear understanding of the needs of those people while ensuring they are all assessed and treated as individuals. Residents were observed engaged with staff in the activity room undertaking individual life skills appropriate to their level and needs. The activity room is used to install structured teaching. This system is to put structure into the daily routine of an autistic person. Residents appeared happy and comfortable with the staff group seeking reassurance where necessary. Care is taken to ensure that the needs of anyone admitted to the home can be met which avoids unnecessary distress. A detailed assessment process for a new resident was seen and records show that residents needs continue to be reviewed once they move into the home. All residents have a plan of care, which is based on their own needs and aims to help them keep existing skills and develop new ones. This is achieved Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 6 through support and encouragement and lots of praise, examples of which were heard throughout the inspection. All written care plans, daily records and risk assessments contained detailed information as to how resident’s needs should be met. There are very good relationships between the home and residents relatives who have praise for the home and staff. A priority is given to staff training in many key areas around autism, communication methods, challenging behaviour, person centred planning and national vocational qualifications. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission process provides sufficient assurances that residents needs can be fully met. EVIDENCE: Records for a resident recently admitted was reviewed to check the adequacy of the assessment process. A detailed assessment process ensures the resident’s needs could be met within the home. Records, observations and discussion with the registered manager and staff indicated that the resident had settled in the home and a structured routine based on his needs had been developed. Resident’s aspirations were evident in care plans, and through daily organised activities and events for individuals. In the afternoon a workshop session was observed in the activity room with three residents and a staff member undertaking tasks and pursuits to build independence skills. Residents fully engaged with the tasks. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 9 Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8, 9, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to fulfil their needs and choices. EVIDENCE: There are care plans for each person who lives in the home. Care plans tell about what is important for each person living in the home. Staff knows what each person who lives in the home needs, and about the things they like and don’t like. Staff make sure friends and relatives keep in contact with people living in the home and know what is happening. The home uses in the activity room TEACCH (Treatment and Education of Autistic and related Communication Handicapped Children). This system puts structure into daily routine of an autistic person with the use of schedules. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 11 Tasks are set to the ability and needs of the individual. One resident was observed in the activity room listening to music on headphones and another resident had worksheets to increase the ability to communicate, this would allow the individual to relay their needs to staff, family and others Individual picture boards are in place for each resident and are used on a daily basis to assist with understanding the routine of the day, which reduces anxiety. The picture boards are also used to assist residents with making choices. Risk factors are identified as part of the assessment process and strategies put in place for minimising risks. Staffs demonstrated a good understanding of the needs, of individual residents, and were observed to be providing residents with an appropriate level of support. Resident’s finances are managed by the home with families closely involved with this aspect. The support manager is responsible for records of balances being kept and the registered manager regularly audits these records. The records and balances for the three residents were checked and found to be accurate. Residents are involved day to day decisions where possible. Suggestions were made to the registered manager around better recording of dates when residents were weighed and further exploring the cultural heritage needs of the identified resident following on discussions with the resident/family. The registered manager agreed to pursue these issues following on the inspection. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 12,13,15,16,17 This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a good lifestyle in the home. EVIDENCE: People who live in the home can do different things they want to do. Care plans confirmed individuals interests and likes and this was confirmed in discussions with staff and from the daily records. Individual plans take account of resident’s social, emotional, communication and independent living skills. On the afternoon of the inspection residents were all going out to the local supermarket, café which is part of a regular activity programme. Some residents were observed independently using the computer to play games. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 13 Work placements have been arranged for individuals in the community in Tesco’s and a local restaurant. Family contact is clearly encouraged and residents are supported in maintaining regular contact with their family. Staff confirmed that they are welcomed into the home, can visit in private and are kept informed of important matters affecting their relative. This was supported by a sample check of records, which showed regular communication with resident’s families. Staff regularly cook meals, and prepare fun snacks with residents, banana cakes, scones, and biscuits. The menus have recently been updated incorporating all the residents’ popular choices. Staff reported residents enjoy a varied diet and one resident case tracked particularly likes chilli and spicy food. Ranges of dishes were offered to meet this preference. During the inspection visit staff were preparing potatoes, sausage and onions and mushrooms, a favourite dish of the residents. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s benefit from mostly good staff attention to health and medical care. EVIDENCE: The assessment and care planning processes take account of individual preferences and needs in relation to personal care. Residents are encouraged to be as independent as possible and picture cards are used in en-suite bathrooms where necessary to remind residents of their personal care routines. When examining care records around applying homely remedies such as skin creams, these were not routinely administered. The Registered Manager agreed to look into this issue. Medication sheets for individual residents were well maintained and checks of medicines demonstrated appropriate administration of medicines. The Inspector noted one intrusive form of Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 15 medicine, which requires staff to be trained first, by a qualified care professional. This would ensure good attention to medical care needs. The home have developed their own training programme in aspects of medication management but this programme could be developed further to meet the National Minimum Standards. Following on the inspection the registered manager made inquiries with the community pharmacist to provide certified medication training for the staff group. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are protected from harm by policies in the home and awareness by staff. EVIDENCE: There is a policy which tells people how they can make a complaint if they want to. No complaints have been received and the registered manager felt this was due to the constant good working relations she builds with the residents and theirs families and friends. Evidence of thank you letters and compliments were shown to the Inspector that supported this view. Staff have had training about how to make sure people are kept safe from harm. Staff confirmed working to safe practices and discreetly checking residents are okay without compromising their privacy and dignity. Policies and procedures and ongoing keeping residents safe training in the home confirmed this. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 -30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a clean and comfortable home, which meets their needs well. EVIDENCE: The home is indistinguishable from other large family houses in the area, it is set back slightly from the main road with car parking at the front of the house. There is a large garden to the side and rear of the house, which is well tended. A full tour of the premises was carried out during the inspection; all areas were very clean and tidy. The home is decorated and furnished to a very good standard, with good quality furnishings that are comfortable. Communal areas of the home include lounge, activity room and a sensory room. The lounge Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 18 was homely and comfortably furnished and the sensory room provides an ideal place to relax, have a foot massage, or just quiet time. All residents have single bedrooms, which have en-suite toilet facilities. Bedrooms were well decorated, comfortably and appropriately furnished for the needs of the individuals. The registered manager advised that residents that are able had been involved with choosing the décor and soft furnishings. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from supported and protected by well- trained staff and through recruitment practices. EVIDENCE: Three staff were on duty supported by the Registered Manager and office staff. Later in the day two staff came on duty late afternoon and then the waking staff will come on duty in the evening. Staff spoke with felt well supported. One staff member said “ We have loads of training it’s none stop, I would like to do the good training again I enjoyed it so much” another staff member said “We have regular supervision, this helps with my work with the residents and gives me confidence.” All staff have a training and development record. The registered manager is involved on a daily basis in the running of the home and goes out with residents on trips, outings and medical appointments. Throughout the inspection residents came and talked briefly and sought Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 20 reaurrance with the registered manager. Staff were observed with residents in attending to residents needs in a warm and friendly way. Three staff recruitment records were examined; all contained an application from which included a full employment history, two written references and evidence of enhanced criminal records bureau checks. Staff are chosen to work in the home who are safe and able to support people well. . Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are kept safe by management systems in the home. EVIDENCE: The registered manager confirmed that the quality assurance process involves seeking views from relatives about the standard of care. Questionnaires are sent out to relatives before and after resident’s reviews, which are carried out every six months. Discussion throughout the inspection confirmed that constant efforts are made to review, maintain and where possible improve the standards of care provided. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 22 Records are kept in good order, in general recording is clear and supports the care provided. Staff have received training in emergency first aid and there are two trained first aiders available to give first aid if required but are not always available on each shift. To improve this a qualified first aider should be available at all times. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x x 3 x 3 3 x 3 Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 24 N/a 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 YA20 Regulation 18 Requirement The Registered Person shall ensure that persons working at the care home receive training appropriate to the work they are to perform: Training to be provided by a qualified care professional around the use of an intrusive form of medicine treatment. Timescale for action 31/03/07 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 Hillcrest Refer to Standard YA6 YA42 Good Practice Recommendations To explore with the identified resident/family an appreciation of the residents cultural heritage and reflecting this within the delivery of care. To improve the administration of first aid- a qualified first DS0000012813.V316120.R01.S.doc Version 5.2 Page 25 2 YA20 aider should be available at all times The medication management training for care staff should be accredited and include: 1. Basic knowledge of how medicines are used and how to recognise and deal with problems in use; and 2. The principles behind all aspects of the homes policy on medicine handling and records. Hillcrest DS0000012813.V316120.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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