Inspection on 23/01/06 for Hillcrest

This inspection was carried out on 23rd January 2006.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillcrest 09/01/09

Hillcrest 12/01/07

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 Julie Conrad Unannounced Inspection 23rd January 2006 09:40 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.V268679.R01.S.doc Version 5.1 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.V268679.R01.S.doc Version 5.1 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 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.V268679.R01.S.doc Version 5.1 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. 5th September 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Hillcrest is situated on the outskirts of Tyldsley 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 have dementia, Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 5 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. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Hillcrest took place on 23rd January 2006, between 9.40am and 12 00 noon. The Deputy Manager Ms. Lorraine Taylor was present at the inspection. The inspection focused on a number of core standards and the requirements made at the last inspection in the main have been met. The inspector conversed with the Deputy Manager, four members of staff and seven residents, the comments made by staff and residents about the care and service provided was good. A tour of the premises took place and records were checked. The general atmosphere within the home is homely, friendly and welcoming. What the service does well: What has improved since the last inspection? Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 7 At the last inspection, nine bedrooms had a hot water supply to the sinks that was not regulated to 43 degrees in temperature. The valve controlling the temperature has been replaced by an electrician and therefore water temperatures throughout the home is regulated. A gas inspection and a fire drill have taken place, ensuring safety for residents and staff. Parts of the home have been redecorated, this includes the main lounge and a bathroom has been refurbished, making the home more comfortable and pleasant for the residents. 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. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The manager carry’s out a full assessment of each individual’s needs, before a service user is admitted into the home, to ensure the needs can be met. EVIDENCE: The inspector checked four resident’s files, which all contained a client profile and a pre-admission assessment, which includes assessing the following; current medication, personal care and wellbeing, mental state and cognition, communication, sight and hearing, dietary preferences, weight and height, oral health, sleeping patterns, mobility, foot care, history of falls, continence, social interests, personal safety and risk, family and significant relationships and medication, this is followed by the care plan objectives. The care plans are very good, they are comprehensive and relevant to each individuals needs. Many residents have varying degrees of dementia, whilst two residents have a mental disorder. The care plans focus on maximising the quality of life for each resident. The inspector spent some time talking to one of the residents. From the conversation with the resident and from talking to staff and reading the care plan, it was evident the residents needs were being met and that the resident’s preferred daily and evening routine was known to and adhered to by staff. The inspector talked to seven residents who had varying degrees of Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 10 dementia, the inspector observed how all the residents get along with each other, there is a relaxed, friendly atmosphere in all communal areas that is created by staff and resident interaction. A couple of the residents told the inspector what they did and did not like to do, this was found to be accurately written in the care plans. All care plans seen had been reviewed on the 21st January 2006. The care plans take a holistic approach to care and staff were observed putting this into practice. Due to many people having varying degrees of dementia, staff focus on lots of one to one interaction, talking and reminiscence, touch is also important this includes hand stroking, nail care, hair brushing, which are all ways of engaging the residents attention to the present and the past. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10 The care plans demonstrate that service users health, personal and social care needs have been assessed and are set out in the care plan, to ensure staff have the correct information on each individual. The homes medication policy and procedure needs to include information on residents wishing to administer their own medication. Staff induction and ongoing training, ensures staff understand the importance of treating residents with respect and that their privacy is upheld. EVIDENCE: The files contain a photograph of the service user their preferred name, personal details and a resident profile. There is a daily living and needs assessment, personal care and physical wellbeing assessment and independent activities assessment. There is a general risk assessment the outcome of the assessment is incorporated into the care plan. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 12 The inspector observed a member of staff assisting a resident to feed herself, this was done in a calm, unrushed manner and the member of staff sat along side the resident. Another member of staff accompanied a resident to the local shop. A resident told the inspector, “If I need a new puzzle book, one of the girls will come with me to the shop, its not far”. The inspector discussed medication with the team leader, the team leader told the inspector there was one resident who has always administered their own medication, however, due to forgetfulness, a risk assessment was carried out, and it has been agreed with the resident, that the medication will be taken to her, she can take her own medication whilst a member of staff is present. This is good practice. However, the inspector read the homes medication policy and procedure and discovered that it does not have information regarding residents administering their own medication. This must be included in the medication policy and procedure. The inspector saw the pharmacist’s checklist and comments, made at their last visit to the home, this was satisfactory, the pharmacist visits four times a year. Staff induction and ongoing training at the home ensures staff understand, that they must always treat residents with respect and that residents have their privacy. When asked a resident said, “If I want to have privacy I can go in my room,” “staff will knock on the door”. The inspector observed staff speaking to people and behaving in a respectful manner. The inspector asked two new members of staff about certain residents, both staff knew the resident’s needs and daily and social preferences. One male resident prefers to spend most of the time in his room, whilst others prefer company throughout the day and early evenings. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 Residents find the lifestyle experienced at the home, meets their current expectations. Visitors are made welcome at the home and come and go freely, ensuring ongoing contact with family and friends is never regimented. EVIDENCE: The managers and staff consult with residents on a day-to-day basis, to ensure their daily needs are met. St George’s church is across the road and residents are able to go there with staff if they choose. The home uses the local community centre once a fortnight on a Wednesday afternoon, to hold afternoon tea and a social event for residents outside of the home. Two members of staff accompany the residents, music is played and residents are able to dance. The centre has tea and coffee making facilities and staff take cakes and biscuits. Groups of two and four residents often go with staff to the garden centre and residents go with staff to the local shops on a one to one basis. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 14 Most activities within the home are on a one to one basis, however, group activities include bingo and dominoes. The deputy manager is currently arranging for a singer who plays guitar, to visit the home to entertain the residents. On the day of the inspection, there was one visitor, who stayed a short time, as the resident was not very well. Visitors are made welcome by staff and are encouraged to visit any time they are able to. The residents benefit from other residents visitors. One resident told the inspector, “I go to my daughters every Sunday, and she lives locally”. “I have lived here fourteen years, I can do my own thing, I like doing puzzles and watching TV and I go out when I want to”. At this inspection the inspector briefly discussed menus with the cook. On the day of the inspection there was a choice of two main meals at lunchtime, chicken and sweet corn pie or shepherds pie served with vegetables. Evening meals are usually lighter meals, however, during the winter months some of the residents prefer a hot substantial meal, therefore, the cook was preparing a bacon and bean hot pot, with an alternative of soup and sandwiches. Staff speak to each resident every morning to ask them their choice of meals of the day, residents are able to change their minds if they decide to. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a complaints policy and procedure, which is made available to residents and their representatives. The home has a policy and procedure on the protection of vulnerable adults, which staff made aware of at induction and ongoing training. EVIDENCE: The home has a complaints policy and procedure, which residents and their representatives are made aware of on admission to the home. The complaints file demonstrated no complaints have been made since the last inspection. However, letters of compliment and thanks from relatives have been received. The inspector spoke to a resident about the complaints procedure, the resident said, “If I had a complaint, I would tell the staff or managers, there is nothing to complain about, the girls are cracking, ‘I have lived here fourteen years and have never needed to complain”. The home has a policy and procedure on the protection of vulnerable adults. The inspector asked a member of staff what they would do if they suspected abuse. “I would go straight to the managers and tell them. We have had training in the protection of vulnerable adults in the past and it is part of the NVQ level 2 course”. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Residents live in a safe, well-maintained environment, ensuring they are protected from any risks or harm. The home is clean, tidy and hygienic, making it a comfortable place in which to live. EVIDENCE: At the last inspection a number of requirements were made that have now been met. Water temperatures to nine bedrooms were not regulated to 43 degrees, an electrician has visited the home and replaced the valve that controls the water temperatures and therefore, all water supplies throughout the home are regulated to 43 degrees. A fire drill has taken place and a gas inspection has been carried out. The lounge has been re-decorated and has new curtains. A bathroom has been re-furbished parts of the home have been re-painted. An upstairs bathroom has a wall that needs painting and the skirting boards outside the bathroom needs repainting, the carpet outside of bedroom 4 needs replacing, Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 17 the deputy manage said this will be done when the electrician informs them if any rewiring is to be carried out or not. The large garden area is being landscaped, there is a very large lawn surrounded by a paved pathway that is wide enough for wheelchair users. Hedges are to be planted around the garden to ensure privacy and safety for the residents. Two residents told the inspector that they intend to sit out in the landscaped garden in summer and that they liked the way it was progressing. The home was clean, tidy and free from odour throughout. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The resident’s needs are met by the staffing levels and the skills of the staff, to ensure residents are in safe hands at all times, and staff must receive training in first aid. Staff are trained and are competent to their jobs, ensuring residents receive a good service. EVIDENCE: On commencing employment at Hillcrest, staff receive induction training, a new member of staff is currently undertaking induction, a member of staff who commenced employment a week ago, is currently shadowing the trained staff. All staff receives mandatory training. Recent training has included medication training and moving and handling. Nine staff have achieved NVQ level 2 in care, two staff are undertaking NVQ level 2 whilst two staff are to commence the course. The two-team leaders have achieved NVQ level 2; one team leader has completed NVQ level 3 whilst the other team leader is undertaking NVQ level 3. The manager has given training to staff on dementia care and training from the Alzheimer’s society ‘building on strengths’. At the last inspection, a requirement was made that staff receive training in first aid. The manager arranged for the training to take place in December 2005, unfortunately the trainer cancelled the course. The course should be reHillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 19 arranged as soon as possible. At present only the deputy manager and the cook are first aid qualified. The home has a policy and procedure on recruitment. The inspector checked two staff files, which contained application, two satisfactory references, photograph, photocopy of birth certificate, self declaration of offences form, and CRB form (criminal records bureau). The home’s aims and objectives leaflet, which is displayed in the hallway, informs the resident and their representatives about the homes recruitment policy and procedure. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 The manager is competent and qualified to be in charge of the home, ensuring the home is run in the best interests of the residents EVIDENCE: The manager is currently undertaking NVQ level 4 and the Registered Managers Award. The deputy manager has already completed NVQ level 4 and the Registered Managers Award. Both managers are competent and are able to run the home efficiently and in the best interests of the residents. This was demonstrated in the records of the team meetings, which take place on a monthly basis, where different issues relating to home life are discussed as well as staff related issues. There are two team leaders who are experienced members of staff, both have achieved NVQ level 2, one team leader is undertaking NVQ level 3 and one has completed the course. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 21 To ensure staff are providing a good standard of care and their training needs are being met, staff are supervised on a regular basis, standard 26 regarding staff supervision was inspected at the last inspection. The managers and staff liaise on a daily basis with relatives and health care professionals who are involved in the residents care. A resident told the inspector that staff, are always very helpful and friendly. Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 22 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 2 x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x x Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 24 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. 2. 3 Standard OP30 OP19 OP9 Regulation 13 23 13 Requirement Timescale for action 28/02/06 A number of staff need to receive training in first aid. Parts of the home need re28/02/06 decorating, repainting and recarpeting. The homes medication policy and 28/02/06 procedure must include information regarding residents who wish to administer their own medication. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. x x Refer to Standard x Good Practice Recommendations Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 25 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: 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. Extracts may not be used or reproduced without the express permission of CSCI Hillcrest DS0000005740.V268679.R01.S.doc Version 5.1 Page 26 - 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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