Inspection on 06/09/05 for Hillcrest

This inspection was carried out on 6th September 2005.

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

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

Other inspections for this house

Hillcrest 19/02/07

Hillcrest 06/02/06

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 Harrowden Road Wellingborough Northants NN8 5BD Lead Inspector Sheila Smith Unannounced 6 September 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hillcrest Address Harrowden Road Wellingborough Northants NN8 5BD 01933 272281 01933 272281 sue@tebmar.freeserve.co.uk Mrs Susan Tebbutt, Tebmar Limited, Hillcrest, Harrowden Road, Wellingborough, Northants, NN8 5BD Mrs Susan Tebbutt CRH 5 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of LD Learning Disability 5 places registration, with number of places Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: All service users accomodated within the home will have a condition that falls within the spectrum of Autism. Date of last inspection 21st June 2005 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 28 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 D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents. The primary method of inspection used was ‘case tracking’ which involved selecting one of the residents and tracking the care they receive through review of their records, discussions with the support workers, and observations of care practices. The inspection took place on an unannounced basis, and as the residents were leaving to attend an evening activity before the inspection could be completed, a further visit was made to complete the process. The first visit took place during an evening and the second during a morning; the total time taken was 4 hours. Communal areas, and some bedrooms were visited. A selection of care records, and essential records of the home were reviewed. The Registered Manager was not available during the inspection. What the service does well: Hillcrest provides a family style home, within a community setting on the outskirts of Wellingborough, where the group, consisting of 4 residents have lived together for some considerable time. Managers and a group of staff, support them, who are dedicated to provide a quality service to the residents, where residents can build their confidence, to determine their own lifestyle and make life choices. The home uses the TEACCH (Treatment and education of autistic and related communication handicapped children and adults) that provides the residents with a structured approach to their lives. Anxieties and the subsequent behaviour resulting from the anxiety are reduced as residents are taught to manage their own difficulties. This type of care requires a consistent approach from a well-trained staff team, who work together with the residents to encourage their independence, and Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 6 give them confidence to carry out daily living tasks, so that they can live in the community, enjoying the benefits given to other citizens. 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. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 The pre-admission process of all potential residents to the home is well managed. EVIDENCE: Considerable effort has been made to make the homes Service User Guide accessible to people with autism. Work is about to begin to update and develop the Statement of Purpose. Obtaining the right match of residents within the home is seen as a priority by the senior staff, therefore particular care is taken during an assessment to ensure that the prospective resident will complement the existing residents. The admission process will take a considerable period of time with the prospective resident being given a number of opportunities to visit the home prior to admission. The home uses the TEACCH, method, which provides a structured approach to the residents day through verbal or picture prompts. This method reduces the need for residents to have to make decisions, and thus reduces the anxiety experienced by people with autism. There was evidence that the staff were well trained, committed and enthusiastic in delivering this type of approach, and worked well together to ensure consistent care. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,9 Care planning is clear, comprehensive and reviewed regularly, so that staff are clear about their responsibilities in meeting residents needs. EVIDENCE: The care plans documented physical care needs including reference to the personal care required and to the help required to perform domestic tasks. References were made to psychological, emotional and behavioural needs. Each resident is allocated a named key worker, supported by a co- worker, and these staff are responsible for ensuring that the goals identified in the care plan are being addressed. The care plans are reviewed monthly by key workers and management, six monthly with the parents and annually with care management and other people involved in the network of care for the individual. Residents at Hillcrest are particularly vulnerable to risk due to the nature of their condition. In response to this staff have put in place detailed risk assessments. These have been drawn up through observations of the resident, and discussions with parents and with other health personnel who are involved. The file inspected showed a range of risks being explored, the Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 10 outcome if the identified risk occurred, and the actions to take to minimise or eliminate the risk. It was acknowledged that due to the nature of Autism it is difficult for residents to participate in the running of the home in the expected way, but through communication with the parents and through observation of the residents, the staff are able to assess the residents satisfaction of the care provided. During the inspection the residents were observed to be engaged in one to one activities with the staff ranging from roller skating, hanging out washing, day centre activities, listening to music, or relaxing in the sensory room Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15, 17. Opportunities for personal development are provided through a broad range of community based leisure and educational activities. EVIDENCE: Schedules are in place for each resident to support their progression in all areas of day to day living. For example the resident is given a daily schedule consisting of a list of activities. The schedule may be in picture form, verbal or written, depending on the level of understanding. The resident works through the list choosing one activity after another, thus removing the possibility of confusion and agitation that may be caused if they had to choose for themselves which activity to do next. Day centre activities are provided on site in a separate building at the rear of the home. Each resident has his/her workstation and is provided with appropriate educational activities. Music is played during the day; there are certain times for calming relaxing music and times for more lively music. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 12 Residents are provided with a variety of community activities, such as the trampoline, swimming, walks in the park, picnics, and shopping. Monday Wednesday and Friday nights are massage and relaxation, whilst on Tuesday and Thursday evenings residents are taken to a pub of their choice. Some of the regular activities do not take place during the school holidays, when crowds can disturb the residents. When activities are changed staff are particularly careful to exchange the scheduled activity for another that is acceptable to the resident, to decrease the levels of stress. Residents were going out to the pub on the evening of the inspection. All residents are taken on holiday each year; this year the holidays have been at Skegness, and Matlock in Derbyshire. Work opportunities take place in a local café, and a supermarket, where residents work in a one to one situation with members of the homes staff. One resident attends an assert training course in Northampton. Regular contact with the parents is seen as a very important part of the overall care given to the resident. Two of the residents visit their parents every weekend, and it is seen as important that parents continue with the program, and work closely with the staff of the home to ensure continuity, and the control of stress. One parent accompanied her daughter and staff on a holiday. The residents have three meals a day, of which one is a cooked meal, alongside snacks and drinks. Residents can choose where to eat their meals, and on the evening of the inspection some residents were observed eating their meal, which consisted of gammon, potatoes and beans, followed by ice cream, in a summer house in the garden. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 The management of residents’ health and personal care was supported by a sound risk assessment, and care planning process, with access to healthcare and professional support. EVIDENCE: All residents have access to the usual healthcare facilities, and are registered with a local medical practice, local Dentists where they have regular check ups and with an Optician who they visit on a two yearly basis. Due to the high dependency of the residents staff have to make some decisions on behalf of them, but it was clear that residents preference on how they were guided and supported, was clearly respected. Care plans are in place for both physical needs as well as for emotional needs, are clearly written, and reviewed regularly. Induction for newly appointed staff is a long process, and staff are not allowed to be alone with the resident until they feel confident and can demonstrate that they have the appropriate knowledge and skills to be able to deliver the individual care. Currently no residents are self-medicating. The Medication Administration Records were fully completed and there are the necessary procedures in place to ensure the safe handling, administration and disposal of medication. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 14 Each resident has a medication profile and a signed homely remedy agreement. The Support Manager was able to demonstrate a good understanding of the medication used in the home. The homes policy on administration of medication was seen, and advice was given that the home should include a procedure for staff to follow in the event of the wrong medication being administered. The home has recently had the experience of one of the residents dying suddenly in the home. It was evident from speaking to the Support Manager that the event was handled competently with the utmost sensitivity. Relatives of the other residents were involved with staff in the process of observation of the residents to detect any signs of distress. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The complaint and protection process within this home is adequate and sufficient to protect residents EVIDENCE: The home has a robust complaints policy and the Support Manager indicated that any complaint would be taken seriously and investigated fully. There has only been one complaint from a parent that was dealt with to the satisfaction of the complainant. The support Manager said that the home had ‘an open door policy’ and parents could ring the home or visit whenever they liked. Parents felt comfortable in discussing concerns with the staff, which were dealt with immediately. The home has an Adult Protection procedure, reviewed January 2005, and a separate Whistle Blowing policy. Formal training on the Protection of vulnerable adults is due to take place in October, nevertheless the staff interviewed demonstrated an awareness of their responsibilities should they suspect abuse. Staff showed a good understanding around the issues of the challenging and sometimes anti-social behaviour, displayed by some of the residents. Restraint has been used on 9 occasions in the past year and all staff have received training in defusing difficult situations, and in positive restraint. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 The standard of the décor within the home is good, and the standard of hygiene was high, so that the residents have a homely place in which to live. EVIDENCE: The premises areas viewed on this inspection were well decorated and furnished to a good standard. General hygiene and domestic maintenance was good. The Home is close to local amenities and is in keeping with the surrounding residential area. An activity room for both leisure and educational purposes has been created; this is only used with staff support. The central area of the home is the hallway where staff write their reports and complete other administrative tasks. From this area staff are able to observe residents discreetly, and able to quickly offer support when necessary. The décor throughout the home, including the bedrooms, was suitable for the age group of the residents. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 17 Residents have their own single bedroom with en-suite facilities. The bedroom seen during the inspection contained personal possessions. The home provides a sensory room, so that residents have a place in which to relax. There is a large enclosed garden that is safe and accessible to residents. The kitchen was clean, tidy and well organised. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34,35 The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles EVIDENCE: Recruitment is a lengthy process, as this highly specialised service requires people who are willing to learn and work with the TEACCH process, and have the patience to be able to put it into practice. New staff need to be introduced into the resident group slowly and carefully allowing the residents to put their trust in the new member of staff without raising their anxieties. There is a robust system in place to ensure that appointments are made on the basis of equal opportunity legislation and that satisfactory checks are completed. One staff file was examined and found to include most of the necessary information as per schedule 2 of the Care Standards Act, and advise was given to include a photograph and proof of identity. It was evident that the care provided by staff is based on a sound philosophy and values that promote enable and encourage residents to work towards their own goals, and live a live as full as possible. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 19 During the inspection staff were observed to be quietly and calmly carrying out their duties, communicating appropriately with the residents. In discussions with staff it was clear they had a good understanding of their own job descriptions and that of other staff deployed with them. In discussions with the Support Manager, it was clear the home maintains good supervision, and that training is targeted and specific to individual staff need. The arrangements for on-call support and management oversight of the home are appropriate, and staff clearly knew what was expected of them while on duty, and how they could call for support/consultation should they require clarification on any issue. There are three members of staff on duty to the four residents during the day, and two staff to two residents at weekends, as two of the residents go home to families. During the night there is one waking and one sleeping member of staff. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42 There is an effective and proactive management in place, that is accessible and responsive to the needs of both residents and staff. EVIDENCE: Staff commented that the Manager was easily accessible to them, and willing to discuss issues and guide them in practice by example. Supervision systems were in place to ensure guidance, support and to identify any training needs. Due to the nature of Autism it is not possible to obtain feedback from the residents regarding their satisfaction with the service, in the usual way, so the home depends on the feedback from professionals and from parents. Parent’s views are sought through regular conversations with them and through twice yearly review meetings. Staff confirmed that equipment is replaced or repaired, and observations made during the inspection confirmed that the residents live in a safe environment. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 21 Records observed included accident reports, and the fire log- book. The Fire Officer was satisfied with the existing arrangements for the protection of the residents. Health and safety checks made on a regular basis were well documented, although it was noted that checks had not been made during July. The Support Manager agreed to ensure that the schedule of checks was maintained. Policies and procedures relating to safe practices were available for all staff. The staff confirmed that there was an adequate supply of disposable gloves and aprons available for staff who need to assist with personal care. The Support Manager said that all staff had a first aid certificate. Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hillcrest Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 23 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Hillcrest D C51 C08 S12813 Hillcrest V243801 060905 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Newland House, First Floor Campbell Square Northampton NN8 5BD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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