CARE HOME ADULTS 18-65
Hillcrest-Beach Road 61 Beach Road Littlehampton West Sussex BN17 5JH Lead Inspector
Gill Davis Announced Friday, 29 July 2005, 3.00pm, V232806
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-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hillcrest-Beach Road Address 61 Beach Road, Littlehampton, West Sussex, BN17 5JH 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) 01243 531277 Mr Adrian Carter CRH 4 Category(ies) of LD-4 registration, with number of places Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25/01/05 Brief Description of the Service: Hillcrest Beach Road is a care home registered to accommodate up to four service users in the category LD (Learning Disability). It is a semi-detached property with a small parking area to the front and a secluded garden to the rear. It is situated in a quiet road within easy walking distance of Littlehampton town centre and the sea front. The establishment offers comfortable and domestic accommodation with service users bedrooms being located on the first and second floors. Hillcrest Care Ltd owns the service and the registered manager in charge of the day to day running of the establishment is Mr Adrian Carter. The responsible person on behalf of the company is Mr Richard Greenwell. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place from 4.30pm until 8pm. The focus of this inspection was to find out about the evening routine, the staffing levels for this time of day and the care that was provided to the residents at this time. There have been no new admissions to Hillcrest-Beach Rd in the past two years and the current four residents enjoy a stable and compatible pattern of life. Prior to the inspection the registered manager completed a pre-inspection questionnaire and information from that has been used to inform this report. Comment cards were provided to enable relatives and visitors to comment on the service provided by the home and two have been received to date. The Inspector had arrived at the home as one of the residents was returning home from hospital. Accompanying him were two other residents who had been taken to meet him and three members of staff to support this. There were four members of staff on duty at the time of the inspection. At night time there are two waking staff on duty. The rotas confirmed that a high staffing level was maintained. During the course of this inspection, the inspector spoke to staff members and communicated by means of touch and voice with one resident although he was unable to hold a conversation. Some time was spent observing the interaction between the residents who were unable to speak and the staff members, there appeared to be good communication between them and a real understanding of the character and motivation of each individual resident. No residents were able to express their views regarding the care they received but appeared to be happy and content at the time of the inspection. There was a relaxed atmosphere, with staff members intervening skilfully with one resident who was unhappy about the Inspector being there and potentially aggressive. Later, the evening meal was being prepared and smelled very appetising; the residents were eating with obvious enjoyment as the Inspector left the home. Each individual was being attended by one member of staff and was engaged in an activity of their choice. All records were found to be in order and up to date. The preadmission information and support plans were excellent, well written and contained all the information needed to look after the residents. All had had an annual review of needs although some aspects of the care plans and risk assessments were in need of review. Staff files were not scrutinised on this occasion. Staff training was ongoing and it was noted that 46 of the staff were National Vocational Qualification (NVQ) trained, others were undergoing training or had undertaken in house training in service related topics. The training records of all staff were well documented and up to date. Most staff members were being supervised on a regular basis and the outcomes recorded.
Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 6 The building has recently undergone some refurbishment of some areas inside including the residents’ bedrooms. Overall the home has been attractively furnished in a domestic style and was warm, clean and welcoming. All Health and Safety issues were up to date. No requirements were made at this inspection. What the service does well: What has improved since the last inspection? What they could do better:
There was one requirement following the last inspection, which has been addressed. The policy of monthly review of the care needs/ risk assessments of each individual had not been carried out consistently and this needs to be addressed. From observations made by the inspector at the time it would appear that the team at Hillcrest Beach Road have established a culture that puts the residents to the forefront of everything that they do. There are no recommendations or requirements resulting from this inspection.
Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 7 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-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 8 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-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 9 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) 1.2.5. Residents and their families have the information they need to make an informed choice about where they live and are suitably assessed before placement. Each person has an individual statement of terms and conditions. EVIDENCE: Each resident has been given a Service User Guide, in pictorial form, which contains a contract and complaints procedure when they enter the home. All of the residents have family or a representative who are able to act on their behalf. The manager or senior staff members assess all residents before they join the home. Careful preadmission planning to make sure that the person is well prepared for admission into the home involves visits to the home for tea, outings with the other residents and an overnight stay/stays before they are admitted. The records of these assessments were seen and found to be very detailed. The resident group has been together for two years and there have been no changes. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6.7.9.10. Residents or their relative/advocate are involved in the drawing up of their care plans and supported to make choices and decisions about their lives to promote a level of independence, which reflects the individual’s ability. EVIDENCE: Care Plans were very detailed and well presented. They contain a complete record of the individual and include all assessments from other agencies. A large section of the pre admission information was composed of two documents “ Finding out about me” and “ What I can do” A programme of daily activities and interests is included. Risk assessments had been undertaken in all aspects of the residents care and the residents were supported to be as independent as possible within their capabilities. Residents are encouraged to take part in outside activities and may go out to local venues and social activities with staff members to support them. There is a high level of staffing to ensure that the residents are able to enjoy individual interests. All personal information is securely stored in a locked cupboard. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 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. Residents appear happy with their lifestyle and are supported to engage in appropriate opportunities for personal development and leisure activities EVIDENCE: Residents are helped to engage in appropriate leisure activities. Residents are involved in community activities and use local resources. A high staffing level ensures that each individual receives one to one attention at all times and at times this can be two to one to enable the resident to undertake an activity that involves a higher degree of risk. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 12 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. The resident’s health, personal and social care needs are well met through thorough assessment; good care planning and staff training. None of the residents are able to self medicate. EVIDENCE: Detailed care plans contain information regarding the preferences of the residents and any health issues, physical and emotional, that there might be. There was evidence of regular Care Managers’ detailed reviews of the care needs along with regular in-house reviews undertaken by the Support Workers. The in-house reviews had not been undertaken as regularly as the home’s policy required and the inspector reinforced the need to carry this out as a matter of good practice. All staff members who administer medication have done an in-house training in the safe administration of medication and the records, policies and procedures were seen to be up to date and well maintained. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 13 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 All complaints are taken seriously and staff, and a complaints procedure available. Staff members are well aware of the Adult Protection Procedures and a Whistle Blowing policy is in evidence. EVIDENCE: Staff members have attended the Adult protection training and the procedures are available for reference at any time There had been no complaints since the last inspection. One comment card received said that there had only been “small grumbles”, which had appeared to be successfully addressed by the staff members. Residents have been given a pictorial Complaints Procedure so that they know who to tell that they are “unhappy” although it is doubtful that they would be capable of acting on this. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 14 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) 24.25.26.27.30. The home provides a comfortable and safe environment where the residents are supported to lead a lifestyle proportionate to their capabilities. There is sufficient privacy provided in the toilets and bathrooms. The home was clean and hygienic. EVIDENCE: A tour of the home revealed that each resident had a single bedroom of generous proportions. They had been decorated to the residents’ tastes and reflected their individual interests. There are sufficient toilets and bathrooms that provide privacy and meet individual needs. The home was maintained to a good level of safety, and was to a good standard of decoration. Risk assessments were in place regarding areas of hazard. Overall the home was clean and there were no unpleasant odours. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 15 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) 31.32.33.34. There is sufficient staff members employed to ensure that residents receive the support that they need. The home has a sound recruitment policy and all checks are made. There is an ongoing training programme. EVIDENCE: All staff members have undergone Criminal Records Bureau checks. Prospective staff members are invited to complete an application form and attend an interview. A member of staff confirmed this to be the case. All staff members are aware of their roles and have job descriptions accordingly. Individual records were not examined on this occasion. Staff training had been undertaken in all areas and evidence showed that all staff members were offered training relevant to their work. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 16 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) 37.38.40.41.42. The home is managed in a safe, competent and accountable manner. EVIDENCE: Each month the responsible person undertakes an audit of the home. A monthly health and safety audit is also undertaken. The manager is currently completing the Registered Manager’s Award. Staff members confirmed that they felt well supported by their senior managers. Discussion with staff members demonstrated that they were aware of the importance of promoting and protecting the health, safety and welfare of the residents. Regular training, and comprehensive policies and procedures further reinforce this. Hillcrest-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 17 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 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score 3 3 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hillcrest-Beach Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 3 x H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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-Beach Road H60-H11 S29869 Hillcrest-Beach Road V232806 290705 Stage4.doc Version 1.30 Page 19 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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