Inspection on 13/02/06 for Hillcrest Care Home

This inspection was carried out on 13th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Care Home 09/11/05

Hillcrest Care Home 17/06/05

Hillcrest Care Home 31/01/05

Hillcrest Care Home 06/05/04

Hillcrest Care Home 23/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Hillcrest Care Home Kenilworth Drive Kirk Hallam Ilkeston Derbyshire DE7 4FJ Lead Inspector Denise Bate Key Unannounced Inspection 13th February 2007 09:30 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 Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address Kenilworth Drive Kirk Hallam Ilkeston Derbyshire DE7 4FJ 01629 580000 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) www.derbyshire.gov.uk Derbyshire County Council Susan Linda Hollingworth Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: This is a Local Authority Care Home providing personal care only for 29 older people of either gender. The Home has 20 single rooms on two floors, and two double bedrooms. There is a shaft lift providing access to the upper floor. The Home is situated in the middle of a housing estate in Kirk Hallam. The local shops, pub and post office are within walking distances. The Home has gardens mainly to the rear of the building which include two central courtyards with seating areas. Fees are up to £364 per week for permanent service users, but a range of prices for short term care service users. Extra charges are made for hairdressing, chiropody, magazines, newspapers and contributions towards outings. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over six hours. During the inspection six residents, four relatives, and four staff members were spoken with. The registered manager was not on duty but the service manager and deputy manager were present during the inspection and provided assistance and information. Written information was provided by the manager in the form of a pre inspection questionnaire. Ten resident were surveys completed prior to the inspection and these provided feedback on the service. Some residents had been assisted by relatives in completing the surveys and both their comments are reflected in this report. A number of records were examined, including care planning documentation, minutes of meetings, staff files and medication records. Five residents were case tracked. A tour of the building took place. What the service does well: There is a stable staff group and management team who know the residents well and are aware of their needs and wishes. Staff spoken to were knowledgeable, enthusiastic and committed and said they worked well as a team. Residents care planning documentation is detailed, clear, up to date and regularly reviewed. Personal support plans are well presented and individualised to provide staff with information and guidance. Independence is promoted wherever possible and residents are treated with respect. Activities and events are organised. The home is clean, well decorated and generally well maintained, having benefited from a refurbishment. There is a choice of attractive and homely communal areas and a well presented dining area. Residents have personalised their bedrooms and arranged them to suit their needs. Residents spoken with expressed a high degree of satisfaction with the accommodation and with the levels of care provided: ‘I like the home’, ‘carers are kind’, ‘the food is excellent’. Several responses to the resident survey were very detailed and included the following comments: ‘a very caring, friendly home – the staff are very helpful, nothing is too much trouble for them’, ‘excellent management and staff with good support from social services’. Staff were observed treating residents with kindness and sensitivity. There is a well established ‘key worker’ system. There are residents meetings where residents can ask questions and air their views. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 6 The home are good at involving relatives in a variety of ways, including invitations to take part in events at the home, and supporting them through difficult circumstances. This has enabled trust to build up between staff and relatives which was clear on the day of inspection and in resident surveys where relatives had added their comments: ‘I leave my relative in very capable hands and have no worries about anything’. Relatives spoken to were grateful for the peace of mind this gave them. Residents said the food was ‘very good’ and that they enjoyed their meals. The home follow Derbyshire County Council’s safe guarding adults and recruitment and selection procedures, and there is a corporate complaints procedure. There is a system of quality assurance that is being developed internally, copies of survey forms are available in the foyer, as well as the corporate system ‘Your Views Our Actions’. What has improved since the last inspection? What they could do better: No requirements were made at this inspection. A number of good practice recommendations were made including formally internally recording visit assessments for prospective residents, some minor amendments to care planning documentation recording. It was noted that at the current time a very high proportion of residents have short term memory loss and/or dementia. It is recommended that prospective new residents are monitored to ensure that they fit the home’s registration category. Please contact the provider for advice of actions taken in response to this Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000035712.V327876.R01.S.doc Version 5.2 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 Care Home DS0000035712.V327876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to ensure residents can make an informed choice about where they live. EVIDENCE: A copy of the Statement of Purpose, Service User Guide, and other information is made available to current and potential residents. Copies are kept in each resident’s bedroom. A copy of the most recent inspection report is kept on the notice board in the foyer together with other relevant information. In practice quite a few residents become long term after attending the home for short term care or day care, so some prospective residents are sometimes already familiar with the service provided. Others decide to become residents through Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 10 the home’s local reputation or personal recommendation. A resident commented: ‘Myself and all the family were given plenty of information. Everyone is very friendly’. The manager visits prospective residents at home or in hospital as part of the assessment process. Prospective residents or their advocates are encouraged to visit prior to making a decision. At present assessment information on prospective residents who make a day visit is recorded in the communication book and fed back to care managers and relatives. The home has a high occupancy rate and sometimes has a waiting list. It was noted that there has been a stable group of residents since the last inspection with only three recently admitted residents. One had been admitted as an emergency, and the other two residents had a variety of needs which included physical needs and short term memory loss. Copies of assessments carried out by social services staff were seen on care planning documentation of case tracked residents. The home does not provide formal intermediate care and therefore standard 6 does not apply. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are completed in detail and are individualised to demonstrate that residents’ health, personal and social care needs are being fully met. EVIDENCE: The five case tracked residents had clearly arranged care planning documentation covering all aspects of care. Items in files included the photo of the resident, copies of reviews, personal service plans, risk assessments (moving and handling, falls prevention, nutrition), weight monitoring, health care professional visits, reviews and detailed day to day logs. A second ‘buff’ file contains financial information and background details and copies of assessments and care plans that have been superseded. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 12 Personal service plans were clearly written and resident focussed. All aspects of care were covered, including social needs, and indicated what personal routines were preferred. They were individualised, e.g. information about one resident’s preferred lighting arrangements in her bedroom. Personal service plans had been signed by residents, indicating that they had been discussed and agreed with them and/or their advocates. The personal service plans are used as a working tool, well presented, written in clear language, and could be used in an emergency by people who are not familiar with their contents. It was noted that at present the home have a high proportion of residents with short term memory loss or dementia. This is mainly due to the changing needs of current residents. The home have responded by supplying staff training, individualising residents personal service plans, using staff ‘uniforms’ so staff are easily recognisable, seeking advice where appropriate on individual residents and making changes to the environment. At present these needs are included under a general ‘health’ section in the personal care plan. For some residents it might be appropriate to use the ‘health’ section for physical health and have a separate section for psychological/emotional/mental health needs. Copies of reviews seen indicated that residents needs were monitored and staff kept up to date of any changes. Staff were observed supporting and reassuring residents. Several individual residents were discussed with the deputy manager and staff, who showed a good knowledge of individual needs, including where residents had very poor verbal skills. The home have an efficient system of communication between staff shifts, which contributes towards consistency of care. All aspects of residents health needs and medication were clearly presented and records were up to date. Information provided in the pre inspection questionnaire indicated a good relationship with social services and health professionals. Several GPs provide a service and District Nurses are ‘excellent’. Community Psychiatric Nurses provide support and advice when necessary and one was involved with a case tracked resident. Her input formed part of the residents care planning documentation and was reviewed regularly. Residents and relatives commented that they were satisfied with access to health care: I can always see the doctor if I’m not well’, ‘medical support is always readily available’. Residents and relatives spoke extremely highly of the excellent quality of care provided; ‘I have every confidence in the staff’, ‘the staff are wonderful’, ‘nothing is too much trouble’, ‘my expectations have been exceeded’. A relative commented that any concern expressed to staff was always listened to and residents were treated with great respect: ‘I can only praise the dedication given to residents, no one could ask for more’. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 13 The home uses the monitored dosage system, and there is a photo of each resident kept with the MARs sheets as well as on care planning documentation. The medication records of some case tracked residents were seen and found to have been recorded correctly.The home have access to medication reference books to provide information about particular drugs and their uses and side effects. On the day of inspection there were no residents who administered their own medication. There is a formal policy on death and dying, and the home and staff are committed to providing support to families and residents during difficult times. Two very detailed care plans were shown to the inspector which gave details of every aspect of patient and relative care, including pain management and medication, care needs, religious and spiritual needs, and clear communication plans. These were reviewed regularly. The homes commitment to supporting relatives and residents was very impressive. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A varied programme of activities, outings and entertainment are provided that suit the expressed preferences of residents, and the needs and views of relatives are also considered. This assists in contributing to a pleasant atmosphere and the overall high level of satisfaction for residents. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Regular activities include craft, quizzes, monthly outings, in house entertainment, bingo, shopping trips, chair based exercises, theme and food tasting evenings, snooker, darts and bowling, reading group, knitting group and religious services. Residents enjoy seasonal celebrations, birthdays, and outings. Some residents go out luncheon clubs, local churches or support Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 15 centres. One resident told the inspector he really enjoyed going out to a club where they did various handicrafts. There is a garden project to provide another amenity for residents. Family and friends are also invited to special evenings and events. Residents and relatives both spoke about the regular ‘candle lit’ dinners which are also themed evenings. Residents confirmed that they are welcomed and encouraged to get involved, at the last quarterly event there were 40 relatives who came. The home are to be commended for working so hard to involve relatives which also benefits residents and extends their social life. Along the corridors there were photographs taken of various outings and community activities. Most residents are local, and reflect the culture of the local community. Residents meetings are held regularly and there is an Erewash Forum of local authority homes in the area which has an independent ‘chair’ to which each care home sends two resident representatives. The minutes are circulated in the home and sent to senior members of staff in Derbyshire County Council. They had been seen by the inspector. Issues raised included some issues of consistency between homes, e.g. standard of meals, as well as specific issues such as staffing and the availability of arrangements for ‘social drinking’. There were also matters on which further information was being sought. The Forum appears to be an innovative and interesting way of empowering residents to voice their views. The Erewash homes also have also started publishing a joint newsletter for residents, relatives and friends and copies were available in the foyer. Relatives indicated they were confident that the home would communicate any changes in their relative’s circumstances. Residents and relatives spoken to were extremely complimentary about the standard of catering, and the choice of menus available. One relative commented ‘I have noticed that the food served is of the highest standard ….I think this shows in how well my father is’. ‘They get all the vitamins they need from the meals including fresh fruit every day’. Copies of menus were provided and indicated a good variety or food with a choice of dishes being offered to residents. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and accessible complaints and safeguarding adults procedures are in place to ensure residents can be confident that any issues raised would be acted on effectively and promptly. EVIDENCE: There is a corporate complaints procedure, although most relatives and residents prefer to raise issues on a more informal basis. Residents and relatives said if they were worried about anything they would talk to one of the managers or the staff. Comments from relatives and residents included: ‘the situation has never arisen but the procedure is clearly available and visible if complaining became necessary’, ‘up to now we haven’t needed to complain’, ‘the manager or another member of staff are always available’. Derbyshire County Council has clear procedures for dealing with the safety of residents and safeguarding them from harm. Staff spoken to showed an awareness of safeguarding adults issues and would pass any concerns on to their line manager. Training in safeguarding adults has been provided for staff, and refresher training is planned for the coming year. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is purpose built and provides residents with an attractive and comfortable place to live. EVIDENCE: During this inspection communal areas of the home were seen. There is a choice of lounge areas, a ‘games’ area, hairdressing salon and smoking room. There is an attractive and safe garden area. There is a regular programme of routine maintenance and refurbishment has taken place. A relative commented that ‘the improvements to the building have made a huge difference’. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 18 Three bathrooms were seen. They are of a reasonable size and well maintained, and one bathroom has recently been fitted with a sovereign bath. The toilets have been refurbished and all have new doors and handrails. The home is well furnished and provides comfort and choice. Several areas of the home have been redecorated. New windows have been put in throughout the building. New handrails have been put in around the building and inner courtyards. New doors and an electronic keypad have been fitted to the front of the building. There is a new call system. New wash hand basins have been fitted in bedrooms. Individual bedrooms are personalised and many residents have their own furniture, televisions, music centres etc. Discussions with residents indicated that they were satisfied with the standard of accommodation. The home was tidy on the day of inspection, and there was a high degree of satisfaction with cleanliness expressed through the questionnaires and on the day of inspection: ‘the home is kept beautifully clean and fresh’, ‘it is always very clean in all the rooms’. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which meet the dependency needs of residents currently accommodated within the home. EVIDENCE: Information on staffing was provided which indicates that there are sufficient staff on duty to meet residents current needs. The manager has access to a ‘flexi-pot’ to finance extra staffing when necessary. Staff spoken to were committed, enthusiastic, knowledgeable, and enjoyed their work. They felt they provided a good quality of care and several examples were given of very specialised approaches to individual need. ‘We always try to involve the families’; as well as the communal events previously described the home have facilitated visits between residents and their disabled family members. Staff took part in both mandatory training and training on specific subjects to enhance their knowledge. Thorough induction had taken place for new staff. All Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 20 staff have achieved NVQ level 2 and have had training in the following areas; stoke awareness, first aid, and continence issues. Further dementia and safeguarding adults training is planned for this year. In addition some staff have received training in chair based exercised, and one member of staff is doing NVQ level 4 in care. Three staff files were seen and all had relevant information including CRB checks, copies of application forms and references (apart from one). The references for a new member of staff are held centrally and will be forwarded to the home. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced. Staff demonstrate an awareness of their roles and responsibilities, thus ensuring the home is run in the best interests of residents. EVIDENCE: The manager is experienced and suitably qualified to run the home. She delegates responsibility for particular aspects of home management to each of the three deputy managers e.g. care planning reviews, environment, and quality. All managers have responsibility for supervising staff. Staff said they received good supervision and support. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 22 The manager has drawn up a five year business plan with clear aims and objectives: ‘person centred delivery of care’, ‘residents listened to and involved in the decisions that effect them’. There are ‘SMART’ goals identified which are achievable within specified timescales. The service manager who is the representative of the registered person was visiting the home on the day of inspection and stayed to assist and provide information. There is good communication throughout the home and between shifts, ensuring that resident care remains appropriate, consistent and resident focussed. There are a variety of quality assurance approaches taken, e.g. questionnaires, residents meetings, Erewash Forum, that are referred to earlier in this report. The independent quality assurance exercise found that all residents and relatives rated the service as ‘good’ or ‘excellent’. Comments included ‘staff are trustworthy and respectful’, ‘the home is welcoming’. The inspector was informed that at present residents’ personal finance records are kept through Derbyshire County Council’s manual scheme which appears to work satisfactorily. An internal financial audit had picked up one issue relating to the amenities fund which was now being addressed. Information on maintenance and health and safety records was provided by the manager in the pre-inspection questionnaire and indicates that matters relating to health and safety are satisfactory. Hillcrest Care Home DS0000035712.V327876.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 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 3 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 2 3 4 Refer to Standard OP3 OP3 OP7 OP29 Good Practice Recommendations A formal record should be kept on care planning documentation of day visit assessments. Any prospective new admissions should be monitored to ensure that they are within the current registration category of the home. The personal service plan should distinguish between physical health needs and psychological/emotional/mental health needs. Copies of references should be kept on individual staff files at the home. Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillcrest Care Home DS0000035712.V327876.R01.S.doc Version 5.2 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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