Inspection on 17/08/06 for Hillcrest Care Home

This inspection was carried out on 17th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Care Home 28/01/09

Hillcrest Care Home 05/02/08

Hillcrest Care Home 04/07/07

Hillcrest Care Home 09/01/07

Hillcrest Care Home 07/11/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Hillcrest Care Home 106 Thorpe Road Thorpe Norwich Norfolk NR1 1RT Lead Inspector Mr Jerry Crehan Key Unannounced 17th August 2006 10:30 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 DS0000065216.V309044.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 DS0000065216.V309044.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address 106 Thorpe Road Thorpe Norwich Norfolk NR1 1RT 01603 626073 01603 765100 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.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Position Vacant Care Home 52 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (20) of places Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 Brief Description of the Service: Hillcrest is a care home providing care for up to 52 older people including service users with dementia. There are 37 single rooms en-suite, 3 single rooms without en-suite facilities and 6 double rooms with en-suite facilities. The home is situated within walking distance of the centre of the city of Norwich and its facilities. The detached property is set in its own grounds; the garden areas have flowerbeds and a terraced patio. There is parking space to the front of the premises. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 9.45 hours on 17th August 2006. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff and manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The manager provided comprehensive pre-inspection information to the Commission prior to the inspection. This included 19 comment cards from service users, relatives and visiting GP’s, which gave broadly favourable comments about the service provided by the home, though expressed some concern about staffing levels. Hillcrest is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is from £261 upwards. What the service does well: What has improved since the last inspection? Although there are still shortfalls in care planning clarity and the recording of life history information (for service users with dementia in particular), there is evidence of work in progress to improve this area of practice. The arrangements for dealing with medication at the home have improved and there are no medication requirements in this report. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 6 What they could do better: There are shortfalls in the following areas that must be addressed: • • • Training – there are shortfalls in the provision of training for care staff in adult protection, NVQ qualified staff, and of particular significance training for senior and care staff in dementia care. Care Plans - these fall short of setting out the action, which needs to be taken by care staff to ensure that all aspects of their health, personal and social care needs, are met. Environment – there are requirements repeated in this report to ensure that misted windows are replaced and lockable storage is provided to every service user. As indicated below some double glazed windows that have become completely misted are windows in single aspect service user bedrooms. A programme of formal supervision for all staff at the home must be established. • 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 Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 7 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 DS0000065216.V309044.R01.S.doc Version 5.2 Page 8 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): 2, 3 & 6 The overall quality outcome for these standards is adequate. There are shortfalls in issuing service users (or their representatives) with a statement of terms and conditions of residence. The assessment process for admission to the home is good. EVIDENCE: The home’s Statement of Purpose was available in the reception area of the home, alongside information about how to make a complaint and a copy of the most recent inspection report. Comment cards received prior to the inspection from relatives indicate that they are not aware of the availability of a copy of the most recent inspection report. See Recommendations Samples of service users contracts were seen. These included Social Services contracts (where appropriate) and ‘Residents Agreements’ that are the home’s statement of terms and conditions. Those seen meet the requirements of the standard. However, a contract for a single service user was not present. See Requirements A review of sample service user files provided evidence of good assessments and pre-admission assessment completed by the manager and care manager. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 10 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, 8, 9, 10 The overall quality outcome for these standards is adequate because some service users assessed needs should be better reflected in their individual plan. There is evidence of work in progress. EVIDENCE: A sample of service user care plans was reviewed. The records for a service user who has been identified as at risk from developing pressure areas has appropriate nutritional risk assessment. Daily records for this service user indicate 2 hourly turns and monitoring of nutritional intake. However, there is no care plan for staff to follow that indicates what the care for pressure area prevention and nutritional intake provision is. This and other care plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of service users care needs are met. See Requirements Care plans should also be more readily available for staff at work on the first floor of the dementia side of the home. At the time of the inspection these were only available on the ground floor, which does not support contemporaneous recording or easy access for care staff. See Recommendation. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 11 Although there is still evidence of limited service user involvement in their care planning and in life story work, there is evidence that this is being addressed. The new manager is undertaking to meet with relatives of each service user, relatives are being invited to contribute toward care planning and life history information held by the home, and the activities coordinators are currently engaged in work with service users. Service users indicated they have access to appropriate health professionals. Three comment cards received from GP’s indicate their overall satisfaction with the services provided by the home to service users. An example of excellent personal care to a very frail service user was seen that included the sensitive supporting of this service user’s own capacity for selfcare in drying her hands, before being assisted with her meal. This too was undertaken with care and sensitivity. An inspection of medication records and practice was undertaken. There are no service users at the home with responsibility for their own medication. There is evidence of generally good recording of the administration of medicines, and no evidence of the non-availability of medicines for service users that had been an issue previously. Service users spoken to indicated that they find care staff helpful. The majority of comment cards indicated that there are usually or sometimes staff available when they need them. Service users spoken to during the inspection indicated that their right to privacy is respected at the home, and that visitors are made welcome and can be seen in private. Screens are provided in shared rooms. There is telephone access, including access to a cordless phone on both sides of the home in order that service users may make or receive calls in private. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 12 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, 14, 15 The overall quality outcome for these standards is good. Social and recreational options available satisfy the needs of service users. Contact with friends and relatives are supported by the home. Meals at the home are good. EVIDENCE: Comments made by service users spoken to at the inspection reflected feedback from comment cards that there are a suitable range of activities on offer. There was evidence of recent artwork and painting undertaken by service users in the dementia side of the home. There was a game of bingo taking place in the residential side of the home that was attended by service users from both sides of the home. There are activities programmes for both dementia and residential sides of the home for seven days of the week, coordinated by two activities coordinators. The activities coordinator spoken to gave a good explanation of what activities were, how they were arrived at and how they were beneficial for service users. Community links include visits from the volunteer PAT dog visitor, attendance at the recent home fete by a local school band. Art work undertaken in the dementia unit reflected local places of interest to prompt discussion and reminiscence. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 13 Discussion with service users provided evidence that the home supports their contact with relatives and friends, enables service users to manage their own affairs if desired, and to bring and keep their own possessions with them. Service users made largely complementary comments about the quality of food at the home ‘Can’t grumble about the food, it’s very good’. The main meal option was sausage casserole; potatoes and vegetables, there were two alternatives on offer in pasties or baked potatoes. Meals seen looked well prepared and presented. Finger foods are available in the dementia side of the home to support service users diet. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 14 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): The overall quality outcome for these standards is adequate. There are arrangements in place to deal with complaints that service users are aware of. Service users are not fully protected by staff training and awareness of adult protection. EVIDENCE: Information from comment cards received prior to the inspection and feedback from service users during the inspection evidence that they know how to make a complaint. This was confirmed in discussion with service users who stated that if they had a concern or complaint that they would speak with the manager or with the administrator. The manager indicated there had been one complaint since the last inspection that was not substantiated. Staff spoken to demonstrate a basic awareness of adult protection, including ‘Whistle blowing’, however, there was evidence through discussion with staff and training records of little training for staff in adult protection, and in particular recognising types of abuse. Thus undermining staff’s awareness of whistle blowing. See Requirements The very low level of NVQ trained staff at the home compounds the situation. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 15 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, 24, 26 The overall quality outcome for these standards is poor, due to the lack of attention to windows and carpets that require replacement. However, a comfortable and safe standard of accommodation is provided for service users. EVIDENCE: The home is well maintained and presented externally. Accessible patio areas at the front benefit from colourful potted plants, sturdy seating and umbrellas that provide shade if required. Service users were using this area at the time of the inspection. Some improvements internally are required, including new carpeting on the first floor of the dementia unit corridor, lock installation to a ground floor bathroom and toilet, and replacement windows for those that have misted. Some double glazed windows that have become completely misted are windows in single aspect service user bedrooms. See Repeat Requirement. There is evidence of new carpeting in other areas around the home, and the installation of a new bath on the first floor. The manager confirmed that the temperature in the dining area on the ground floor of the dementia side of the home is difficult to regulate. They hope that Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 16 the installation of blinds will help. Windows that cannot be properly secured when open make the situation more difficult. See Recommendation There is improved signage at the home including photographs of the home’s staff and of service users and their ‘key worker’ on bedroom doors. Service users accommodation was reasonably furnished and evidently service users are able to bring their own possessions with them to furnish their bedrooms and create a homely atmosphere. Progress in ensuring service users have access to lockable storage within their bedrooms has been made. However, some bedrooms still do not. See Repeat Requirement The home was clean, pleasant and hygienic at the time of the inspection visit. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 17 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 overall quality outcome for these standards is adequate rather than good; due to lack of numbers of dementia and NVQ trained staff. There are adequate numbers of staff on duty to meet service user need. Staff recruitment practices protect service users. EVIDENCE: There were fifty-two service users accommodated at the home at the time of the inspection. There are usually eight care staff deployed each morning and six care staff each afternoon to provide care. The manager stated that this is the usual deployment. The manager indicated that she has agreement from the proprietor to increase staffing levels for both sides of the home in the afternoons. This is supported, as although service users spoken to indicated broad satisfaction with the care they receive, the majority of comment cards from service users received prior to the inspection indicated that they felt that staff were ‘usually’ or ‘sometimes’ available to them. Similarly, half of all comment cards received prior to the inspection visit from relatives and visitors to the home indicated a view that there are not enough staff on duty. There are a total of 26 care staff at the home. Three of these have training at NVQ level 2 or above. The manager indicated that 13 staff are part way through the completion of NVQ 2. If successful the home will achieve the minimum 50 requirement. The manager stated that a further 10 staff will be undertaking the training in September 2006. Staff files looked at demonstrated evidence of that service users are protected by the home’s recruitment practices. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 18 Staff training records seen provided evidence of appropriate induction and ongoing training (including mandatory training) for care staff with the exception of adult protection training (as indicated earlier in this report) and dementia awareness training. At the time of the inspection 7 care staff have had ‘dementia awareness’ training, 6 staff were due to undertake the training on 23rd and 24th August 2006, and there are a further 14 staff without this training, many of who will be required to work with service users with dementia. See Requirement. Care staff spoken and observed have a good understanding of service users needs. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 19 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, 35, 36, 38 The overall quality outcome for these standards is good despite the absence of a coordinated approach to providing staff supervision. The home is well managed by the new manager who service users and staff speak favourably of. EVIDENCE: The new manager has been in post for two months and is a Registered Nurse. She has extensive experience of working in a senior professional capacity within hospital settings. She also has experience as a trainer. She will need to undertake NVQ training at Level 4 in management (or equivalent). See Recommendation. Both service users and staff spoken favourably about the new manager and said that she is approachable. Further to issues described above with regard to deficits in training for staff in dementia care, the manager and proprietor should allocate a person in charge of dementia care at the home. They should have an enhanced level of Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 20 knowledge and training of dementia in order that they may properly train and supervise other staff. See Requirement Service users spoken to indicated that their views are sought on aspects of their care. The views of service users are also supported by the undertaking of questionnaires which are provided to both service users and their relatives. There is evidence of staff meetings being undertaken, of internal monthly audits, and external monthly audits undertaken by the proprietor, these include reports provided to the Commission and required by Regulation. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. However, the home has a safe where valuables may be held on behalf of service users. It was apparent from personnel records, and anecdotally from care staff that formal staff supervision is taking place only sporadically. Discussion with the manager confirmed that there is not yet a coordinated approach to providing supervision at the home. See Requirement The health, safety and welfare of service users are largely met, though issues concerning care records and staff training are the subjects of requirements in this report. Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 21 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(1)(b) Requirement The Registered Person must ensure that service users or their representatives are provided with terms and conditions in respect of accommodation to be provided. The registered person must ensure that individual care plans set out in detail the action which needs to be taken to ensure that all aspects of service user health and personal care are met. This Requirement Is Repeated The registered person must make arrangements by staff training to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must ensure that premises are kept in a good state of repair, including carpeting and particularly faulty window units. This Requirement Is Repeated The registered person must ensure that all service users are DS0000065216.V309044.R01.S.doc Timescale for action 17/08/06 2 OP7 13(4)(c) &15(1) 17/08/06 3 OP18 13(6) 31/10/06 4 OP19 23(2)(b) 30/09/06 5 OP24 16(2)(l) 30/09/06 Hillcrest Care Home Version 5.2 Page 23 6 OP30 18(1)(c)( 1) 18(1)(a) 7 OP31 8 OP36 18(2) provided with a place where money or valuables may be deposited. This Requirement Is Repeated The registered person must ensure that all staff receive training appropriate to the work they are to perform. The registered person must ensure that there are suitably qualified and competent and experienced persons responsible for dementia care delivery and supervision working at the care home. The registered person must ensure that care staff at the home are appropriately supervised. 31/10/06 31/12/06 17/08/06 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 OP1 OP7 OP19 OP31 Good Practice Recommendations It is recommended that copies of the most recent inspection report for the home are made more available to visitors to the home. It is recommended that care plans for service users accommodated on the first floor of the dementia care side of the home be stored on the same floor. It is recommended that a solution be found to maintain satisfactory ventilation and temperature in the conservatory dining area on the first floor. It is recommended that the manager undertake NVQ training at Level 4 in management (or equivalent). Hillcrest Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Care Home DS0000065216.V309044.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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