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Inspection on 02/08/05 for Hillcrest Care Home

Also see our care home review for Hillcrest Care Home for more information

This inspection was carried out on 2nd August 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The information available about the home has been re written to ensure that all current and perspective service users have accurate information about what to expect at the home. The Homes Statement of Purpose, which gives the detail of how and to whom the service is to operate, has also been improved. Staff turnover at the home is low which gives service users and staff the opportunity to get to know each other.

What the care home could do better:

Although the care planning records at the home have developed since the last inspection these need to improve further to describe the actions staff take to support the needs of service users and include detailed plans of action where restraint is used to protect service users from injury or harm. Medication records need to be reviewed to ensure that they remain accurate and appropriate storage of creams must take place. Daytime opportunities especially for those with dementia type illness need to be improved and more appropriate types of food must be available for people with these needs. The general maintenance of the building needs to be planned in advance especially heavily used areas. Although the manager periodically works alongside staff so that she can support and develop their care practice, structured one to one supervision must take place more frequently. Records of staff fire protection training and service user payments need to be kept at the home.

CARE HOMES FOR OLDER PEOPLE Hillcrest Care Home Wear Street Jarrow Tyne and Wear NE32 3JN Lead Inspector Steve Tuck Unannounced 2 August and 16 September 2005 nd 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 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 B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address Wear Street Jarrow Tyne and Wear NE32 3JN 0191 489 0200 0191 428 6343 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) Hillcrest Care Homes Limited Pauline Hughes Care home only 49 Category(ies) of OP Old age (23) registration, with number DE(E) Dementia - over 65 (26) of places Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22/3/05 Brief Description of the Service: Hillcrest Care Home is a purpose built three-storey building located within the busy town centre of Jarrow. The building compromises of 49 single occupancy bedrooms all of which have an en-suite facility. Access throughout the building is provided by a passenger lift or two staircases which are located at either end of the building. There are a number of communal areas, such as lounges, dining rooms and a reminiscence area. A fireplace with surround and easy chairs, located in the spacious corridors of both the first and second floor, provide a popular place where service users can choose to spend their time. A call system, which is accessible to the service users, is provided in all parts of the home. There is a garden to the rear of the home and parking facilities are available for the convenience of visitors. The laundry and staff facilities are located on the second floor of the home. The home is registered to provide care to 26 people who have varying degrees of dementia and 23 people who are elderly. The home is not registered to provide nursing care. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days and was a scheduled unannounced inspection. The inspection process involved the inspector spending time talking to a number of the people who live in the home, visitors and relatives as well as the manager and staff. A sample of records were examined including care plans and rotas. A tour of the building took place, which included all communal areas and a selection of service users bedrooms. The inspector was invited to join service users upstairs at lunch and observations were made of the support the staff offered to service users at this time and throughout the day. A number of service users or their relatives completed questionnaires prior to the inspection. And their expressed views have been used to compile this report. The judgements made are based on the evidence available on the day of the inspection. What the service does well: The people who live here had many positive comments to make about the service they receive. Families and visitors described staff, as “top class “and one said,” they look after my mum like I would – you cant ask for better than that”. There is clearly a good rapport between service users, staff and visitors. The home has bright, cheerful accommodation. All bedrooms are spacious single rooms with en-suite facilities. The home is warm, comfortable and has a number of different lounges for people to use. Staff recruitment procedures are thoroughly enforced ensuring that all successful applicants have appropriate checks carried out to ensure that they are suitable for the role they are to undertake, prior to the commencement of their duties. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 6 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 Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 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 standard(s) 1 3 and 6 A range of information is available which enables service users to make a fully informed choice about where they would like to live. Each service user’s needs are assessed prior to their move to the home. This will help ensure that each service user’s needs are met at the home and inappropriate admissions are avoided. The home does not provide intermediate care. EVIDENCE: The service user guide is used by the manager to provide potential customers and their relatives with easily understandable information on the facilities available to them at the home. This includes information about how to make a complaint. All service users and their relatives who were spoken to said they had seen this booklet. A social work assessment, the homes own assessment process or both are used to determine the social and care needs of service users. Evidence from the care plans and discussion with the manager and staff confirmed that relevant advice and guidance is sought from other healthcare specialists if these are required Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7 8 9 and 10 Service users’ care plans are in place, but do not fully reflect their observed needs. This can limit the guidance available regarding care practice and consistency. The physical and emotional needs of service users are supported by the home to ensure that they remain as active as possible. The homes procedures for storing and administering medication are not sufficiently robust to safeguard service users. Staff have a friendly and respectful approach towards service users, which empowers them and gives them control over their lives. EVIDENCE: Although a general improvement has taken place since the last inspection, a random sample of service users’ records were examined which indicated that service user plans do not yet adequately describe the actual support and intervention which staff are currently carrying out. Service user plans do not yet consistently detail how service user needs, which have been identified by the assessment are to be supported by staff. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 10 Also where service users present behaviour which challenges staff or other service users, this is not currently sufficiently detailed in care plans so that staff good practice can consistently take place. It is not yet consistently recorded in care planning documents where service users rights and freedoms are restricted by the home for example where they would be exposed to unacceptable levels of risk. The manager described how she monitors the healthcare needs of service users and ensures that involvement of healthcare professionals e.g. district nursing staff and general practitioners takes place, should these services be required. These are consistently recorded in care files. Staff were observed to treat service users who took part in discussions with respect and service users described staff as “good lasses” and “helpful” and one stated, “I wouldn’t know what to do without them”. Staff were observed to have a good interaction with service users and their visitors. One visitor said “I know that they will help my mum just as I would and that helps me”. Several service users commented that staff have time to sit and talk to them. When asked, staff talked about service users’ needs in a sensitive and respectful way. Despite work undertaken by the manager, medication procedures at the home could not be successfully used to carry out a sample audit of the medication held there. There were a number of omissions in the administration record which meant that in some cases, it was impossible to establish how much medication was stored. Prescribed creams were found in bathrooms. This is not suitable storage for medication and compromises infection control as the creams could be mistakenly used by another service user. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 13 and 15 Service users are offered a varied menu with wholesome food, which promotes their health and well being. However, for some people need food which is easier for them to eat which will promote their independence and dignity. Arrangements to provide activities and occupation are underdeveloped for some service users within the home. The development of a planned, structured and well delivered activities programme can contribute to a more interesting and stimulating lifestyle for service users. EVIDENCE: All service users spoken to commented that they liked the food provided. They said that they were given a choice of main meal, and that there was always sufficient. Examination of the kitchen stock and menus available indicated that whilst a variety of fresh produce was available, there was a fair amount of pre packaged and prepared meals in stock. Some service users were no longer able to use cutlery to eat their meals. Unfortunately some of the meals consumed were difficult to eat in this way making it hard for service users to consume their meal. There were a number of activities available at the home during the day and the manager has recently appointed an activities co-ordinator. However lifestyle opportunities are not yet sufficiently structured to ensure that all service users lead fulfilled and stimulating lives especially for those who have dementia care needs. Staff demonstrate that they have an understanding of the needs of Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 12 people who have dementia type illness but have not yet developed strategies which will ensure that appropriate lifestyle opportunities are available. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 and 18 Complaints in the home are handled objectively and openly and the manager and staff encourage service users, their friends and families to offer comment on the services that are offered so that further improvements can be made. The home has adult protection procedures, which ensure that if abuse is suspected or witnessed then appropriate action is taken to safeguard service users. EVIDENCE: Service users and their relatives commented that they are confident that any complaints made would be acted upon. The manager and owner continue to encourage service users and their relatives to express their views and opinions about the service and can demonstrate instances where actions have been taken in response to service user preferences. All service users have a copy of the home’s complaints procedure, which is available in each room. Discussions with service users indicate that they have no complaints at present but would approach the manager if this occurred and feel confident that she would act on this immediately. Although there have been no instances or recent allegations of abuse at the home, specific procedures, which link to the statutory responsibility of the local authority, are in place and staff spoken to were knowledgeable of these. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 20 21 24 and 26 The home is clean, warm and well maintained offering service users a homely environment in which to live. Service users bedrooms are furnished to a good standard. This contributes to their comfort during their stay at the home. However, there were a number of maintenance issues, which need to be addressed, which could compromise the health and safety of service users. EVIDENCE: All communal areas and some service users bedrooms were viewed during the inspection. Some of the communal areas have been redecorated and refurbished since the last inspection but there is no programme of routine maintenance and replacement to organise and ensure that the home remains in good condition. Service users spoken to say that they liked their rooms, some of which have been individually decorated to reflect their lifestyles, tastes and interests. Some of the first floor communal areas had been redecorated since the previous inspection but these now needed further decoration due to the high levels of wear and tear in these areas. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 15 Water temperatures in one bathroom were too high could place service users at risk of scalding, However this was immediately remedied and was working properly by the second day of inspection. The garden areas around the home appeared to be untidy and in poor condition with a partially demolished wall and wood storage making access by service users difficult. There were a number of maintenance issues noticed around the home, which were brought to the attention of the manager. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 and 30 The deployment and number of staff on all shifts ensures that at all times service users are supported by an experienced group of staff. EVIDENCE: There are sufficient staff available to meet the needs of service users at the home. Staff were noted to spend quality time with service users, listening to their opinions and experiences and taking part in discussions and demonstrating good humour. Staff turnover at the home is low which gives service users and staff the opportunity to get to know each other. The homes recruitment process ensures that all staff have appropriate checks carried out prior to them taking up employment to ensure that they are suitable to work with vulnerable people. An increasing number of the staff team have now attained NVQ awards in care at level 2 and some are undertaking level 3. They are able to describe the needs of service users, and information from the manager indicates that they have received training relevant to their job roles and the specific needs of service users. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 36 37 and 38 The manager offers clear leadership and direction to the staff so that they can consistently meet the needs of service users. Staff have support from the manager to ensure that they carry out their role effectively but they do not receive sufficient formal supervision to ensure that their care practice meets the needs of service users. Arrangements to ensure that the health safety and welfare of service users and staff are in place and are usually successful. Service users financial interests are safeguarded but appropriate records are not kept at the home which makes it difficult for service users and their families should they have a query. EVIDENCE: Since the inspection, the manager has successfully undergone an assessment by the Commission to ensure that she is fit to be the registered manager of the home. The manager has experience of leadership in care services and is Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 18 currently undertaking NVQ level 4 in care having already achieved NVQ level 4 in management. Although there is evidence that day-to-day supervision and discussion occurs between the manager, senior and care staff, formal one to one supervision does not yet take place six times per year. There are clear lines of accountability within the home. The ethos of the home ensures that where possible service users and staff are consulted about issues affecting the home. Service users are enabled and supported to assert themselves and their opinions are valued by the manager and owner. A number of types of meetings are organised including consultation with families and friends. However the manager and proprietor have yet to develop a full quality assurance process for the home. There is not currently a record kept at the home of each individuals account payment details therefore, there is no evidence that these payments are being appropriately managed. The manager was advised that these records must be available for inspection and to assist service users and their families to resolve any payment queries. The home is also regulated by the local authority for safe working and hygiene practices and the Fire Protection Authority to ensure that adequate arrangements have been put in place to protect service users and staff. The local authority have also recently assessed this service to ensure that standards defined in their contract with the home have been met. A number of maintenance issues were noted and brought to the attention of the manager. Instruction which ensures that staff know of the measures they must take in the event of a fire has not been carried out sufficiently and accurate records were not available in the home. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 2 x 2 2 2 2 Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 20 Yes 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 7 Regulation 15 Requirement Care plans must continue to develop so that they are sufficiently detailed to guide staff practice in meeting service users needs and record the work they currently undertake. Information must be compiled where individual service users rights are limited. This must become an integral part of the service user plan. (Previous timescale1/7/05) If service users are restrained for example so that they care prevented from injuring themselves or others, this must be recorded in detail which includes specific instruction about when and how these actions are to be carried out. The manager must ensure that records accurately reflect the levels of medication held and administered at the home. Prescribed creams must be kept in the residents own bedrooms or in a designated medication cupboard. All service users must have a range of suitable lifestyle opportunities in which they can B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Timescale for action 15/12/05 2. 7 17 11/12/05 3. 7 13 1/11/05 4. 9 13 01/11/05 5. 9 13 01/11/05 6. 12 16 01/12/05 Hillcrest Care Home Version 1.40 Page 21 be supported should they wish. 7. 15 16 The meal choices of service users must include menus which they find easier to eat. For example foods which can be eaten without cutlery. The manager must submit to the Commission a maintenance plan, which demonstrates when, and how decoration will take place to the building. (Previous timescale 1/6/05) The manager must ensure that garden areas around the home are maintained and are accessible to service users. At least 50 of care staff must have an NVQ at level 2. The manager must have an NVQ4 in Management and in Care. The homes quality assurance process must continue to be reviewed and implemented. A record of payments from each service user must be kept and made available at the home for inspection. (Previous timescale 1/6/05). All care staff must receive formal supervision, at least six times per year. All staff must receive sufficient fire protection training with records kept. 11/11/05 8. 19 23 11/12/05 9. 20 23 11/12/05 10. 11. 12. 13. 28 31 33 35 37 18 9 24 17 31/12/05 31/12/05 15/12/05 11/11/05 14. 15. 36 37 38 18 17 23 11/12/05 15/11/05 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 15 Good Practice Recommendations The manager should promote the use of fresh ingredients as the ideal means to meets the dietary needs of service B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 22 Hillcrest Care Home users. Hillcrest Care Home B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT 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 B52 B02 S234 Hillcrest V219282 2 Aug 2005 Stage 4.doc Version 1.40 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!