Inspection on 05/02/08 for Hillcrest Care Home

This inspection was carried out on 5th February 2008.

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

The inspector 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 04/07/07

Hillcrest Care Home 09/01/07

Hillcrest Care Home 17/08/06

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 & Mr Mark Andrews Unannounced Inspection 5th February 2008 09:00 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.V359065.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.V359065.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 hillcrest@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) 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.V359065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last key inspection 4th July 2007 Brief Description of the Service: Hillcrest is a care home providing care for up to 52 older people including service users with dementia. The accommodation is located on both ground and first floors. There are 37 single rooms en-suite, 3 single rooms without ensuite 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 is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is £289 - £500. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Before the inspection the manager of the service completed a lengthy questionnaire about the service. Twenty-one comment cards were received from people who live at the service. Eight comment cards were received from relatives of people who use the service; four comment cards were received from staff that work at the service. These generally reflected positive views about the home, its management and care. There were positive comments about the service made by people spoken with at the time of the inspection visit including visiting professionals. Records held by the Commission and previous inspection reports were checked. This key inspection compromised an unannounced visit to the home that took place over 7.5 hours on 5th February 2008. Opportunity was taken to tour the premises, look at care records and policies, and communicate with residents, care staff, visitors and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Pharmacist inspector Mr M Andrews inspected the medication standard. This was against a background of poor previous medicine management practices identified at the home during 2007 when a series of pharmacy inspections were undertaken. What the service does well: • • • People who use service receive good health and personal care that is based on their individual needs and set out in their individual care plan. Staff seen were observed to be hard working and attentive in meeting the needs of people who use the service. Social and recreational activities are on offer at the home and sufficiently varied meet individual’s needs and expectations. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 6 • • • People who use the service have access to a good diet and meals that are well prepared. Arrangements for responding to the concerns and complaints of people who use the service are good. The Manager has been confirmed in post, is very experienced and has an open and inclusive style of management. What has improved since the last inspection? • Care plans contained additional information about the resident’s background in the form of a ‘life story book’ that can usefully assist the care staff to build a relationship with residents as individuals. Improved medication practices better safeguard the health and welfare of people who use the service as sample audits were satisfactory and all medicines were accounted for. There were no sedative medicines prescribed for administration to residents at the discretion of care staff. In addition, there was noted overall to be fewer of these medicines prescribed for regular use. Some hallways and communal areas have recently been redecorated; the manager stated that resident’s bedrooms would then be redecorated. This is welcomed as parts of the home are in need of improvement. There have been improvements to the induction training and support available to new and existing staff. There is increased staffing at the home. This is an improvement since the last inspection of the home and it was evident that care staff were managing to provide the care that residents needed. • • • • Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 7 What they could do better: • • There are still medication storage and recording matters that require attention in order to ensure the health and welfare of people who use the service. The environment at the home is safe, and reasonably well maintained though some areas should provide more comfort and convenience for people who use the service. The management of laundry at the home requires the ongoing attention of the manager. To ensure that the mental health needs of people using the service are met there should be staff who are qualified to a more advanced level in providing dementia care. There is an absence of a planned system of quality audit where the views about the service have been sought and evaluated, and the results of these surveys provided to the Commission. • • • 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. The summary of this inspection report can be made available in other formats on request. Hillcrest Care Home DS0000065216.V359065.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 DS0000065216.V359065.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): Standards 1, 2 & 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people to use the service have their needs assessed, contracts issued, and access to all of the information they need about the service they may choose. EVIDENCE: The home has ‘Statement of Purpose’ and ‘Service Users Guide’ documents available in the reception foyer to reflect the services provided at the home. These documents contain sufficient information for anyone to make an informed choice about long-term care. The Service User Guide contains a summary of the home’s complaints procedure and is available on audio cassette for those with visual impairment. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 10 Terms and conditions of residence are issued to residents at the point of moving to the home. Those seen contained information about services to be provided and fees payable. The home has a well-designed assessment pro-forma (pre-admission assessment) used by the manager or deputy manager when collecting information to ascertain the level of support required by prospective residents. There is evidence of assessment for prospective residents seen in their files, and the manager stated that he or the deputy manager always seek to visit prospective residents in their accommodation prior to admission. Hillcrest Care Home DS0000065216.V359065.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): Standards 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services receive good health and personal care that is based on their individual needs. Improved medication practices better safeguard the health and welfare of people who use the service. EVIDENCE: Each resident has an individual care plan and a sample of these were reviewed. Care plans include admission information, health, social and mental health care needs and risk assessments relevant to them, to enable them to be independent where possible. Each of the care plans seen had been subject to regular review. Each plan seen includes a risk assessment of individual care needs, such as moving and handling, falls risk, continence care and management, and nutritional needs with weight management included. Comments received from relatives and carers prior to the inspection visit were generally favourable Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 12 about the care provided to residents at the home: ‘the standard (of care) now seems as good or better than at any time my relative has been at the home’. Care plans contained additional information about the resident’s background in the form of a ‘life story book’ that can usefully assist the care staff to build a relationship with residents as individuals. There was good information in place such as, the person’s young adulthood, middle age, later years, favourite things and other information including their religious background. A health professional spoken to during the visit was positive about the home’s communication over the health care of residents, indicating that staff ask for advice when appropriate, and that staff at the home manage pressure area prevention and care well. The medication standard was inspected against a background of poor previous medicine management practices identified at the home during 2007 when a series of pharmacy inspections were undertaken. Mr Andrews inspected medicines and records currently available in the Dementia wing only. He found medicines secure at the time of arrival and the morning medicine round had been promptly completed. It was found that external creams and ointments in use were secured within resident’s rooms to avoid the risk of harm. Medicine refrigerator temperature records were found to be satisfactory, however, at the time of inspection the temperature was 0°C at time of inspection and below the accepted temperature range (See Requirement 1). Current medication records were examined to establish if medicines were being given to residents in line with recent prescribed instructions. Sample audits were satisfactory and all medicines were accounted for. This represents an improved outcome for residents. The home has an internal medication audit conducted most days to provide a close system of monitoring. The home had found no errors recently, however, two relatively minor errors were reported to the home December 2007 and January 2008. These were discussed during the inspection. The home has good levels of information available for staff when administering medicines for specific residents, however, to reduce risks of such errors arising it was recommended that clearer highlighting of medication charts is implemented. This is also to include medication records for residents prescribed complex schedules of anti-coagulant warfarin (See Recommendations). Members of staff involved in the errors have been temporarily taken off medication related duties until further training is provided. The next training event scheduled for staff was reported to be due 15/02/08. There are currently no sedative medicines prescribed for administration to residents at the discretion of care staff. In addition, there was noted overall to be fewer of these medicines prescribed for regular use. This also represents an improved outcome for residents. There was evidence of prescriber reviews of such medicines, however, for one resident with dementia, the dose of one such Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 13 medicine quetiapine was recently increased. There were no records indicating the prescriber intervention or daily records suggesting why the increase was justified. This was later discussed with the manager who explained why the dose of the medicine was increased (See Requirement 2 and Recommendations). The home also has files available to record reasons why PRN medicines have been given. The observed care approach of staff during the visit was good. Despite the demands on their time care staff were caring and attentive toward individual residents. Comments from residents and others seen on the day and in comment cards included ‘staff are always friendly and helpful’ and ‘care staff always have the right approach toward my aunt’. All of the residents spoken with stated that their right to privacy is respected at the home, and that their visitors are made welcome and can be seen in private (in their rooms) if they wish. Hillcrest Care Home DS0000065216.V359065.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): Standards 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to a good diet and meals that are well prepared. Social and recreational activities are on offer at the home and sufficiently varied meet individual’s needs and expectations. EVIDENCE: There is a full time activities coordinator in post who produces a weekly activities schedule that is posted around the home. On the day of the inspection visit the activities coordinator was observed undertaking a small group activity with residents in one of the communal lounges. Later in the day there was entertainment provided in the main lounge on the other side of the home. A pianist and musician entertained a large group of residents for several hours that evidently enjoyed the experience. There are weekly visits to the home from the ‘PAT’ dog service, a monthly visit from a musician or other entertainer, and the mobile library. A relative commented that ‘the entertainment they put on at the home is very good’, Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 15 another indicated that the home could improve further by providing ‘more daily activities for residents’. The manager stated that those residents who do not wish to, or are not able to participate in wider group activities are visited by the activities coordinator individually where they may spend time talking, playing cards doing jigsaws together. There is an improved activities room where residents can participate in artwork. This area has a vibrating chair that a resident was using for relaxation; two other residents were attempting a jigsaw puzzle. Photograph collages of recent events at the home, including the Christmas party and Halloween party were on display. It is recommended that the manager’s monthly newsletter includes information of forthcoming events at the home so that residents relatives have as much notice as possible of their taking place (See Recommendations). Residents confirmed that their relatives and other visitors could attend the home at any time. There were visitors to the home at the time of the inspection visit. Resident’s bedrooms seen on the day of the inspection visit are reasonably well furnished and equipped to suit people’s daily lifestyle and reflect their personal choices and preferences. Advocates are in place for some residents who require someone to represent their interests. There was a three-course lunch menu on the day of the inspection visit. This was a vegetable soup starter, followed by a main course of pork steak or Cornish pasty with potato, broccoli and swede. Sweet was rhubarb crumble and custard. The meal looked well prepared and well balanced and was served in a congenial setting. Dining tables were well presented with clean tablecloths and napkins. Residents were complimentary about their lunch and the quality of meals generally and a relative commented that ‘the food always looks very nice and there is plenty of it’. Some residents had evidently opted for alternative options at lunchtime, for example one resident indicated a preference for tomato soup rather than vegetable while others with special dietary requirements had their needs met also. Although care staff were extremely busy during the lunch period they managed to support residents that need support or assistance to eat. This took place both before and after they served the majority of meals to residents eating in the dining rooms. The cook leaves her kitchen at lunchtimes to take an interest in whether meals served are meeting with the approval of residents. The manager stated that the home has recently a ‘safer food award’ from Norwich City Council for fulfilling a number of food related requirements. The home scored four stars out of a possible five. A recommendation was made at the visit that the manager considers introducing tea and toast making facilities into selected communal areas subject to an assessment of its safety (See Recommendations). There are Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 16 many residents at the home who may be willing and able to play a part in the preparation of drinks and light foods for themselves. The manager stated that he would explore this possibility and liaise with residents. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 17 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): Standards 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for responding to the concerns and complaints of people who use the service are good. People who use the service are protected from abuse. EVIDENCE: The manager keeps a record of all complaints, though stated that no complaints had been received since the last inspection visit to the home. The home has a detailed complaints procedure and information on how to make complaints is detailed in the home’s guide for residents. The manager holds a ‘surgery’ for resident’s relatives every Wednesday. He says that this is for anyone to attend. Residents spoken with during the inspection visit stated that they would speak with the manager, administrator or carers if they had a concern or complaint. Each of the staff spoken with during the inspection visit were clear about the action they would take if concerned about the possibility of abuse taking place at the home and were confident that they could deal with this appropriately. They were equally aware of the home’s ‘Whistle-blowing’ procedure and its function. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 18 The manager has arranged for the majority staff to undertake ‘Protection of Vulnerable Adults’ (POVA) training with further training on offer over coming months. The training programme is detailed, including identification of what abuse is, different kinds of abuse, the role of the carer in dealing with reported or witnessed abuse, and defining a vulnerable adult. It is recommended that evidence of learning and validation be kept in individual staff training files (See Recommendations). Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home is safe, and reasonably well maintained though some areas should provide more comfort and convenience for people who use the service. EVIDENCE: A tour of the home’s environment was undertaken and there is evidence of ongoing redecoration. Some hallways and communal areas have recently been redecorated; the manager stated that resident’s bedrooms would then be redecorated. This is welcomed as parts of the home are in need of improvement. With the occasional exception, furniture was satisfactory and robust throughout the home. There remain two bedrooms with faulty window units restricting the available natural light and unpleasant in appearance. The manager stated that these Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 20 were due to be replaced. One of the home’s assisted baths was broken and awaiting a replacement hoist. Residents were using other facilities in other parts of the home in the interim. One of the toilets used by residents on the ground floor was unable to be used, as its floor was faulty and unsafe. Many pillows seen on resident’s beds have become clumped and would not provide comfort (See Requirement 3). Doors to residents private accommodation is lockable and there are lockable facilities within each bedroom for money and valuables. The home has a relatively small laundry for its size and the numbers of people it supports. However, the laundry was clean, tidy and safe. One of the homes two washing machines was out of use at the time of the inspection visit, though this had been reported to the engineer. The home has a single industrial dryer in almost constant use often causing a backlog of clothing/linen to be dried. It is recommended that another dryer be provided (See Recommendations). It is also recommended that the layout of the laundry be revised to ensure that clean and dirty clothes and linen can be kept well apart (See Recommendations). Some comments from staff and from relatives of residents received prior to the inspection visit expressed concerns about the management of clothing and laundry generally, one card indicating ‘always having problems with mothers clothes going missing’. These concerns were shared with the manager who stated that he was aware of difficulties had addressed some of them and was in the process of dealing with others. Hoists and other equipment were safely stored, and the home was clean and tidy. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29, 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are deployed in sufficient numbers to support the needs of people who use the service. For this outcome to be good, people who use the service should be supported by staff with sufficient specialist training and expertise. EVIDENCE: There were forty-seven residents accommodated at the time of the inspection visit. They were cared for by eight care staff including senior care staff. Other staff included the manager, deputy manager, administrator, maintenance engineer, chef and kitchen assistant and three laundry/domestic staff. There is a total care staff compliment of thirty-four. There are up to twenty service users accommodated on the residential care side of the home, (though at the time of the inspection visit the number was sixteen residents in this part of the home). In the morning and afternoon these residents are cared for by three care staff (including a senior carer) when at full, or nearing full occupancy. This is an improvement since the last inspection of the home and it was evident that care staff were managing to provide the care that residents needed. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 22 From information provided by the home eleven care staff currently hold a qualification at NVQ 2 or NVQ 3. A further six care staff have registered to undertaken NVQ 2. The successful completion of this training by these staff would see the home achieve the minimum 50 requirement of trained staff (See Recommendations). A review of sample staff files provided evidence that residents are protected by good recruitment practices. There have been improvements to the induction training and support available to staff. Care staff spoken with indicated that they had access to appropriate induction training when newly employed, and the opportunity to work in a supernumerary capacity observing experienced colleagues. The manager with the support of senior staff is responsible for mentoring new staff through their induction to the home, and the training programme is in line with ‘Skills for Care’ requirements. Existing staff who have been employed within the last six months will also receive this improved induction training and support. Since the last inspection visit to the home a number approaching half of the care staff complement have undertaken dementia awareness training. The home’s training records provide evidence that further staff will have access to this training over the coming months. It is anticipated that this will help to provide care staff with an insight into the specialist and individual needs of a person with dementia, and the training provided is welcomed. However, there is an absence of staff at the home who are trained to a higher level. This is a significant factor given the home’s substantive registration is to provide specialist care to people with dementia. The deputy manager has more advanced dementia training (she is a ‘Yesterday, Today, Tomorrow’ (YTT) trainer), which should be provided to those care staff whose substantive role is to provide care to people who use the service with dementia (See Requirement 4). There are improved numbers of staff who have completed infection control training since the last inspection visit, though the significant proportion of care staff have not had this training. This is being addressed within training provided from the month of the inspection visit onwards. There were no infection control concerns identified at the time of the visit. Care staff and other staff at the home have access to a full range of other mandatory, and some specialist training. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36, 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is competent and experienced to run the home. Management systems should be further developed to measure success in meeting the aims and objectives of the home, and to ensure consistency in safeguarding the health of people who use the service. EVIDENCE: The Manager has been in post since January 2007 and was previously the Manager of the service. He has extensive experience of managing in residential care services, including services providing specialist dementia care. He has not yet achieved the ‘Registered Managers Award’. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 24 He is well though of by people who use the service, their relatives, and by staff. He is consistently described as hard working, caring and approachable, and is developing a staff group who are generally competent and knowledgeable to care for residents. As indicated above, a higher level of specialist training is necessary to further improve the outcomes for residents at the home. Care staff spoken with state that there is a good team spirit developing at the home, and that this is helped by a larger care staff compliment and the fact that they are asked to work fewer extra shifts each week than was the case previously. A comment from a relative praised the home’s efficiency: ‘good administration – quick to record and inform over any difficulties or incident’. There is an on-call system at weekends for management advice and support. The system provides access to the manager or deputy, and to an area on call support system operated by the proprietor. There are several processes at the home for monitoring the quality of the service it provides. There are systems in place that provide staff with formal supervision of their work and there are regular staff meetings. The Manager and the Proprietor carry out quality audits covering a range of topics, and they send monthly monitoring reports to the Commission. The home has an ‘in house’ newsletter produced periodically by the manager, where general information about life in and around the home is shared. It is still clear that a more formal quality assurance exercise that seeks the views of people who use the service, and others associated with it, has not been carried out. It is important that the views of residents and others are sought and used to inform any development or improvements to the service offered by the home, and more work is needed in this area (See Requirement 5). Relatives or appointees manage most resident’s financial affairs. Financial records reviewed were satisfactory and are evidently audited periodically for the protection of residents and staff. The home demonstrates generally good practices ensuring residents health, safety and welfare, however, does not have a consistent record of ensuring the health and safety of residents through its practice over recent inspections. Maintenance and fire records seen were satisfactory. There is relevant training for staff, including moving and handling, medication, first aid and improved numbers of staff with infection control training support practices. Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 25 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 2 X 3 X X 3 X 2 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 2 X 3 3 X 3 Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13.2,13.4 Requirement People using the service must have their medicines requiring refrigeration stored within the correct temperature range at all times to ensure these medicines are safe to use. This Requirement is Repeated The manager must ensure that requests for changes to doses of medicines must be fully documented and there must be recorded evidence that such requests are clinically justified. The manager must ensure that all of the people who use the service have bedding and other furnishings and equipment that are comfortable and in good repair. Timescale for action 05/02/08 2. OP9 13.2,13.4 05/02/08 3. OP19 16.2(c) 30/04/08 4. OP30 18.1(a) The manager must ensure that 31/05/08 there are at all times suitably qualified, competent and experienced staff in providing dementia care. This will help to ensure that the mental health needs of people using the service DS0000065216.V359065.R01.S.doc Version 5.2 Page 27 Hillcrest Care Home are met. 5. OP33 10.1 & 24.2 The Manager must ensure that the views of people who use the service user sought and included when making decisions that effect outcomes for people living at the home. This Requirement Is Repeated 31/05/08 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. Refer to Standard OP9 OP9 OP12 Good Practice Recommendations It is recommended that clearer highlighting of medication records is implemented to assist in ensuring all medicines are safely selected for administration to residents. It is recommended that records of prescriber interventions leading to changes in medication are entered in dedicated records at all times. It is recommended that the manager’s monthly newsletter includes information of forthcoming events at the home so that residents relatives have as much notice as possible of their taking place It is recommended that the manager consider introducing tea and toast making facilities into selected communal areas subject to an assessment of its safety. It is recommended that evidence of learning and validation be kept in individual staff training files. It is recommended that another dryer be provided. This Recommendation Is Repeated It is recommended that the layout of the laundry be revised to ensure that clean and dirty clothes and linen can be kept well apart. This Recommendation Is Repeated It is recommended that all care staff are supported to undertake NVQ 2 (or above) training to update their skills. 4. 5. 6. 7. OP15 OP18 OP26 OP26 8. OP28 Hillcrest Care Home DS0000065216.V359065.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 DS0000065216.V359065.R01.S.doc Version 5.2 Page 29 - 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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