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Inspection on 06/12/05 for Hillcrest Care Home

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

This inspection was carried out on 6th December 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

The people who live here had many positive comments to make about the service they receive. Staff turnover at the home is low which gives service users and staff the opportunity to get to know each other. And relatives are confident because they also know staff well. One said `they`re like his second family` and ` the staff are very, very good`. There is clearly a good dialogue 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. The proprietor and manager ensure that there are sufficient training opportunities so that staff have the right skills to support service users. And they work well as a team. The service is managed by a competent leader who successfully directs the way in which the home responds to the needs of service users.

What has improved since the last inspection?

The home has appointed an activity worker who, along with the staff team, has successfully introduced a series of opportunities both in and outside of the home so that people have the opportunity to lead stimulating and interesting lives. The variety of meals available have been improved to make it easier for some service users to eat independently and a greater variety of fresh produce is now used.

What the care home could do better:

Care planning records at the home continue to develop but need to improve further to describe the actions staff take to support the needs of service users. The ways in which the home stores and administers medication need to be improved to ensure that service users get the medication they have been prescribed and mistakes are avoided. 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 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 Mr Steve Tuck Unannounced Inspection 10:30 6 December 2005 and 26 January 2006 th th 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 DS0000000234.V254153.R01.S.doc Version 5.0 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 DS0000000234.V254153.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address Wear Street Jarrow Tyne And Wear NE32 3JN 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) 0191 489 0200 0191 428 6343 Hillcrest Care Homes Limited Miss Pauline Hughes Care Home 49 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (23) of places Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 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 DS0000000234.V254153.R01.S.doc Version 5.0 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 and observations were made of the support the staff offered to service users at this time and throughout the day. A number of relatives or friends of service users gave comments about the service 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. Staff turnover at the home is low which gives service users and staff the opportunity to get to know each other. And relatives are confident because they also know staff well. One said ‘they’re like his second family’ and ‘ the staff are very, very good’. There is clearly a good dialogue 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. The proprietor and manager ensure that there are sufficient training opportunities so that staff have the right skills to support service users. And they work well as a team. The service is managed by a competent leader who successfully directs the way in which the home responds to the needs of service users. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 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 DS0000000234.V254153.R01.S.doc Version 5.0 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 DS0000000234.V254153.R01.S.doc Version 5.0 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): 1 and 3 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. 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. The manager reviews this information regularly to ensure that it is updated when required. 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 DS0000000234.V254153.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 Service users’ care plans are in place and have improved, but do not sufficiently reflect their assessed needs. This can limit the guidance available regarding care practice and consistency. 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: Further improvement in the care planning arrangements have taken place since the last inspection however there are still areas which require more detail so that plans describe the describe the actual support and intervention which staff are currently carrying out. 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. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 10 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 and examples of good communication and positive debate between healthcare and home staff is notable. Despite work undertaken by the manager, medication at the home is not always successfully administered or recorded. 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 or whether service users have received medication or not. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 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 the following standard(s): 12 13 14 and 15 A selection of social activities are provided enabling service users to make positive choices about how they spend their day and friends and families are encouraged and involved too. This can contribute to a more interesting and stimulating lifestyle for service users. Service users are offered a varied menu with wholesome which promotes their health and well-being. 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. Other preferences could be provided if they asked for them. Meals provided were made from ingredients delivered to the home or purchased locally on a regular basis every couple of days to ensure freshness. Appropriate menu choices are now available for service users who are no longer able to use cutlery to eat their meals so that their dignity and independence can be promoted. An activities co-ordinator has been appointed at the home and the number of activities available at the home during the day has improved so that service users have some lifestyle opportunities which helps them lead fulfilled and stimulating lives. Specific activities have also been started for those who have dementia type needs who may require different types of activity or additional support to take part. The manager is considering further strategies to structure the lifestyle opportunities of service users at the home. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 12 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): 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 DS0000000234.V254153.R01.S.doc Version 5.0 Page 13 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 and 26 The home is clean, warm and comfortable offering service users a homely environment in which to live. However there are no organised plans to make sure the home stays in good condition. 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. On the first floor, some communal areas had been redecorated since the previous inspection but other areas needed further refurbishment due to the high levels of wear and tear in these areas. Redecoration Work has been started in the corridor upstairs and the manager plans to install local period photographs which are relevant to service users who have lived in the area. 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. A handyman has been employed by the home to carry Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 14 out the maintenance work which this home requires however there is no programme of routine maintenance and replacement to organise and ensure that the home remains in good condition. The home was free from unpleasant odours and there were no issues noted which compromised the health and safety of service users or staff. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 15 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 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 and rotas which organise when staff are working are well structured and arrangements are in place should staff need to take leave at short notice. All of these measures ensure that there are sufficient staff at the home. Staff are also supportive of each other and their manager both in their practice and also in their willingness to remain flexible about their working practices so that service users will benefit. 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 remains very low which gives service users and staff the opportunity to get to know each other and helps the manager to structure and train her team. 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. All staff have now either obtained NVQ at Level 2 or are working towards Level 2 or 3. Induction training is in place for new staff and the owner has allocated a training budget which is Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 16 being used to ensure that staff have all of the training they need to carry out their role with skill and competency. This is reflected in staff practices, knowledge and confidence. Staff can describe the needs of service users in detail; they get on well together and with service users and promote an inclusive and supportive structure at the home. The staff team have good relationships with relatives and visitors who are complimentary about them and their approach. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 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 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 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. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 18 EVIDENCE: The registered manger has several years experience in a variety of care roles as well as a number of years’ management experience at this care home. From observations and discussions, it is evident that the manager is sufficiently competent and skilled to carry out this role and has demonstrated the capacity to undertake additional training in order to update and expand her knowledge. She has recently completed an NVQ Level 4 qualification in management and plans to complete NVQ 4 in care in the near future. 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. The manager and proprietor have developed a quality assurance process for the home which will be beneficial once it is put in place. The home helps some service users to manage their day to day spending and accurate records are kept of these transactions. However 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. Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 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 2 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 2 2 3 Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 20 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 OP7 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) The manager must ensure that records accurately reflect the levels of medication held and administered at the home. (Previous timescale 01/11/05) 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) At least 50 of care staff must have an NVQ at level 2. The manager must complete an NVQ4 in Care. The homes quality assurance process must be implemented. DS0000000234.V254153.R01.S.doc Timescale for action 01/05/06 2 OP7 17 01/04/06 3 OP9 13 01/04/06 4 OP19 23 01/04/06 5 6 7 OP28 OP31 OP33 18 9 24 01/05/06 01/06/06 01/05/06 Hillcrest Care Home Version 5.0 Page 21 8 OP35OP37 9 OP36 17 18 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. 01/04/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hillcrest Care Home DS0000000234.V254153.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection South of Tyne Area Office 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 DS0000000234.V254153.R01.S.doc Version 5.0 Page 23 - 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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