Inspection on 07/11/05 for Hillcrest Care Home

This inspection was carried out on 7th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillcrest Care Home 28/01/09

Hillcrest Care Home 05/02/08

Hillcrest Care Home 04/07/07

Hillcrest Care Home 09/01/07

Hillcrest Care Home 17/08/06

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 Announced Inspection 7th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillcrest Care Home DS0000065216.V254438.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 DS0000065216.V254438.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address 106 Thorpe Road Thorpe Norwich Norfolk NR1 1RT 01603 626073 01603 765100 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne (Eton) Limited Position Vacant Care Home 52 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (20) of places Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th June 2005 Brief Description of the Service: Hillcrest is a care home providing care for up to 52 older people including service users with dementia. There are 37 single rooms en-suite, 3 single rooms without en-suite facilities and 6 double rooms with en-suite facilities. The home is situated within walking distance of the centre of the city of Norwich and its facilities. The detached property is set in its own grounds; the garden areas have flowerbeds and a terraced patio. There is parking space to the front of the premises. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 8.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the forty-nine service users in addition to visiting relatives, staff and the registered manager. Two comment cards were received from visiting G.P’s prior to the inspection. These expressed satisfaction as to the care provided at the home. As no other comment cards were received prior to the inspection, the manager is advised to consider ways in which comment cards can be made more accessible to relatives and others. What the service does well: What has improved since the last inspection? What they could do better: Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 6 Despite acknowledged improvements, care plans require further development as a working tool for care staff. Care plans need to be reflective of the care that is provided to service users, though it is clear that service users health and personal care needs are actually well attended to. Care plans should involve service users and relatives in their construction and review to a greater extent. This and other measures to ensure the home is run in the best interests of service users require further development, including the introduction of a customer care audit (in the form of a questionnaire), and the establishment of a residents committee. Service users must be better supported or protected by the home’s recruitment practices. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillcrest Care Home DS0000065216.V254438.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 DS0000065216.V254438.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, 2, 4 The home provides clear information that would assist service users in making an informed choice as to the home’s ability to meet their needs. EVIDENCE: The home has produced documentation including a Statement of Purpose and Service User Guide that are provided to service users and were available within the home, including the reception area. The home has clear written information available to prospective service users, which would provide them with a good understanding of the home’s capacity to meet individual need, including needs arising from dementia. Either service users or their relatives sign terms and conditions (or contracts) for their accommodation at the home. These appeared to reflect services provided. The relevant documentation was seen and adequately meets the standard required. Hillcrest Care Home DS0000065216.V254438.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, 8, 9, 10 Service users individual care plans do not set out health and personal care needs in adequate detail and are not reflective of the care that is provided to service users, as their health and personal care needs are actually well attended to. EVIDENCE: A sample of service user care plans was reviewed. These had improved since the home’s last inspection, set out care requirements in reasonable detail and were evidently reviewed on a regular basis; though need to become a more informative tool for care staff in individual care delivery, and to involve service users and relatives in their construction and review. Care plans associated with needs arising from continence, challenging behaviour and nutrition were reviewed and contained appropriate information as to assessed needs but do not go on to clearly set out what care is required as a consequence. However, it is acknowledged that care staff were demonstrably providing the care required in these and other instances. Care plans refer to the involvement of a variety of community health professionals. Service users confirmed access to, among others, the G.P, chiropodist and district nurse as required. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 10 There are currently service users accommodated at the home who take responsibility for administering some of their own medication. Medication records and storage were reviewed and were found to be satisfactory. One incidence of the non-availability of a service users medication was noted. It was evident that the home had taken steps to obtain the prescribed medication, though these had been unsuccessful. It was recommended that the home make immediate contact with the prescribing GP for advice. Service users and their relatives spoken to during the inspection indicated that their right to privacy is respected at the home. It was noted that the doors to service users rooms are lockable supporting their privacy. However, the current arrangements for access to making or receiving telephone calls in private are restricted, particularly for service users accommodated on the first floor of the home. A payphone is available on the first floor, though in a communal area. The manager indicated that the home’s telephone switchboard was due to be replaced in order that a ‘cordless’ or ‘portable’ telephone (not compatible with the present switchboard) may be made available. Service users indicated that all staff at the home are caring and respectful in approach. Hillcrest Care Home DS0000065216.V254438.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): 14 & 15 Service users are able to exercise choice and control over their lives. Menus in the home offer choice and variety. EVIDENCE: Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. It is evident that service users are entitled to bring and to keep personal possessions at the home. Several visitors to the home were present at the time of the inspection. The home has promoted the use of independent advocates for service users, where necessary, to promote their best interests. Service users spoken with were complementary about the quality and variety of food available at the home. The meals seen at the time of the inspection looked wholesome and appealing. It was also clear that there were at least two main meal options available at lunchtime, one of these was a meat option (mince and onion pie) and the other a vegetarian option (cauliflower cheese). Both were served with a selection of vegetables. The manager had acknowledged difficulties in a lack of continuity in catering staff, though this was not reflected in comments made by service users about the quality of meals on offer. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 12 Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 Arrangements for dealing with complaints and for protecting service users from abuse are satisfactory. EVIDENCE: Service users and relatives spoken to indicated that they would speak with the manager or with their carers if they had a complaint or concern, and that they felt they would be listened to. Information about complaints is readily available within the home, including a confidential telephone helpline operated by the proprietor. A complaint (regarding the health care of a service user) had been made since the home’s last inspection and was investigated by the Commission. The complaint was partially substantiated and relevant requirements were made. The home has training for staff (resident welfare) and a procedure for responding to allegations of abuse, including ‘whistle blowing’. Staff spoken to are aware of these procedures and their function. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 23, 24, 25 Service users live in a safe and comfortable environment that is evidently improving, though maintenance issues and personal storage issues compromise this. EVIDENCE: The home provides adequate communal space including access to outdoor space that is accessible to those in wheelchairs or with other mobility needs. The decoration and furnishings throughout the home are requiring a great deal of attention. However, it is evident that a significant effort has been made, and is continuing to be made, in improving the comfort and appearance of the environment. There are many new carpets in evidence in communal areas and in service users bedrooms, new furniture is in evidence and much of the home has been redecorated. The home is commended for efforts to improve the interest and stimulation of the environment on the first floor accommodating service users with dementia. It is understood that further improvements are planned and that these correspond with current practice regarding dementia care. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 15 Two first floor bathrooms are not lockable and therefore do not support service user privacy. The bath in one of these rooms is in need of minor repairs to the panel and side. A requirement has been made that these matters be addressed. The majority of bedrooms at the home are single with en-suite facilities, though there are six shared rooms. As referred to already in this report, each of the bedroom doors in the home are lockable. However, as yet not all service users have lockable storage space for medication, money or valuables. The home provides a satisfactory standard of accommodation that is safe, and comfortable. It was noted that some of the bedrooms to the rear of the home do not benefit from a great deal of natural light, consequently the home has a practice of ensuring artificial light supplements the available natural light. However, two bedrooms with particularly limited natural light also have double-glazed window units that have become clouded with moisture that further restricts available light. Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 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 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): 29 & 30 Service users are not fully supported or protected by the home’s recruitment practices. Staff training programme addresses service user needs, though the delivery of induction training requires revision. EVIDENCE: Sample files reviewed included evidence the recruitment of care staff prior to obtaining two satisfactory written references. It is evident from staff spoken to and from training records seen that staff have access to induction training and a full range of mandatory training, including specialist training in relation to dementia care. Staff also appeared to show interest and enthusiasm in their role. Some staff induction training records to be discussed and demonstrated by new staff within the first twelve weeks of appointment had been ‘signed off’ on a single date at the beginning of the employment. It is unlikely that staff had safely received or understood this volume of training within such a short period. This training should be delivered over the designated period in order that it is fully understood by new staff. Hillcrest Care Home DS0000065216.V254438.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): 33, 34, 35, 36, 37 The home is well managed by an experienced manager who is well regarded by service users, relatives and staff alike. The home is run in the best interests of service users, though further development is required to ensure ongoing review of the quality of care provided at the home. EVIDENCE: Feedback from service users and staff during the inspection regarding the manager and his approach to running the home was very good. The manager described strategies employed at the home to ensure that it is run in the best interests of service users. These include regular staff meetings and the promotion of comment leaflets in the home’s reception area. Evidence of the use of these leaflets (by a variety of people connected with the home) was seen alongside constructive responses by the manager to issues raised. These and other measures to ensure the home is run in the best interests of service users require further development, including the introduction of a Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 18 customer care audit (in the form of a questionnaire), and the establishment of a residents committee. Discussion took place with the manager about a greater role for service users and their relatives in care planning and the reviewing of care plans as part of these measures to monitor quality. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. Staff are appropriately supervised and service users further supported by the home’s policies and record keeping. Hillcrest Care Home DS0000065216.V254438.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 3 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 2 2 X STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 3 3 X Hillcrest Care Home DS0000065216.V254438.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4)(c) &15(1) Requirement The registered person must ensure that individual care plans set out in detail the action which needs to be taken to ensure that all aspects of service user health and personal care are met. The registered person must ensure that written care plans are prepared with the involvement of service users or their representatives. The registered person must ensure the availability of prescribed medicines at all times. The registered person must provide telephone facilities to enable service users to use such facilities in private. The registered person must ensure that premises are kept in a good state of repair, particularly bathroom areas and faulty window units. The registered person must ensure that all service users are provided with a place where money or valuables may be deposited. DS0000065216.V254438.R01.S.doc Timescale for action 07/12/05 2 OP7 15(1) 07/12/05 3 OP9 13(2) 07/12/05 4 OP10 16(2)(b) 31/01/06 5 OP19 23(2)(b) 07/12/05 6 OP24 16(2)(l) 28/02/06 Hillcrest Care Home Version 5.0 Page 21 7 OP29 19(1)(b) (1) 8 9 OP30 OP33 18(c)(1) 24(1) The registered person must ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. The registered person must ensure that new staff receive appropriate induction training. The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home. 07/12/05 07/12/05 30/04/06 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 DS0000065216.V254438.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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