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Inspection on 30/10/06 for Hillcrest House Limited

Also see our care home review for Hillcrest House Limited for more information

This inspection was carried out on 30th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 home enjoys a good working relationship with local Primary Health Care team members. There is only one local practice therefore all service users are registered at one practice. On the both days of the inspection a General Practitioner was visiting the home, first day on Trevena and second day on the General Unit to review all the service users. The services that are provided included chiropody, physiotherapy, mental health services, General Practitioner, dentist and hairdresser. Service Users spoke highly of the care that they received and the staff without exception. The inspectors gathered feedback from service users and relatives, who confirmed that they feel that their privacy and dignity are respected. The quality, choice and flexibility of food provision from the catering team under the supervision of a new chef since the last inspection were noted by the inspectors, this was confirmed by the service users. Student nurses from Plymouth University are placed at the home. One member of staff reported feeling supported to settle into their new role. One relative commented that the staff delivered `professional, yet compassionate care`. Staff spoke freely with the Inspectors about the support and training that they are offered and that they value the clear leadership and managerial support that is offered. The Inspectors observed that staff were enthusiastic and motivated in their work. The inspector was very impressed with the organisation for the health and safety in the home. There is a designated lead for health and safety who performs this role to a high standard.

What has improved since the last inspection?

Since the last inspection service users and their representatives are being involved in the initial information sharing and planning of the service user`s care plan. Since the last inspection the information technology systems have been reviewed to ensure that the daily record is accessible to all members of staff and entries are made using a unique identifier and password. New furniture has been provided to most of the rooms on the General Unit, once completed this is due to be extended to Trevena (one room has it already). New mirrors, furniture and plants have introduced in Trevena to make the environment more homely and it has does this very effectively.

What the care home could do better:

The Registered Manager must ensure that the plan of care demonstrates that the Service User is involved in the drawing up of the care plan, recorded in a style accessible to the Service User, agreed and signed by the Service User. The registered person must make the service user`s plan available to the service user and where appropriate involve the service user and/or their representatives in any revisions. The inspectors and Registered Managers discussed the importance of ensuring that all service users are offered appropriate dental care, the inspectors were reassured that this would be reviewed and would be addressed. Service Users wishes concerning death and dying need to be discussed and recorded, to include the changing needs of the Service Users with deteriorating conditions or dementia. There are up to date Policies and Procedures relating to expected deaths and death of a service user, since the last inspection the Registered Manager has developed a Policy for ageing, these must be developed into procedures that are reflected in practice. Service users interests are recorded, however there was no evidence that the activities provided met the individual or collective needs of the service users. Service users and relatives commented that activities within the home could be improved, during the inspection the inspectors were able to confirm this. It was not possible to evidence at inspection that all new staff undergo a structured induction. The Skills for Care induction has been obtained and four staff are due to commence the inspectors were informed. The Registered Managers are planning to review the training provided and the record keeping to enable the Managers to monitor who has attended what and be aware of the need for updates e.g. moving and handling. All staff must have a completed Criminal Records Bureau check.

CARE HOMES FOR OLDER PEOPLE Hillcrest House Limited Hillcrest House Barbican Road East Looe Cornwall PL13 1NN Lead Inspector Kerensa Livingstone Key Unannounced Inspection 30th October 2006 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 House Limited DS0000046312.V305174.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 House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest House Limited Address Hillcrest House Barbican Road East Looe Cornwall PL13 1NN 01503 263489 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.hillcrestlooe.co.uk Hillcrest House Limited Ms Sharon Jane Keast Care Home 88 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (38), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (38), Old age, not falling within any other category (57), Physical disability (57), Physical disability over 65 years of age (57), Terminally ill (57), Terminally ill over 65 years of age (57) Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: Hillcrest House offers care and accommodation to service users in need of care by reason of old age. The home has two units, the General Unit that provides nursing care for up to 57 people and Trevena which provides care for up to 31 older people who have mental health problems or dementia. The home is situated on the outskirts of Looe and has scenic views over the surrounding countryside and sea. There is a small group of shops nearby. The home is a modern building, purpose built prior to the implementation of the Care Standards Act to provide care and accommodation. There is a large car park to the front of the home. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection conducted over two full days by two Inspectors. The Inspectors had the opportunity to meet Service Users, relatives, staff, the Registered Managers and staff working within the home. Service User documentation, Policies and Procedures, record keeping and the environment were inspected. Service user and relatives questionnaires were also gathered prior to the inspection. Since the last inspection the Manager of the Trevena Unit has become a Registered Manager, a role that he will share with the existing Registered Manager. All the service users and visitors spoken with at the time of the inspection were very happy with the quality of care that they are offered, the staff and their environment. The Service Users spoke of the individualised care that they receive, which is all the more commendable given the relatively large size of the home. Management structures are clearly defined, the comments of service users and visitors reflect effective everyday management and communication. The current fees are £293.25 - £585. What the service does well: What has improved since the last inspection? Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 6 Since the last inspection service users and their representatives are being involved in the initial information sharing and planning of the service user’s care plan. Since the last inspection the information technology systems have been reviewed to ensure that the daily record is accessible to all members of staff and entries are made using a unique identifier and password. New furniture has been provided to most of the rooms on the General Unit, once completed this is due to be extended to Trevena (one room has it already). New mirrors, furniture and plants have introduced in Trevena to make the environment more homely and it has does this very effectively. 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 House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective Service Users are provided with detailed information that they require ensuring that they are able to make a choice about where to live and their needs are fully assessed. EVIDENCE: The Statement of Purpose is a comprehensive document that has been recently reviewed to include the additional Registered Manager. The inspectors observed that the service user’s guide was available in the reception. This is clearly written and an attractive document, providing details of the environment. Following feedback that a relative had commented that they did not have access to the most recent report, the Registered Manager suggested putting a copy in the reception. This document is provided to all prospective Service Users including qualitative information and a copy of the most recent inspection report. These documents are kept under review. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 9 Since the last inspection the home’s written contracts have been updated as recommended at the last inspection to refer to the accompanying document that include the rights and obligations of the Service User and Registered Provider. New service users are admitted following a full assessment undertaken by a qualified nurse. The assessment is undertaken in hospital, their home or on a visit to the home. This information forms the basis of the service user’s individual plan of care. The inspectors observed comprehensive assessment information including documentation from other professionals. Copies are retained of these assessments. The majority of service users come to the home directly from hospital so that choosing and viewing the home is generally the responsibility of families or other close relatives. Some service users do have respite stays before making the final decision to move into the home and have the opportunity to make pre-admission visits. This home does not provide intermediate care, therefore this standard was not applicable. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service user’s health and personal care needs are met, these are clearly directed by the plan of care following an initial assessment. Service users stated that they felt they were treated with respect and their privacy respected. Service user’s wishes in planning for and dealing with increasing infirmity and death must be discussed and carried out. EVIDENCE: A registered nurse, based upon the pre-admission assessment and assessment tools, plans the plan of care for each individual. The care plans incorporate the health, personal and social needs of the Service User. The Registered Manager must ensure that the plan demonstrates that the Service User is involved in the drawing up of the care plan, recorded in a style accessible to the Service User, agreed and signed by the Service User whenever possible and/or representative. Since the last inspection, there is evidence that service users and their representatives are being involved at the initial stages of planning the care. The registered person must make the service user’s plan available to the service user and where appropriate involve the service user and/or their Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 11 representatives in any revisions. These are reviewed monthly. Relatives commented that they had ‘nothing but praise for the care in management and staff regarding my father’s care’ and ‘initial positive feelings about the unit have been reinforced continually throughout the year’. A comprehensive range of assessment tools are utilised to identify individual’s needs for example; dietary requirements, weight monitoring and nutritional assessment, pressure sore prevention, moving and handling assessment, falls risk assessment. An initial risk assessment is completed and this is developed into a comprehensive risk assessment, identifying risks and including an action plan to reduce the risk. These were observed to be reviewed at least three monthly. It is recommended that service users be provided with regular structured opportunities for appropriate exercise and physical activity. Specialist input is sought on an individual basis. The need for an up to date continence assessment was discussed with the Registered Manager in relation to Trevena and whether the document in use met the needs of the unit. The home enjoys a good working relationship with local Primary Health Care team members. All service users are registered at one practice. On the both days of the inspection a General Practitioner was visiting the home, first day on Trevena and second day on the General Unit to review all the service users. The services that are provided included chiropody, physiotherapy, mental health services, General Practitioner, dentist and hairdresser. The inspectors and Registered Managers discussed the importance of ensuring that all service users are offered appropriate dental care, the previous dentist was no longer available and a new arrangement has been made. The inspectors were reassured that this would be reviewed and would be addressed. Service Users spoke highly of the care that they received and the staff without exception. There is a computerised Patient Care System utilised for documentation, these records are printed off and filed within the service user record. At this and the previous inspection the Inspectors discussed with the Registered Managers the Carers role in record keeping. Since the last inspection the information technology systems have been reviewed to ensure that the daily record is accessible to all members of staff and entries are made using a unique identifier and password, which will clearly identify whose made those entries, as a signature to identify the originator of the record. A qualified nurse administers all medicines. The inspectors observed medicines administered safely on both units within the home on the days of the Unannounced Key inspection. Medicine trolleys are used to allow the staff to transport the medicines. Controlled medicine are stored in a suitable lockable provision and recorded according to pharmaceutical guidelines. Record keeping was noted to be update and accurate. Oxygen cylinders are stored with appropriate signs in place. The home has medication Policies and Procedures. A lockable space is provided in the service user’s room, if it should be appropriate for the service user to self-administer their medication. The inspector was informed that records are kept of all medicines coming into and leaving the home. The home has a contract with a disposal company to ensure Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 12 the safe disposal of medicines. There are designated drugs fridges for the storage of medicines. The inspectors discussed with the Registered Managers how lotions and creams were stored in several different places around the home. Service users feel they are treated with respect and their right to privacy is upheld. Service users are addressed by their preferred name, which is recorded within the individual admission plan. Staff were observed to treat service users with respect. Service users doors are knocked upon prior to entering. The inspectors gathered feedback from service users and relatives, who confirmed that they feel that their privacy and dignity are respected. Respect for the service users was evident throughout and in all aspects of the inspection. Family and friends are encouraged to visit service users at any time. There is evidence that care and comfort is given to Service Users and their families when they are dying. Service Users wishes concerning death and dying need to be discussed and recorded, to include the changing needs of the Service Users with deteriorating conditions or dementia. The Service Users family and friends should be involved (if that is what the Service User wants) in planning for and dealing with increased infirmity, terminal illness and death. There are up to date Policies and Procedures relating to expected deaths and death of a service user. Since the last inspection the Registered Manager has developed a Policy for ageing, this must be developed in procedures that are reflected in practice. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users and relatives were complimentary about the quality of life, the food and standard of care offered at Hillcrest House, this is a credit to the hard work of the staff and management. All the service users and visitors spoken to said that they (the service users) could determine their own lifestyle within the confines of their care needs. Social activities within the home are limited and were the one area that service users felt could be improved. The catering manager and staff work hard to meet the individual needs of the service users. EVIDENCE: Service users commented that they were able to make choices about the time that they get up, go to bed, who they see and where to spend time. Visitors are welcomed and encouraged to participate with the care of their loved one, if they wish to. Meal times are flexible and snacks were readily available during the inspection days. Service users confirmed that staff did aim to provide a flexible service. Service users interests are recorded, however there was no evidence that the activities provided met the individual or collective needs of the service users. Service users and relatives commented that activities within the home could be improved, during the inspection the inspectors were able to confirm this. There is an activities coordinator, in the month of October the Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 14 activities detailed included a library afternoon, sing-along, two service users out on a shopping trip and a lacy lady visit. The activities coordinator stated that there had been a trolley shop but this had been stopped currently. Records should be kept of who participated in which activities to ensure that these are meeting the individual and collective needs of the service users. Visiting is encouraged and the visitors that the inspectors spoke to confirmed there are no limitations on visiting. Service users maintain contact with family/friends/representatives and the local community as they wish. Visitors are welcomed to the home, as detailed in the service users guide, and were present during the inspection. A visitor’s book is available in the entrance porch. There are communal areas available for receiving visitors as well as private accommodation areas. Service users are encouraged to partake in community activities and are supported by transport being provided if necessary, carers will also support service users to utilise local shopping facilities or go for a walk within the local area. The home organises trips for service users who choose to partake of this service, in October two service users went shopping, in September there had been a tip to Hannafore Point for an icecream and two shopping trips. Service users and staff stated that choices regarding personal preferences were afforded, (i.e. bedtimes, clothing worn, daily routine). These are recorded within the plan of care. Service users are encouraged to handle their own affairs, with the support of their family or representatives. There is a policy and procedure is in place in accordance with the Data Protection Act 1998 and inspectors have been advised that the Service users are made aware of their right to access their own records. Personal preferences are recorded for each service user. Service Users are offered a six weekly rotational choice of menu for all meals. On the day of the inspection Roast Pork or Cheese Salad were available. Staff were observed to be asking service users what they would like for tea. A cooked breakfast is offered twice weekly (Tues/Sat), boiled or scrambled eggs are available daily. Breakfast is a choice of four fruit juices, four cereals, porridge, toast and fruit. One service user commented how much they loved their cooked breakfast. Fresh fruit was observed to be on tables in communal areas for service users to help themselves to and in the afternoon baskets are prepared for the evening and overnight to include crisps, cakes, chocolate, plain biscuits and packets of soup. There is a separate menu for vegetarians. Service users were aware of the choices for lunch on the day of the Unannounced Inspection. Individual requests for snacks or meals are met, if at all possible. Staff were observed during the inspection, to be able to go into the kitchen at anytime to prepare a drink or snack for a service user e.g. hot milk, toast or a sandwich. Service Users informed the Inspectors that they enjoyed the meals that are offered and can choose whether to join other Service Users in the dining room or to remain in their own room. Staff were observed to offer assistance in respectful manner, chatting with the service Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 15 user and offering the meal at a pace that seemed acceptable for the service user. Food was observed to be attractively presented. There are daily, weekly and monthly cleaning schedules and fridge temperatures are recorded twice daily. The Inspectors were impressed with the enthusiasm and pride that was apparent within the catering team under the supervision of a new chef since the last inspection. The chef has twenty-three and a half years experience, the Intermediate food hygiene certificate, 7061 and 7062. Service users commented without exception that the food was ‘very good’ and that it had improved over the last year. Nutritional assessments are undertaken, records are kept of the food on offer and Service User’s records of what is eaten. A variety of drinks are offered to the Service User. Cake and/or biscuits are offered with drinks provided at 07.30, 10.30, 14.30 and 20.30. Liquidised and pureed food are prepared and offered, as required. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 16 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 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The inspectors met service users that were confident if they had any concerns these would be acted upon promptly. Staff are provided with training on the Protection of Vulnerable Adults. EVIDENCE: Service Users informed the Inspectors that they knew who to speak to if they had any concerns and were confident that action would be taken. There is a clear complaints procedure for the home, this includes stages, timescales and the Commission for Social Care Inspection, and this is included in the Service Users Guide. The registered manager and inspectors discussed the need to include that service users can contact the Department of Adult Social Care in relation to a complaint. A record is kept of all complaints made, including the investigation and the action taken. The Commission for Social Care Inspection has not received any complaints or allegations about this home since the last inspection. There are policies and procedures in the home regarding Whistleblowing and types of abuse. The inspectors were informed that these subjects form part of induction training for all staff. Protection of Vulnerable Adults policy and procedural information is included in the Whistleblowing documentation. The Protection of Vulnerable Adults Procedure includes local contact details for the key agencies. Two staff have attended external training in this area. Further two staff are due to attend the Social Services Protection of Vulnerable Adults Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 17 Trainers day. The inspector was informed that all staff have received training in this area, the records need to reflect this. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 18 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 & 26 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a safe, comfortable and homely environment. Specialist equipment is provided as required. The accommodation meets their individual and collective needs. EVIDENCE: Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 19 The home is accessible, decorated in a comfortable, homely manner and well cared for. It is located on the outskirts of Looe. The home is purpose built prior to the Care Standards Act. The layout of the home is suitable for its stated purpose. Many rooms have super views into the valley and of the river. The Provider has ensured that there is a programme of redecoration and refurbishment. There is a maintenance record book and three maintenance staff who respond promptly to requests for work to be undertaken. The grounds were tidy. There is a large car park to the front of the home. The home complies with requirements of the Fire Officer and Environmental Health Officer. There is wheelchair access to the home. There is adequate office space for support services, managerial and clinical staff. New bedroom furniture is being provided for each room in the General Unit and one room in Trevena has benefited from this. Additional pictures, mirrors and plants have been purchased for Trevena to make it more homely, staff, relatives and service users commented positively about these changes. The home provides a range of communal facilities. The general unit has a large lounge and separate dining room, whilst Trevena has a large lounge with a dining area. Trevena is a locked unit, where access is gained by a numbered keypad. There is a separate entrance to Trevena. There is a reception area with staff to receive visitors to the home. The furniture in communal areas is of a good standard. There is natural light and opportunities for ventilation within both. There are five double rooms in Trevena, a screen is provided. The inspectors were advised that these are used as singles, unless a couple come to live at the home together or there is a special request to share accommodation. The Inspectors were advised that all rooms are ensuite. Additional bathroom and toilet facilities are provided near to communal areas. There are adequate facilities for the needs of the Service Users. A large range of equipment is provided to assist in the care of Service Users, this includes suitable beds, portable hoists, handrails, moving and handling aids, special mattresses etc. Individual Service Users needs are assessed and the equipment required is provided. Staff informed the inspectors that if any equipment is required, they just need to ask for it and it will be provided. There is a lift to the first floor. There is wheelchair access to the home. Call bell systems are provided, the inspector discussed with the Registered Manager who manages Trevena that service users need to be able to access their call bells, depending on their needs and risk assessment. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 20 Service users’ rooms generally contain the furniture and fittings required. All doors have a lock and this can be overridden from the outside. Screening was provided in double rooms. The majority of the rooms have adjustable hospital type beds. Service users were very satisfied with their rooms, informing the Inspectors that they were able to bring in personal belongings and furniture. Service Users rooms are carpeted as a rule, the inspectors understood that special flooring is used but this based upon risk assessment and carpet replaced for a new Service User. On the days of the inspection, in Trevena fifteen rooms did not have carpet. The inspectors expressed concerns at this and asked the Registered Managers to clarify this high level of impermeable, clinical flooring. All hot surfaces are covered, hot water regulated and windows restricted. Environmental risk assessments are undertaken for all risk factors within the home. The premises were clean and tidy. The General Unit was generally free from odours, although there were slight odours on Trevena. Hand washing and sluice facilities are provided. Alcohol solution is provided at the entrance to all units and visitors are encouraged to use this before entering. There is an active maintenance programme. There is allocated storage space within the home, which meets the needs of the home. The laundry was inspected and it showed that there are systems in place to prevent cross infection. Industrial machines are in use and there are two tumble driers. The floor covering is impermeable. Gloves are available for hand washing. All laundry is done in the home and there are designated laundresses. There is an additional room used for ironing and storage of the individual box system for each service user. Hillcrest House Limited DS0000046312.V305174.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. A structured induction must be provided to all staff and the robust recruitment procedures must apply equally to all staff. Service users and relatives speak highly of the professionalism and motivation of the staff. Staff delivering care are supported by a comprehensive support team. EVIDENCE: On both days of the inspection it was considered that an appropriate number and skill mix of staff were on duty. Each shift is managed by a qualified nurse and there was a second trained nurse available on both units, on the days of the inspection. Staff were observed to be carrying out their duties in an unhurried and calm fashion and service user comments supported this observation. Ancillary staff support the carers and nursing staff in their roles e.g. laundry, housekeeping, administrative, maintenance, catering. No one under twenty-one years of age is left in charge of the home and not one under the age of eighteen provides personal care. Staff were observed to be professionally attired in uniform. There are twenty-three care staff excluding registered nurses and 54 have achieved National Vocational Qualification level 2 or 3. New dementia care training is planned for the Trevena staff and a Link Trainer programme is due to commence where members of staff will be trained and then go on to train other staff within the home. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 22 The home operates a thorough recruitment procedure, which includes an application form, interview, two written references and a criminal records bureau check. Volunteers employed in the home undergo a recruitment and selection procedure. Random staff files were inspected and found to be complete with the exception of one, who required a Criminal Records Bureau check. All staff must undergo a Criminal Records Bureau check including overseas staff. All staff receive a contract detailing their terms and conditions. It was not possible to evidence at inspection that all new staff undergo an induction that complies with Skills for Care. The Skills for Care induction has been obtained and four staff are due to commence the inspectors were informed. However no staff had completed or commenced it. All members of staff must receive this induction, in addition to the home’s orientation programme. The inspectors and Registered Managers discussed the importance of a structured induction supported and supervised by their line manager. Staff are offered training, this should be a minimum of three paid days a year. Individual training records are kept. The Registered Managers are planning to review the training provided with regular training afternoons. The inspectors supported this and the need to review the record keeping to enable the Managers to monitor who has attended what and be aware of the need for updates e.g. moving and handling. Student nurses from Plymouth University are placed at the home. One member of staff reported feeling supported to settle into their new role. One relative commented that the staff delivered ‘professional, yet compassionate care’. Service users comments about the staff were very positive. Staff spoke freely with the Inspectors about the support and training that they are offered. The Inspectors observed that staff were enthusiastic and motivated in their work. Staff value the clear leadership and managerial support that is offered. There are six NVQ assessors employed within the home. Hillcrest House Limited DS0000046312.V305174.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 & 38 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home and staff are supported by a robust management and administrative system with clear leadership. Considerable work is undertaken to promote the health and safety of the service users. EVIDENCE: The first Registered Manager has been at the home since 1987, is a registered nurse and has completed the NVQ Level 4 in management. Since the last inspection the Manager of Trevena has become an additional Registered Manager, he is a registered mental health nurse and has the NVQ Level 4 in management. The Registered Managers are involved in the day-to-day running of the home and there is evidence of clear and strong managerial leadership. The organisational structure of the home demonstrates how responsibility is Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 24 delegated to Heads of Departments, this is displayed and provided to all service users and representatives. Another staff member has completed the NVQ Level 4 management. Service users commented that they felt able to offer their feedback and that it would be listened to. In May, the annual quality assurance questionnaire was circulated, information collated and actions taken as required. A copy of the report was provided at the inspection. A copy of the report resulting from any further annual reviews conducted within the home shall be forwarded to the Commission. Internal audits are conducted for housekeeping, catering, maintenance and new expenditure. The results of the service user’s survey are made available within the Service User’s Guide. Policies and Procedures are reviewed annually in light of changing legislation. Action is taken within agreed timescales to meet CSCI requirements. One relative commented that they did not know that they had access to report. Following discussion with the Registered Manager it was agreed that this would be made available on both units and in the reception area. As a limited company suitable accounting and financial procedures are in place. There is clear evidence of reinvestment into the home. Records of all transactions are kept. Employers Liability insurance is in place (October 2007). There is an annual business and financial plan for the establishment. Evidence of financial viability has not been formally requested at this inspection. Service Users and their family or representative are encouraged to maintain control of their money in almost all situations. Written transactions are maintained, receipts provided and invoices issued for all dealings with Service Users monies. There is a Safe Handling of Service Users Monies Policy and Procedure. One of the Registered Managers is the appointee for one Service User. All records were found to be in order. The Registered Provider shall not pay money belonging to any service users into a bank account unless the account is in the name of the service user, to which the money belongs and the account is not used by the registered person in connection with the carrying on or management of the home, Regulation 20(1) Care Homes Regulations 2001. No monies are held for Service Users. There is a facility for the safe keeping of valuables on behalf of the Service User, a receipt is provided. Record keeping was observed to be of a very high standard, a Visitors Book is situated in the reception area of the home. Notification under Regulation 37 regarding a recent issue was discussed. Accidents are recorded in an accident book that complies with data protection legislation. Individual records are generally stored securely, although some confidential records were found in the lounge on the General Unit, this was quickly remedied and the records are kept up to date. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 25 The inspector was very impressed with the organisation for the health and safety in the home. There is a designated lead for health and safety that performs this role to a high standard. The emergency lighting in the home is tested monthly and a record kept. The Fire Officer visited in November 2005 and there is a Fire risk assessment in place. Legionella checks are made and recorded, an external test was conducted in October and the certificate of results presented at inspection. The Inspectors were informed that all water is regulated, all hot surfaces covered and all windows restricted. There is evidence that regular servicing and maintenance is undertaken e.g. lifts, hoists. Evidence is kept on file e.g. PAT testing (June 2006), gas certification (Sept. 06). There are three maintenance staff. The maintenance personnel were evident on the days of the unannounced inspection. There is a designated Moving and Handling trainer and a designated Fire trainer. Individual records are kept of training, however this is to be reviewed to ensure updates are provided for all staff to promote safe working practices e.g. moving and handling. COSHH assessments are completed and kept under review. Infection control Policies and Procedures have been updated and developed. Health and Safety Policies and Procedures are available in clinical settings, the office and reception. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 26 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 2 X 3 3 Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 27 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 OP11 Regulation 12 Requirement The registered person shall promote and make proper provision for the health and welfare of the service users and so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare e.g. dying and death. The registered person shall consult with service users about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall having regard for the size of the care home, the Statement of Purpose and the number and the needs of service users ensure that the persons employed by the registered person receive training appropriate to the work they are to perform e.g. induction. Timescale for action 01/03/07 2. OP12 16(2n) 01/03/07 3. OP30 18(1c) 01/03/07 Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP29 Good Practice Recommendations For interview records to be kept. Hillcrest House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 House Limited DS0000046312.V305174.R01.S.doc Version 5.2 Page 30 - 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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