CARE HOMES FOR OLDER PEOPLE
Hillcrest Residential Care Home 12 Hill Top Road Leeds West Yorkshire LS12 3SG Lead Inspector
Ann Stoner Key Unannounced Inspection 13th March 2007 10:15 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 Residential Care Home DS0000001461.V331451.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 Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hillcrest Residential Care Home Address 12 Hill Top Road Leeds West Yorkshire LS12 3SG 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) 0113 263 9002 0113 263 9002 Mrs Sandra Eastwood Mr John Eastwood Mrs Susan Kettlewell Care Home 19 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (19) of places Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The places for DE(E) are for the named service users only Date of last inspection 16th March 2006 Brief Description of the Service: Hillcrest is situated in the Armley suburb of Leeds. It is a detached, period property, which has been adapted to provide accommodation, without nursing, to nineteen older people, of either sex, over the age of 65. Many of the features of the property have been retained and add to the character of the building. There are gardens and a patio area to the rear of the building and some car parking is available. There are two communal lounges and a dining room, both of which are well furnished in a domestic and homely style. The home is on four levels, three of which are accessible to residents. People with limited mobility have access to a passenger lift or a stair lift. The home is close to local shops, public houses and other amenities and there is good access to public transport to the city centre. Fees that applied at the time of this inspection were stated in the preinspection questionnaire as ranging from £374.99 - £426.51. More up to date information may be obtained from the home. Copies of previous inspection reports are available in the home. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk The last inspection was unannounced and took place on the 16th March 2006. There have been no further visits until this unannounced key inspection, which took place between 10.15am and 6.00pm on the 13th March 2007. The purpose of this visit was to monitor standards of care in the home and to look at progress in meeting the requirement and recommendations made at the last visit. Before the inspection a pre-inspection questionnaire was sent out to the home, this provided some information for this report. The people who live in the home prefer the term ‘resident’ and this will be used throughout this report. Before the inspection I sent out survey cards to residents and health care professionals and had a telephone conversation with two relatives. I received twelve completed survey cards from residents and four from GPs. Comments from the survey cards and telephone conversations can be found throughout this report. During the inspection I spoke to residents, staff on duty, the manager and one of the registered providers (owners). I looked at records, made a tour of the building and watched staff working with residents. Feedback at the end of this inspection was given to the manager and one of the registered providers. I would like to extend my thanks to everyone who contributed to the inspection and for the hospitality during the visit. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home has continued with a rolling programme of decoration and refurbishment. The main kitchen has been re-fitted and refurbished, several rooms have been decorated, some windows have been double-glazed, a new carpet has been fitted in the dining room and lighting has been replaced to the first floor corridor. The manager has now completed the Registered Manager’s Award. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Standard 6 does not apply to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to make an informed choice before making any decision about moving in and the home makes sure that it can meet people’s needs. Residents do not always have a contract at the point of admission, which means that they, and/or their relatives, may not be fully aware of the terms and conditions of their stay. EVIDENCE: During discussions with relatives before the inspection visit it was clear that residents and/or their relatives had visited the home or knew of the home because of previous family involvement, and in one case stayed for a meal to meet other residents, before making any decision about moving in. All had access to written information about the home and the service that it provides.
Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 10 One relative said that during her introductory visit she was ‘very impressed’ by the friendly and homely atmosphere and the fact that staff were friendly and sociable. Three care records were looked at and in all cases the home had completed a detailed pre-admission assessment before deciding that the person’s needs could be met at the home. There was no contract or terms and conditions of the home in any of the care records sampled. The manager said this was because she was unable to specify the current fee structure due to delays with Local Authority funding. All residents should be made aware of the terms and conditions of their stay at the point of admission. Some amendments are needed to the terms and conditions document, to make sure that it accurately reflects all of the additional charges and conditions of the person’s stay at the home. The manager and registered provider agreed to address this. A recommendation has been made. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are detailed and records show that resident’s health care needs are met. Medication is managed properly and staff understand the importance of respecting resident’s privacy and dignity. EVIDENCE: Three care plans were looked at in detail. These were comprehensive and outlined the resident’s needs, strengths and the action that staff should take to meet these needs. Areas where the plans could be developed further were discussed with the manager and one of the registered providers during the feedback session. These included more detail about how staff should address the specific needs of people with dementia, particularly in relation to orientation and memory loss, and a more detailed monthly review of the care plan. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 12 During telephone conversations before this inspection visit, relatives said that they were confident that the home meets resident’s health care needs well. One relative said that she was ‘very impressed’ by the way that the home was trying to encourage and tempt one person to eat. This person’s care records showed that the home was working closely with the community dietician, district nurses and her GP. Another relative said that she was always informed about her mother’s changing health care needs. All four GPs who returned survey cards stated that the home communicates clearly and works in partnership with them, and that staff have a clear understanding of the care needs of residents. Care records showed that residents have optical, dental and chiropody treatment. The home orders, stores and administers medication in line with guidelines issued by The Royal Pharmaceutical Society of Great Britain. The home does not use any homely remedies and none of the residents were self-medicating at the time of this visit. Medication Administration Records were sampled and found to be in order, but handwritten entries made on these records are not checked and signed by a second person. A recommendation has been made. Throughout the inspection staff were seen respecting the privacy and dignity of residents. All bedroom doors are fitted with locks and some residents hold their own key. When asked staff were very clear about the ways in which they respect the dignity of residents, and a new member of staff confirmed that this subject was included in her induction programme. Hillcrest Residential Care Home DS0000001461.V331451.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff recognise and respect the choices that residents make. Visitors are made welcome. A nutritious and varied diet is provided. EVIDENCE: In returned survey cards from residents six said that there was always activities provided by the home that they could take part in, three said that there usually was, and three said that sometimes there was. These conflicting views were echoed on the day when some residents said that they were bored, but an activity programme on display in the front entrance of the home showed a range of activities being available. It was clear from the survey cards that residents have a choice about whether or not to join in activities. One person said, “The activities arranged by the home are good, but I don’t always take part in them, another said, “They always ask if I want to join in. Sometimes I do, and sometimes I don’t.” The manager said that she was hoping to introduce a gardening project that some residents might be interested in, and during the feedback session following this visit she agreed to look at ways of providing a more varied programme.
Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 14 Residents spoke about the choices they make such as choosing what time to get up in the morning and go to bed at night, choosing what to wear, whether to have a bath or shower and at what time of day, and a choice of meals. Staff had a good understanding of the importance of choice in resident’s lives, one member of staff said, “Giving people choice is an important part of respecting someone’s dignity.” This person was also able to describe how she respected the choices of those residents who are less able to communicate their preferences. Staff are aware of the diverse needs of people, and spoke about how the religious needs of different people are met. The manager described how one resident is being supported to attend a remembrance ceremony in France later in the year. During telephone conversations with relatives before the inspection visit they confirmed that they are always made to feel welcome and offered refreshments. Menus supplied with the pre-inspection questionnaire show that residents receive a varied diet with a choice at each meal. On the day on this inspection visit the lunchtime meal was roast ham or beef burgers with roast potatoes and broccoli, followed by a choice of sponge and custard, milk pudding or yoghurt. During the inspection visit some residents expressed concern about how often sandwiches appear on the teatime menu. The manager said that other options are available but agreed to discuss this at a residents’ meeting that was planned to take place the following day. Comments about meals in returned survey cards from residents included, “I really enjoy the meals that are offered to me,” and “The cook is great.” Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home complaints and adult protection procedures. EVIDENCE: The home’s complaints procedure is clear and easy to follow. This is displayed in the reception area and is included in the statement of purpose and service user guide. The home has received three complaints during the last twelve months. All three were recorded, taken seriously and dealt with properly. In returned survey cards from residents they said that they knew who to speak to if they were unhappy and knew how to make a complaint. Staff had a good understanding of adult abuse and how to report any suspicions of abuse. A senior member of staff has completed training on adult abuse and the Multi-agency adult protection procedures. She now provides this training to other staff in the home. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and meets the needs of the residents. Infection control is well managed. EVIDENCE: The communal areas of the home are bright and airy. During the last twelve months the home has continued with its programme of redecoration and refurbishment. The pre-inspection questionnaire shows that the kitchen has been re-fitted, the dining room has been decorated and a new carpet fitted, tiling and flooring has been replaced in some toilets, new lighting fitted to the first floor corridor, some windows have been double glazed and some bedrooms have been decorated and refurbished. There are some radiators in the upstairs corridor and two of the bedrooms that still do not have guards fitted. This was identified at the last inspection visit. The manager said that
Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 17 these are to be addressed during the 2007/8 refurbishment programme. A recommendation remains in place. The home has a number of people that have dementia, but the environment does not reflect this. There is little signage, use of colour, memory boards and large clocks and calendars to orientate people. During the feedback session the manager and one of the registered providers agreed to give this area some consideration. A recommendation has been made. During the refurbishment programme the small garden at the rear of the home has been neglected, but the registered provider said that plans to address this are already in hand. Records show that fire appliances are maintained as required. Weekly tests of fire equipment are carried out and recorded. All areas of the home were clean, tidy and free from any offensive smells. The home’s domestic was very enthusiastic and proud of her work and it was clear that her passion for cleaning certainly benefits the home and the residents. All of the residents surveyed said that the home is always fresh and clean. Staff had a good understanding of the measures that they should take to stop the spread of infection in the home. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Taking into account the layout of the home and the number of residents, staffing levels are not always sufficient to meet the needs of residents. Staff receive a good level of training and recruitment practices protect residents. EVIDENCE: Looking at duty rotas and discussions with staff identified that on an evening shift there are only two people on duty in the home. The cook finishes her shift after the lunchtime meal is prepared, which means that care staff have to prepare, serve and clear away the teatime meal, in addition to their caring duties. At times when staff are assisting residents to bathe or prepare for bed, other residents are left unsupervised in the lounge areas. A requirement has been made. The recruitment records of two members of staff, appointed since the last inspection, were sampled. In both cases there were completed application forms, written references, and CRB/POVA (Criminal Record Bureau/Protection of Vulnerable Adults) disclosure checks. The home does not keep any records of the recruitment and selection interview, therefore does not have any
Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 19 evidence that good equal opportunities practices are followed. A recommendation has been made. Both staff members had completed a very thorough induction programme based on the Skills for Care induction standards. The pre-inspection questionnaire shows a good level of training in the home which in the last twelve months has included training on food hygiene, fire safety, first aid, moving and handling, infection control, health & safety, diabetes, introduction to dementia, dementia awareness, caring for confusion, catheter care and adult protection. 73 of staff have achieved a National Vocational Qualification (NVQ) at level 2 or above in Care. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents. EVIDENCE: The manager is respected by staff, and a number of completed survey cards showed that residents hold the manager in high regard. The manager, who has recently completed the Registered Manager’s Award, is enthusiastic and confident and leads a team of staff who receive a good level of supervision and training. The home distributes quality assurance questionnaires twice a year. The manager said that she analyses the responses from the questionnaires to
Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 21 inform future development and working practices. Residents and staff meetings are held regularly. The manager gave examples of how issues raised at residents’ meeting have been dealt with. Staff said that they are able to voice their opinions at staff meetings and that the management team are always responsive to any concerns. The home does not act as appointee on behalf of any of the residents. Some residents have cash placed in safe keeping at the home to use whenever they need it. Appropriate records are kept, but it is recommended that when any money is handed over on behalf of a resident for safekeeping a signature be obtained from the person handing over the money and the person receiving it. The pre-inspection questionnaire shows that servicing and maintenance of equipment takes place as required. The manager analyses all accidents to identify any patterns or trends. There are no bed rails in use in the home, but the manager was aware of the safety precautions required should they be needed at a future date. Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 22 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 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 23 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 OP27 Regulation 18 (1) (a) Requirement The home must review staffing levels, particularly on the evening shift, to make sure that the needs of residents are met. Timescale for action 31/08/07 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 OP2 Good Practice Recommendations All residents and/or their relatives should be given a contract at the point of admission, so that people are aware of the terms and conditions of their stay. The terms and conditions should be amended so that it accurately reflects all additional charges and conditions of the resident’s stay at the home. To reduce the risk of errors when staff make a handwritten entry on Medication Administration Records, the entry should be checked and countersigned by a second person. The home should consider using colour, signage, memory boards, large clocks and calendars to orientate people with memory loss. Arrangements should be made to ensure that all radiators
DS0000001461.V331451.R01.S.doc Version 5.2 Page 24 2 3 4 OP9 OP19 OP25 Hillcrest Residential Care Home are fitted with a guard, for the safety and comfort of residents. This remains outstanding from the inspection in March 2006. In order to provide evidence of good equal opportunities practices the home should keep a copy of staff recruitment and selection interviews. These should be signed and dated by both people conducting the interview. Where money is handed over on behalf of residents for safekeeping, a signature should be obtained from the person handing over the money and the person receiving the money. 5 OP29 6 OP35 Hillcrest Residential Care Home DS0000001461.V331451.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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