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Inspection on 20/10/08 for Hillcrest Residential Home

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

This inspection was carried out on 20th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Hillcrest completes an assessment of need before residents move in and therefore is able to be confident they can meet peoples needs. Information is available about the home and contracts are in place. Two surveys completed by residents told us that contracts were in place and that that their was enough information provided about the home. People can expect a good standard of health and personal care at this home. The home is good at bringing people back to a good level of health if they have been admitted with concerns about their wellbeing. Medication is safely managed and privacy and dignity is respected. One resident spoken with said `The staff are lovely they look after us alright`. We spent time observing staff and residents together and saw the interaction was friendly, respecting choices and that staff were quick to respond to requests. Staff were seen to aid residents with personal care ensuring privacy and dignity. The overall atmosphere was very relaxed and unhurried.

What has improved since the last inspection?

Since our last visit to the home a number of environmental improvements had taken place. The exterior of the home had recently been painted and the main entrance, stairs and landing had also been recently decorated. A new gas boiler had been installed and a new bath had been fitted upstairs. At the previous inspection of this service there were 6 matters that we asked the home to look at and address. On this inspection we found that all matters had been improved upon. Assessments before admission to the home are now in place and health prevention interventions are now in place. In relation to medication the use of codes was in place to ensure a full audit of medication could be undertaken. Recruitment procedures were satisfactory to ensure residents are protected.

What the care home could do better:

There is one key area of development that this service must concentrate on and that is the management of the home. The management of this home is adequate and the manager knows that development that is required. The manager needs to become suitably qualified. The quality assurance systems in place need to be further developed and safety matters such as the fire risk assessment need to be addressed to ensure everyone at the home is a safe as can be expected.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Hutton     Date: 2 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB 01284760774 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Magda Hope Type of registration: Number of places registered: Mr Christopher J and Mrs Magda Hope care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named individual as notified to the Commission on 23/11/06 in the category of Physical Disability. Condition to expire on 07/01/09. Date of last inspection Brief description of the care home Hillcrest Residential Home is a privately run care home based in a Victorian property that has been extended and adapted to provide residential care since 1997. The home is located in a quiet residential area of Bury St. Edmunds. It is close to a small shop that is accessible to some residents. Hillcrest provides two single bedrooms and one double bedroom on the ground floor along with nine single bedrooms on the first floor. Access to the first floor is by stair lift. There is a step between the lift and the bedrooms, which may prove difficult for service users with mobility difficulties. One of the bedrooms benefits from the provision of en-suite facilities. There are two Care Homes for Older People Page 4 of 26 Over 65 13 0 0 1 Brief description of the care home communal assisted bathrooms and five assisted toilets within the home. Residents have access to a lounge that overlooks the pleasant garden with seating provided. There is also a separate dining room on the ground floor. Fees at this home range from £355 to £448 per week but do not include the cost of newspapers, hairdressing, toiletries, chiropody and transport. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced on a weekday, which lasted 5 hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from 4 Have Your Say surveys. The Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) was returned completed by the new manager. This selfassessment gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). Care Homes for Older People Page 6 of 26 A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home and 2 members of staff. The manager of the home was available during this inspection and fully contributed to the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hillcrest completes an assessment of need before residents move in and therefore is able to be confident they can meet peoples needs. Information is available about the home and contracts are in place Evidence: During our visit we requested information about the home and were given a Service Users Guide. This contained some good information about the home and was available for anyone to read. The self-assessment completed by the manager told us that they would continue to develop this information. We requested to see the needs assessment completed on two new residents. The selfassessment had told us that a full assessment was completed prior to admission along with consultation with the prospective resident. These assessments were available and had been completed. The assessment was based around the activities of daily living Care Homes for Older People Page 10 of 26 Evidence: and therefore gave a good base line on which to develop a care plan. Two surveys completed by residents told us that contracts were in place and that that their was enough information provided about the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect a good standard of health and personal care at this home. Medication is safely managed and privacy and dignity is respected. Evidence: We looked at 3 current care plans for people of differing dependency levels and found a good plan of care in place that gave information to staff on how best to support the individuals. Plans also included risk assessments for personal safety and falls prevention. Two staff spoken with said the plans were good and it was useful that everyone was involved in these plans. There was evidence that these were reviewed regularly. Two surveys from residents said that they always received the care and support they needed another person said they usually did. One resident spoken with said The staff are lovely they look after us alright. For two individuals tracked both had a need to increase their weight and monitor health with screening of sight and hearing. One individual had been at the home some time and from their care plan and daily records it was evident that they had gained Care Homes for Older People Page 12 of 26 Evidence: weight and had been monitored by the GP and had their blood pressure monitored. Another resident was new to the home and needed diet supplements that had been prescribed and the dietitian was involved. Weight was monitored and this was seen to be slowly increasing. Both these residents were met and spoken with. Both appeared well and healthy with one being independent and going out daily for a walk. A relative was spoken with and they said my relative used to weigh just 7 stone - now look at her. The resident was smiling and of a good size. There was evidence that the district nurse was involved with some residents and residents had all been offered the flu vaccine. The surveys returned said that residents did receive the medical support they needed. We spent time observing staff and residents together and saw the interaction was friendly, respecting choices and that staff were quick to respond to requests. Staff were seen to aid residents with personal care ensuring privacy and dignity. The overall atmosphere was very relaxed and unhurried. In relation to medication at the home we saw the lunch time medication being given out. This was completed well as staff were pleasant, chatting but observant that medication was taken and then records completed. The records completed were good and showed that residents received their prescribed medication and if residents chose not to have their medication then this was noted appropriately on the forms. We also checked the controlled drugs stock and records and these were well maintained. Storage was appropriate. Staff spoken to confirmed they had received training in how to administer medication. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hillcrest provides individual activities and social contact for residents. The residents are provided with a wholesome and appealing balanced diet to keep them well and healthy. Evidence: We spent time in the main lounge observing the routine of the home and talking to residents. Two residents were playing a game of dominoes and one resident was chatting to a relative who was visiting. Preparations were under way for lunch with the dining tables being set out nicely with table clothes, condiments and drinks. One resident spoken with spoke of the small craft toys that they were making and showed me their work. We asked them about the food at the home and they said yes the food here is very good. We were told that lunch was cod in parsley sauce with vegetables and potatoes. Another residents said the food was lovely and if you did not like what was on the menu then you could have a veggie burger or sausages. A resident came down for lunch and told us they had been in their room doing a word search puzzle. Twelve people had lunch at the small dining tables. During the meal mellow music was put on and the residents ate their meal to Three coins in a fountain One resident Care Homes for Older People Page 14 of 26 Evidence: chose to stay in their lounge chair. Their lunch was served on an individual tray and the meal was covered to keep it warm. A plate guard was used and the resident was encouraged to eat the meal for themselves, but with staff assistance. This resident was given a special cup that enabled them to drink for themselves. Close attention was paid by staff to requests made by the residents. One resident upon seeing their meal asked if they could have a smaller meal. Staff immediately went to the kitchen and returned with a smaller portion. After lunch one resident got themselves ready to go out into Bury town center. Another resident retrieved their magazine with their name upon it. We were told that yesterday residents watched a DVD on the new large flat screen TV in the lounge. Surveys returned say that activities are provided and staff spoken with were asked what did they feel Hillcrest did well and they said spending time doing one to one activities and encouraging independence. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident that concerns, complaints and safeguarding will be taken seriously and acted upon. Evidence: With regard managing complaints the self-assessment told us that all residents and relatives are issued with a copy of the complaints procedure and have the advantage of being able to raise any concerns directly with the owner/manager. The owner manager is at the home most days and is in day to day control of the home and is approachable should their be any concerns needing to be raised. The complaints procedure was clearly displayed upon the wall for anyone to access. In the last 12 moths the home has received 2 complaints. We were able to view the log where these were recorded and found that these had been looked into and responded to. Three surveys from residents all said they were aware and knew how to make a complaint should they need to. With regard to safeguarding adults the home has a copy of the local policy and procedure for reporting possible abuse of vulnerable people. The manager confirmed that staff had received training as part of their induction and some staff had attended a specific training course. We spoke to staff and they confirmed that they had read the homes policy and procedures and were aware of different types of abuse. Staff were Care Homes for Older People Page 16 of 26 Evidence: also clear that they had a duty to alert any suspicions and knew the process for doing this. This service has had no safeguarding issues in the last 12 months. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hillcrest provides a comfortable environment that is safe, clean and homely. Evidence: We toured most of the home. The home was nice and warm in all areas visited. This may be as a result of a new gas boiler recently being installed. The surveys returned from residents said that the home was always fresh and clean. The exterior of the home had recently been painted and the main entrance, stairs and landing had also been recently decorated. All areas were clean and well maintained except for a couple of matters discussed with the manager. The wash hand basin in the downstairs room was chipped and the seal discoloured. The bay in room 3 had a damp patch - the manage explained that the damp had been resolved and the decor needed putting right to make it look good. In order to maintain the carpets in the home the manager had purchased a rug doctor. There is a specific small building for laundry that is well equipped. Hillcrest provides two single bedrooms and one double bedroom on the ground floor along with nine single bedrooms on the first floor. Access to the first floor is by stair lift. There is a step between the lift and the bedrooms, which may prove difficult for service users with mobility difficulties. One of the bedrooms benefits from the provision of en-suite facilities. There are two communal assisted bathrooms and five assisted toilets within Care Homes for Older People Page 18 of 26 Evidence: the home. Residents have access to a lounge that overlooks the pleasant garden with seating provided. There is also a separate dining room on the ground floor. In terms of aids and adaptations the home has a stair lift in place. We saw a resident use this and they required and received support to use it. There was a hoist available and we saw this had been serviced. In the lounge some residents were sat upon inflated cushions to prevent any pressure areas. A new bath upstairs had also been installed. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hillcrest has sufficient staff that are generally well recruited and trained. Evidence: We examined the roster for the previous 2 weeks and found that consistently there were 2 staff on duty during the day and at night there was a waking night staff and a staff member sleeping in case of an emergency. All surveys completed by the residents said that staff were available when they needed them. Staff spoken with said that staffing levels at the home were OK and that an advert had been placed for the one staff vacancy. The self-assessment told us that the home had a stable senior staff team in place and that there were regular team meetings and hand overs from one shift to the next which were supervised by the manager. With regard to staff training the manager told us that 75 of staff had NVQ 2 and above. We spoke to one individual who told us they were doing nutrition and health at a local college and had completed training in dementia. We also spoke to someone who had been at the home a short time and had started their NVQ 2. Records examined showed that staff had a good base line training in matters such as manual handling, basic food hygiene, 1st aid and medication. We looked at the recruitment records for 3 staff and found that all required checks had Care Homes for Older People Page 20 of 26 Evidence: been undertaken according to regulation, however one person had a second reference still outstanding. This was brought to the managers attention and she agreed to rectify this straight away. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of this home is adequate and the manager knows that development is required in becoming suitably qualified, developing quality assurance and further developing safety such as the fire risk assessment. Evidence: The manager of this home has many years experience in looking after older people. She originally trained as a nurse. The manager has yet to complete her registered managers award as due to circumstances the 2 different courses she had enrolled on were not able to be completed. The manager gave an undertaking to enroll upon an appropriate course and become suitably qualified. Staff spoken with thought well of the manager and one person said shes easy to talk to. Staff also confirmed they received supervision and a record of this was maintained. In relation to assuring quality within the home the manager is aware that this is an area for development and is keen to develop monitoring systems to look at all aspects Care Homes for Older People Page 22 of 26 Evidence: of the service. In relation to seeking residents views there were residents meetings that had taken place. We were able to see the minutes of these and topics such as decoration of the home, meals, drinks and activities were discussed last time. The manager has also received back 3 surveys from residents and their families. The overall feedback was positive. The home does not take control of financial matters for residents, but they do hold small amounts of cash for people. We looked at the storage and records for this and found that these were satisfactorily maintained with receipts kept. We looked at health and safety matters. The self-assessment told us that all required policies and procedures were in place and that all equipment was appropriately maintained. We sampled a number of these records and found them in place. We also found hot water temperatures from baths to be within safe limits and a landlords gas safety certificate had recently been issued. The home had a visit from the fire and rescue service and they had written to the home with work required to ensure the safety of residents. The manager was able to confirm that the physical work on exits and fire detection had been completed, but that she had yet to complete the review on the homes fire risk assessment. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 12 The fire risk assessment must be reviewed and up to date in line with the fire rescue recommendations. Currently people do not have their health and safety promoted and protected. 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 29 A thorough recruitment process should be followed before staff start work at the home in order that residents are protected. This should include 2 references. The owner manager of this home should become suitably qualified so that they are able to fully discharge their duties and responsibilities. The manager should establish a quality review process and send the outcome to the CSCI. 2 31 3 33 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!