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Inspection on 08/11/05 for Hillcrest Residential Home

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

This inspection was carried out on 8th November 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mrs Hope, the manager is very dedicated and caring. Both she and care staff are all approachable and friendly. The recording in the daily statements about residents in the home is good and shows what care had been provided and by whom. Care staff were seen to be respectful and preserve dignity. The home is comfortable and on a smaller scale than some care homes therefore has more of a domestic feel. Two residents one of whom was new and one who has been at the home some time said they would recommend the home as it provides all the care you may need and you can `do as you like`. Feedback cards received from four residents expressed a positive response to questions asked.

What has improved since the last inspection?

There has been a significant and measurable improvement in this service since the last inspection at the home. At the last inspection there were thirteen requirements made, eleven of which were repeat requirements. At this inspection all but three of the requirements have been actioned and progress made. The most significant improvement has been the recruitment of more staff to ensure there is sufficient staff available to care for the residents and allow the manager time to manage. A falls prevention officer has visited the home and offered assessment and support in how to prevent three residents from falling and injuring themselves. All new staff recruited have an enhanced CRB in place. There was evidence of assessments completed before residents move into the home, limited activities on offer and a choice of meals on a planned menu.

What the care home could do better:

There are two main focuses to further improvement at Hillcrest. The first is to address the remaining repeat requirements made and secondly to now ensure those staff recruited have the appropriate training in place. Mrs Hope agreed that this would be her focus for the coming months and she would develop a training plan. The first priority would be to have manual handling training in place for all care staff.

CARE HOMES FOR OLDER PEOPLE Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB Lead Inspector Claire Hutton Announced Inspection 8th November 2005 10:00 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 Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillcrest Residential Home Address 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB 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) 01284 760774 Mr Christopher J and Mrs Magda Hope Mrs Magda Hope Care Home 13 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (13) of places Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. One named individual to be accommodated with dementia (DE) (E) as detailed in the application for variation dated 16/06/05 10th June 2005 Date of last inspection Brief Description of the Service: 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. Hillcrest is registered under the provisions of the Care Standards Act 2000 and can accommodate up to 13 older persons, one of whom has a diagnosis of dementia. 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 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. Smoking is not permitted at the home. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection lasted 5 ½ hours on a mid week day in November. This inspection is the third to be completed in this inspection year and the two other inspection reports from 14th April 2005 and 10th June 2005 will provide an overview of all standards covered and the progress made. Time was spent with both Mr and Mrs Hope and private time was spent with two residents and two care staff. All residents were seen in the communal areas and all areas of the home were inspected. Records examined included care records for three residents and recruitment records for three staff. Other records examined included rosters, servicing records, training and menus. What the service does well: What has improved since the last inspection? There has been a significant and measurable improvement in this service since the last inspection at the home. At the last inspection there were thirteen requirements made, eleven of which were repeat requirements. At this inspection all but three of the requirements have been actioned and progress made. The most significant improvement has been the recruitment of more staff to ensure there is sufficient staff available to care for the residents and allow the manager time to manage. A falls prevention officer has visited the home and offered assessment and support in how to prevent three residents from falling and injuring themselves. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 6 All new staff recruited have an enhanced CRB in place. There was evidence of assessments completed before residents move into the home, limited activities on offer and a choice of meals on a planned menu. 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 Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People who use this service can expect to have their needs assessed before they move into the home and be provided with suitable information. EVIDENCE: A revised Statement of purpose and Service Users guide were sent to the CSCI and these are suitable and meet the regulations. Three resident records were examined. All three individuals had an assessment of their care needs in place. In the case of a new resident recently admitted to the home the manager stated she had completed this before they had moved into the home. A date should be placed upon the form used to clarify and evidence this. There was also evidence of close liaison with the social worker concerned and with the resident’s family. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Residents can expect that their health and personal care needs will be known and met by staff and assessments such as falls prevention within the home will be followed up. EVIDENCE: The care plans for three residents were examined. Information required by regulation was recorded. There was a care plan in place for elements of care such as personal care, diet and weight, sight and hearing, oral health, foot care, mobility, continence and risk assessments. Each element of the care plan had a clear set of instructions for care staff to follow in how to care. Four replies from resident’s questionnaires stated that all four residents felt well cared for. Six replies to relative’s questionnaires were received. Five of the six felt that they were consulted about the care of their relative. One person felt they were not consulted. In one assessment that stated that the person had a history of falls, this had been followed up by a visit from the falls prevention officer. The falls prevention officer was said to have visited three people at the home and given Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 10 specific advise on their individual circumstances and how to prevent further potential falls. Daily notes were looked at. These showed a record of the care given. An example was ‘ settled, laughing and chatting in the lounge. Assisted to the toilet, drank well through out the day. Helped to wash and assisted to bed.’ As part of the care plan, assessments on mental health and nutritional screening were seen in place. Evidence of being registered with a GP and District Nurse visits were seen. The District Nurse had recently been to offer the flu jab to residents at Hillcrest. There was evidence of chiropody and optician visits too. Records showed that two residents who required hospital treatment recently, had treatment and one returned to the home and had made a good recovery from a broken bone. The falls prevention officer also followed up this person. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Residents can expect a wholesome balanced diet with a choice to be offered. Residents were satisfied with the social opportunities presented. EVIDENCE: The home has a notice board and upon it are advertised occasional social events. The manager explained that yesterday there was an art session and today the hairdresser was due to visit. Four of the residents, asked about activities at the home, felt that the Hillcrest does provide suitable activities. The manager was also planning trips for Christmas shopping using the ‘buddy’ scheme in Bury St Edmunds. One resident approached the inspector and wanted her to know that ‘they let you get on with life here’. Lunch on the day was pork casserole with mash potatoes, green beans and carrots. One person had the alternative of a steak and mushroom pie that they had also chosen the day before, because they enjoyed it so much. The meal was served quickly and efficiently and was hot when taken to the residents. There was ample food for all the residents. One resident said the food was ‘very tasty’ and that he tended to ask for more. Records of menus planned were seen. That evening the menu was soup and a sandwich. There was a record of all food eaten and the choice offered. Some residents occasionally took this. Food temperatures were recorded, as were fridge and freezer temperatures. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 This service does not have regular complaints made about it, but not all parties are aware of the procedure if they need it. The home does take reasonable steps to protect residents from abuse. EVIDENCE: There have been no complaints received about this service since the last inspection at the home. The complaints procedure was set out in the recent Statement of purpose and Service Users Guide sent to the CSCI. Three out of the six relative questionnaires stated that they did not know of the complaints procedure. This was discussed with the manager and she agreed that a good way of informing people would be to display the procedure on the notice board. At the previous inspection there was a concern that not all staff had a CRB (criminal records bureau check) or a POVA 1st check in place. New staff recruited, were seen to have this in place at this inspection. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22 and 26 The environment at Hillcrest is comfortable and generally meets the needs of the residents, however the safety in use of the stair lift currently cannot be guaranteed. EVIDENCE: A tour of the communal areas and some bedrooms was undertaken with the manager. The home was clean throughout and on the whole odour free. There was just one bedroom that had an odour. This was discussed with the manager and she had recently purchased a new enzyme product that she hoped would solve the matter. The rusty toilet seat in the toilet near the lounge has been replaced with a new raised seat. The toilets were clean and the locks could be used to ensure privacy. The toilet used by staff had liquid soap and paper towels in place. A resident was seen to use the stair lift independently. Instructions on how to use the stair lift were not posted on the wall. No care plans seen had an Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 14 assessment on individual use and support required to use the stair lift. This matter was mentioned in the last two reports and has not been actioned. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The number of staff employed at this home has improved and is likely to improve further, however the training of these staff to a sufficiently competent level will take longer as English is not their first language. EVIDENCE: The rosters for the three weeks before the day of inspection were examined. The deployment of staff was much improved. Mostly there was two care staff on duty and a third person to do the cooking. Only on three occasions in the four week period did this drop to two care staff and no cook. The roster also showed that the manager was not working excessive hours and did have allocated manager hours in which to manage. This has been possible as the home has recruited more staff and there was evidence of recruitment of more staff in hand. The recruitment was improved and more robust. However one person only had one reference in place and a second is needed. The manager was also reminded that photographic identification was required by all staff not just those from abroad. Staff had been recruited from abroad and their English was not particularly good. The home had taken measures to improve this and they were enrolled these staff on an English course at the local college. One member of staff tended to translate for those staff that had difficulty. The training for staff that are unable to understand or speak English is a problem that the home are working on to overcome. The manager had planned a manual-handling course Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 16 to be run at the home with an interpreter present on the course. The same was to be planned for other courses that are found on the induction training such as first aid. The manager agreed to develop a training plan for all staff to ensure they had minimum induction training and regular updates. An induction to Hillcrest had been completed for each new member of staff and was evidenced in their files. Two care staff were met and spoken with. One was from abroad and was able to understand short simple sentences. She spoke about the needs of the residents and appeared to know them well. The staff member recounted how they had given first aid to a resident and had saved their life as the resident had swallowed their tongue. This same person is currently doing her NVQ 2 in care at the local college. The second staff member said that they had nearly finished their NVQ 3 in care. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33 and 38 The intentions of the owners are good and they are beginning to address requirements made. EVIDENCE: The manager was helpful to the inspector and along with staff comment and residents comment concludes that her approach is one of kindness and a genuine wish to care for older people. Staff and residents found her approachable and that she listened. Since the last inspection there has been a reduction in the number of repeat requirements and the manager has been spending less time as a carer and more time in the managers’ role, thereby ensuring matters are addressed. Mr Hope was present at part of the inspection and time was spent discussing the ways in which quality assurance systems could be implemented into Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 18 Hillcrest. At this time there are no systems in place and Mr Hope intends to implement a system in the coming months. In addition he was developing a manual of policies and procedures that he intends to make available to all staff. In relation to health and safety matters, certificates for servicing were seen for electric and the landlords gas certificate. Evidence of the stair lift being serviced was seen, however the certificates for the hoists was not available, but the manager gave an assurance that these were under contract and had been seen recently by an engineer. Environmental precautions were in place such as: restriction on the hot water in baths to prevent scalding (records were seen of temperatures), covers on radiators to prevent burns and window restrictors to prevent anyone falling from a window. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X 3 2 X X X 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X X X X 3 Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP22 Regulation 23(2)(n) Requirement Residents must have safe access to all parts of the home therefore: - appropriate safety signs and instructions for use must be clearly displayed at each end of travel. - residents must be risk assessed to ascertain whether they are able to use the stair lift safely without assistance. - Where residents require help, staff should be trained in its use and the best way to assist the resident. (This is a repeat requirement from 14/04/05 and 10/06/05) The home must be clean and hygienic therefore the odour in bedroom 7 must be eliminated. Residents needs must be met by the numbers and skill mix of staff therefore, two members of care staff must be on duty throughout the waking day, available at all times to attend to care tasks. In addition to these two staff members, a separate DS0000024417.V253936.R01.S.doc Timescale for action 08/11/05 2 3 OP26 OP27 13(30 16(2)(j) 10(1) & 18(1)(a) 30/01/06 08/11/05 Hillcrest Residential Home Version 5.0 Page 21 4 OP29 7,9,19 5 OP30 18(c) (i)(ii) 6 OP33 24 staff member must be available to attend to the kitchen duties. Residents must be protected by 08/11/05 the homes recruitment policy and practice therefore the manager must ensure all checks required by this regulation are in place. (This is a repeat requirement of 14/04/05 and 10/06/05) The registered person ensures 01/05/06 that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of residents. (This is a repeat requirement of 14/04/05 and 10/06/05) Effective quality assurance and 01/05/06 quality monitoring systems, based on seeking the views of service users, must be in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 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 2 Refer to Standard OP12 OP16 Good Practice Recommendations Residents should be consulted and a suitable programme of activities should be provided based on the outcome. The complaints procedure should be displayed at the home for all residents, visitors and relatives to see. Hillcrest Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Residential Home DS0000024417.V253936.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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