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Inspection on 16/12/05 for Hillcrest (Smethwick)

Also see our care home review for Hillcrest (Smethwick) for more information

This inspection was carried out on 16th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The overall impression is one of a strong feeling of `community`. Activities are frequent, well planned, and well organised, with clear evidence of active involvement and influence from Residents. The Home works well at identifying and meeting the care needs of individual Residents in a flexible and effective manner. Particularly notable was the provision of meals to meet individual preferences, and the involvement in `family` activities, e.g. shopping, visits to local entertainment activities, including the local public house.

What has improved since the last inspection?

The Owner and the Manager have effectively addressed all three `Requirements` cited at the previous Inspection. The Home has also benefited from the replacement carpets throughout.

What the care home could do better:

Judging by observation during the Inspection, there appears nothing of significance, to which the Homes` Owner, or Manager, might turn their attention.

CARE HOME ADULTS 18-65 Hillcrest 13 William Road Smethwick West Midlands B67 6LN Lead Inspector Keith Salmon Unannounced Inspection 16th December 2005 09:30 Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 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 DS0000004781.V271089.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 Adults 18-65. 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 DS0000004781.V271089.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillcrest Address 13 William Road Smethwick West Midlands B67 6LN 0121 429 4645 0121 429 2218 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) Mr Michael Jenkins Mrs Deborah Fatile Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 11 November 2004 may be accommodated at the home in the category LD(E). This will remain until such time that the identified service users placement is terminated, The home may from time to time continue to provide care to service users who have lived in the home who have reached the age of 65 years of age. Once the placement is terminated the registration category reverts back to LD. 31st March 2005 2. Date of last inspection Brief Description of the Service: Hillcrest is a small Home providing accommodation and care for three adults with learning difficulties. The property is a traditional semi-detached house, well maintained, and situated in a residential area of Smethwick. There is a small driveway with on-road parking to the front of the Home. To the rear of the premises is a garden, with a lawned area and greenhouse. The Home benefits from close proximity to public transport routes. The ground floor of the house comprises a communal sitting room, kitchen, conservatory/dining area, a bedroom for one of the Residents and a laundry room. The first floor comprises two large bedrooms for Residents, a bathroom with toilet and a ‘sleeping in’ room/office used by Staff. The facilities are well maintained with décor and furnishings providing a warm, homely and comfortable ambience. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection commenced at 09.30, lasted 3.5 hours, and was undertaken by one Inspector. This Report is a product of a review of progress of ‘Requirements’ cited at the previous Inspection, held in March 2005, of care related documentation, including staff recruitment/deployment records, plus a range of documents/records reflecting the general operation of the Home, together with observations made during a tour of the Home, and discussions with the Proprietor, Registered Manager and a member of the ‘night’ care staff. High standards of direct care provision, and overall management are provided in a very friendly, homely, and open atmosphere. This was strongly reflected through discussion with one of the three Residents – the other two Residents attending college at the time of the Inspection. Comments made by the Resident interviewed included …“I enjoy my food and they let me have what I like…” “The Staff take us on smashing holidays in Spain…” “I go swimming when I want, which I like very much…” What the service does well: What has improved since the last inspection? 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 DS0000004781.V271089.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 & 5. Prior to taking up residency prospective Residents are enabled to reach an informed choice, and to fully understand the service they can expect to receive. Furthermore, prospective Residents are able to partake in a well thought through programme to enable a ‘test-drive’ of the Home. Processes to ensure appropriate, and thorough, assessment of care needs and aspirations are diligently and effectively applied prior to admission. Each Resident is issued with an individual statement of ‘Terms and Conditions’. EVIDENCE: The Home has a Statement of Purpose and User Guide, both of which are concise, easy to read and contain content, which meet the requirements of the Standard. Service Users are provided with an individually appropriate Statement of Terms and Conditions detailing the accommodation to be provided. All Care Plans were reviewed which clearly demonstrated the Registered Manager assesses all prospective Residents prior to admission, and new Residents have the opportunity to visit the Home, or enter the Home on a trial basis, prior to admission. This process begins with initial visits of a few hours to see the Home, and to meet the other Residents, moving on to overnight and weekend stays. Following ‘admission’ there are regular monthly reviews with a formal case review after six months has elapsed. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9. Care needs are comprehensively identified in Care Plans, and acted upon, through clearly stated, current instructions and interventions. Care Plans are regularly reviewed and revised as necessary. Residents are thoroughly involved in determining all aspects of their life at Hillcrest and are enabled, and supported, in conducting their lives at risk levels consistent with individual capability. EVIDENCE: Care Plans showed related Care Planning documentation to be well organised, current, clearly written and comprehensively encompassed the range of ‘care areas’, and lifestyle ‘decision’ areas, necessary to ensure the delivery of care appropriate to the needs of each Resident. The Resident spoken with confirmed this was so. The Home has developed a comprehensive set of individual and appropriate generic risk assessments. The Inspector observed evidence that risk assessments are reviewed on a regular basis. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &16. The Home provides an interesting range of activities that are appropriate to Residents’ needs, wishes, and capabilities. Residents are enabled to participate in a range of social and recreational pursuits and are actively supported in maintaining/developing links with relatives and the wider community. Transport is always available through the Manager or the Proprietor, who is regularly and actively involved in the running of the Home. EVIDENCE: Observation and discussion with Management and one Resident showed routines are flexible to suit the needs of individuals. An open visiting policy is operated with Relatives/Friends being encouraged to become involved in the service delivery. Individual ‘diaries’ (entitled day records) provided evidence of support for Residents wishing to engage with the local community, undertake group activities with the other Residents and of activities focussed on the individual. Activities include, trips out using the Home’s mini-bus, attendance at the local Church, ten-pin bowling and visits to the local pub. One Resident described to the Inspector how he frequently attends a swimming club, a local ‘luncheon club’ and joins the Staff, and other Residents, to do the weekly household shopping at the local supermarket. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 10 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The Report from the previous Inspection ‘Required’ the Home to review systems for the administration of medicines, specifically the decanting of medicines from the containers in which they are supplied into a ‘Medidose’ container for each Resident. This practice has ceased and inspection of the medicine storage provision, and medicine administration records, demonstrated the Home’s practices now, with the exception of the matter identified below, meet the guidelines of the Royal Pharmaceutical Society. EVIDENCE: Examination of the Home’s systems for the receipt, storage, and disposal of medicines, and related records, showed them to be satisfactory. Staff informed the Inspector of difficulty in reading the dates at the top of the Medicine Administration Sheets (MAR sheets), as supplied by the pharmacy, due to slight misalignment. In an attempt to overcome this problem, the Manager transcribes each medicine prescription from the printed MAR Sheet to the Home’s own design of handwritten sheet – the accuracy of this is checked by a second person. Ideally the Home should discuss the matter with the Pharmacy to correct the misalignment. However, if the practice is to continue, it is ‘Recommended’ that a written ‘risk assessment’ be completed. This should clearly identify the rationale for continuing this practice and provide an accompanying written procedure. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 11 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. The interests of Residents are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure. Staff are clearly aware of their role in protecting Residents from abuse. EVIDENCE: A clear and concise Complaints Procedure is displayed, which includes reference to the Commission for Social Care Inspection as the regulatory body, together with contact details. Policies relating to the protection of Residents from abuse were observed to be in place and readily accessible, these included, ‘Whistle Blowing’, ‘Abuse Awareness,’ and ‘Adult Protection’. Staff training files indicated that Staff had received training in respect of these Policies. The Home maintains a system for the recording of complaints, with none having been lodged since the previous Inspection. Records demonstrated that two Residents have support from close relatives, and the third Resident has regular contact with an ‘advocate’. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 12 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28 & 30. The Home’s bedrooms, dining and lounge/sitting areas offer a comfortable ‘domestic’ ambience, with furnishings being in good order. Bedrooms are decorated and furnished to the Residents’ wishes and personal choice. EVIDENCE: The Home has a full range of maintenance contracts in place, with all areas clearly benefiting from regular refurbishment/redecoration. Carpeting has recently been replaced throughout the Home. The garden provides a safe environment, is easily accessible to Service Users at all times of year, and provides opportunity for Residents to be involved in its maintenance. Residents are clearly encouraged to personalise bedrooms with their own possessions. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 13 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 & 36. Staff numbers on duty, and skill-mix were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are now consistent with the safeguarding of Residents. The commitment of the Home to providing training for Care Staff, and to continuing supervision and support, is good. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. The previous Inspection cited a ‘Requirement’ that all staff must have Protection of Vulnerable Adult’ register clearance prior to commencing employment. Staff Personal Files demonstrated evidence that the Home is now in accordance with this ‘Requirement’ and of full compliance with the Standard and Schedule 2 of the Regulations. Staff are subject to a thorough, and relevant, orientation/induction programme, which is followed by comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 14 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,40,41 & 42. The Home has excellent leadership from the Manager, who, in turn, is very well supported by the Owner. The ambience of the Home is warm, friendly, and inclusive. Operationally, the Home is very well organised, with the central purpose being ‘the best interests of Residents’. All Staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices were satisfactory. EVIDENCE: Residents and Staff were seen to approach the Manager with a range of issues, which were received in an interested and involved manner. In turn the Registered Manager is well supported by the Owner, who visits the Home on most days. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Records are maintained for hot water supply to baths, and water tested during the Inspection was satisfactory and COSHH data sheets are up to date. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 15 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hillcrest Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 3 X DS0000004781.V271089.R01.S.doc Version 5.0 Page 16 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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations The practice of transcribing each Resident’s medicine prescription(s), from the printed MAR Sheet, to the Home’s own design of handwritten sheet should be subject to written ‘risk assessment’. Also there should be accompanying documentation, which clearly identifies the rationale for continuing this practice, together with a written procedure that includes a requirement for the signatures of both members of staff involved in the process of transfer. Hillcrest DS0000004781.V271089.R01.S.doc Version 5.0 Page 17 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 DS0000004781.V271089.R01.S.doc Version 5.0 Page 18 - 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!