CARE HOME ADULTS 18-65
Hillcrest-Vernon 10 Maltravers Drive Littlehampton West Sussex BN17 5EY Lead Inspector
Gill Davis Announced Wednesday, 19 October 2005, 09.30am, V247284
th 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 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 Stationary 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-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hillcrest-Vernon Address 10 Maltravers Drive, Littlehampton, West Sussex, BN17 5EY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 716556 01903731023 vernon@hillcrestcare.co.uk Hillcrest Care Ltd Mrs Tania Helen Carter CRH 14 Category(ies) of LD-14 registration, with number of places Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23/06/05 Brief Description of the Service: Hillcrest Care Limited is a privately owned organisation and the Responsible Individual is Mr Richard Greenwell. Hillcrest-Vernon is a care home registered to accommodate 14 service users. (Category of Learning Disability) The premises consist of a large detached house based in a quiet residential street, close to the sea and town centre amenities. The accommodation is based over two floors, with a lounge on each. Each resident has his or her own room, which is decorated to their specification. There is ramp access to a pleasant garden with fruit trees. Parking is located at the front of the property. The registered manager for the home is Tania Carter. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place from 9.30am until 12.30pm. Prior to the inspection the manager had completed a pre-inspection questionnaire and information from that has been used to inform this report. Comment sheets had been distributed to the residents and their relatives/representatives to enable them to comment on the care provided by Hillcrest-Vernon. One response from a resident and five from relatives have been received to date. All were very positive regarding the standard of care provided. Three also contained some constructive criticism mostly around communication, which was shared with the manager at the time of the inspection. Further discussion with those three persons identified that they were very satisfied with the service provided – in particular the quality of the staff group - and did not want any issues to be taken any further. The focus of this inspection was to assess the standards that were not assessed in the previous inspection, the staffing levels for this time of day and the care that was provided to the residents at this time. To gain a full picture of the overall standard of care this report should be read in conjunction with the previous inspection report of the 26th June 2005. Where there have been no changes in the standard this will be reflected in the report. During the course of this inspection, the inspector undertook a tour of the building; spoke to one resident who was able to communicate verbally and the five staff members on duty at the time, three in depth. The resident, was very positive about the way he was being supported. He said, “I feel I am getting on very well ---- the staff are very nice”. There are eleven residents living at the home currently and the home continues to provide a staffing ration of one member of staff to two residents. On the day of inspection three residents were taken out in their wheelchairs individually. Apart from one person, those residents who are able to communicate verbally were attending day centres. Some time was spent observing the interaction between the residents who were unable to speak and the staff members. The inspector was able to identify that staff members knew the individual residents well and were able to respond to signs and signals to meet their needs. The residents themselves appeared to be relaxed and calm and content. The records were not examined on this occasion apart from some Health Action Plans, which are being piloted by the GP for three residents as part of a Government initiative. Staff training was ongoing and it was noted that the majority of staff were either National Vocational Qualification (NVQ) trained, were undergoing or about to complete their training. The training records of all staff were well
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 6 documented and up to date. Staff members were being supervised on a regular basis and the outcomes recorded. The building has recently undergone some refurbishment of some areas inside. The home was warm, clean and welcoming. There were five members of staff plus the manager on duty at the time of the inspection. At nighttime there are two waking staff on duty. The rotas confirmed that a high staffing level was maintained. All Health and Safety issues were up to date. No requirements were made at this inspection. What the service does well:
The home continues to have a team of dedicated staff who are keen to raise the levels of care and support they give and who get good direction from the management team. From observation, it was evident that staff members work hard to improve the quality of life of those in their care. This is extended to the friends and family of those that live at the home who are welcomed and made to feel at ease. Much care is taken to ensure that a thorough assessment of need is undertaken prior to the person being admitted, this information is then used to make it easier for the person to get to know the home and the existing people who live there. A prospective resident is given a variety of information in an accessible form and encouraged to visit and try it out as much as they need before making the decision to move in. Care Plans are well written and contain all the information needed to care for the resident. The Registered Provider has produced all information for the residents using symbols and a Pictorial Service User Guide and service agreement has been given to all residents. It contains a section on how to complain if they are not happy with the service being offered. The Registered Provider has produced excellent policies and procedures for the guidance of staff members and the protection of the residents. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 7 A great deal of effort is made to advocate and promote the rights of the residents to access all services in the community regardless of their disability. What has improved since the last inspection? What they could do better:
There were no requirements following the last inspection. From the comments made by the resident and staff spoken to, feedback cards received and observations made by the inspector at the time it would appear that the team at Hillcrest-Vernon continue to nurture the culture they have established. This puts the residents to the forefront of everything that they do. Feedback cards from two relatives indicated that they did not consider that they were consulted enough regarding significant issues, but in discussion via the telephone with the inspector they confirmed that they were entirely satisfied with the overall care given by the home.
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 8 There are no recommendations or requirements resulting from this inspection. 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-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 10 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 standard(s) 3.4. Residents and their families have the information they need to make an informed choice about where they live and are suitably assessed before placement. EVIDENCE: Each resident has been given a Service User Guide, in pictorial form, which contains a contract and complaints procedure when they enter the home. Most of the residents have family or a representative who are able to act on their behalf. Careful pre admission planning to make sure that the person is well prepared for admission into the home involves visits to the home for tea, outings with the other residents and an overnight stay/stays before they are admitted. The records of these assessments were seen and found to be very detailed. It is important to the home that new residents fit in with others living in the home. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 11 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 standard(s) 8.10 Residents have a number of opportunities to contribute to and take part in all aspects of life in the home. Information regarding confidentiality and storage of information is provided in an accessible format to residents. EVIDENCE: Residents take part in monthly meetings where they are encouraged as far as possible to contribute views on activities and other issues within the home. At the last meeting they were consulted about the business plan for 2005/6. They are consulted individually as part of the home’s monthly audit and have one to one meetings with their key worker to discuss various issues. Each member of staff is asked to sign a clause regarding confidentiality at the beginning of their term of employment and it is discussed as part of the interview and induction process. The residents have information regarding confidentiality in their service user guide, which uses symbols and pictures alongside plain English. All personal information is securely stored in a locked cupboard.
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 12 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 standard(s) 14. 16 Residents take part in appropriate leisure activities and are supported to have as much control possible over their daily lives. EVIDENCE: Residents are helped to engage in appropriate leisure activities and achieve personal goals. Residents are involved in community activities and use local resources. One resident has been supported to venture out into the town on his own on occasions. Documentation was available to evidence that the residents are supported to complain, make choices and decisions. The use of advocacy reinforces this. Key workers help residents to respect each other and will liaise with other professionals to ensure that the residents are included in all aspects of community life and enjoy all rights associated with citizenship.
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 13 Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 14 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 standard(s) 20.21 There are appropriate policies and procedures in place regarding the administration and storage of medication. Issues regarding the ageing, illness and death of a service user are managed with sensitivity. EVIDENCE: There are no residents capable of managing their own medication. The home has robust policies and procedures regarding the administration, storage and disposal of medication. Detailed care plans contain information regarding the preferences of the residents regarding any wishes they might have regarding their death. A system of personal care plans in an appropriate format using symbols is used that involves the residents in all aspects of the plan. The use of symbols has also been used to explain what happens when someone dies along with a video. The recent death of one of the residents at the home was managed with sensitivity and respect and included the residents in all aspects of the subsequent arrangements. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22.23. All complaints are taken seriously and staff, residents and their families know how to complain. Staff members are well aware of the Adult Protection Procedures and a Whistle Blowing policy is in evidence. EVIDENCE: Staff members have attended the Adult protection training and the procedures are available for reference at any time. There have been no complaints since the last inspection. Residents have been given a Complaints Procedure written in symbols so that they know who to tell that they are “unhappy”. The key worker uses this to explain to the residents what to do if they were upset or worried about something. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 16 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 standard(s) 27.28. The home provides a comfortable and safe environment where the residents are supported to lead a lifestyle proportionate to their capabilities. The home was clean and hygienic. EVIDENCE: A tour of the home revealed that each resident had a single bedroom of generous proportions. They had been decorated to the residents’ specifications and some contained equipment to allow the person more independence. I.e. ceiling hoists. Other bedrooms had areas dedicated to specific interests or in the case of one person who was unable to communicate verbally and with poor mobility, floor cushions and various objects to stimulate and interest him. Recent redecoration of the ground floor bathrooms and toilets had improved the appearance of those facilities and provided a more domestic and warm environment for the residents. The toilet facilities were provided with specialist equipment to meet each individual’s needs and offered a suitable degree of privacy.
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 17 There was a variety of shared space including an activity room, dining room, lounge/television room, and small quiet/visitors room on the first floor. On one of the comment cards from a relative it had been stated that it was difficult to have a private conversation with the resident due to the difficulty of accessing the first floor, although the use of the resident’s bedroom was available as well as the activity and dining rooms if not in use. The home was maintained to a good level of safety, and was to a good standard of decoration, although inevitable signs of wear and tear were present due to the constant buffeting by the electric wheelchairs. Risk assessments were in place regarding areas of hazard. Overall the home was clean and there were no unpleasant odours. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.35. There are sufficient staff members employed to ensure that residents receive the support that they need. The home has a sound recruitment policy and clear roles and responsibility of staff. There is a comprehensive induction, corporate staff training and supervision programme in place. EVIDENCE: All staff members have undergone Criminal Records Bureau checks. Prospective staff members are invited to complete an application form and attend an interview. Records showed that application forms and two references were always completed before staff started working at the home. All members of staff are given a job description and are made aware of the staffing structure of the Company and home. The residents are given visual aids in the form of photographs to help them to know who is working in the home and what they do. New members of staff complete the Learning Disability Award Framework (LDAF) in the first months of employment and are supervised on a weekly basis for the first six weeks.
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 19 Staff training had been undertaken in all areas and evidence showed that all staff members were offered training relevant to their work. Formal supervision of the staff is carried out and records showed that supervision was being carried out and notes kept. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37.38.39.41 The home is managed in a safe, competent and accountable manner. EVIDENCE: Each month an audit of the home is undertaken by the responsible person and the views of the residents are always sought as part of this procedure. A monthly health and safety audit is also undertaken. During the period of time that the manager was temporarily seconded to Operations Manager, the home was ably managed by the Deputy Manager revealing a robust infrastructure of management policies and procedures, which, coupled with a competent and knowledgeable staff team, maintained a calm and homely environment for the residents. Discussion with staff members revealed a staff group who were enthusiastic and committed to provide a good quality of life to all residents. They were
Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 21 unanimous in their respect of the abilities and skill of their manager, who they considered was very supportive. They also considered that the senior management of the company as a whole were very approachable and provided good support. Regular supervision of staff members makes sure that the staff members are aware of the importance of promoting and protecting the health, safety and welfare of the residents, this is further reinforced by regular training, and excellent policies and procedures. Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 22 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 x x 4 4 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x 4 x 4
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x 3 3 x x Standard No 11 12 13 14 15 16 17 x x x 4 x 4 x Standard No 31 32 33 34 35 36 Score x x 3 x 4 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hillcrest-Vernon Score x x 3 4 Standard No 37 38 39 40 41 42 43 Score 4 4 4 x 4 x x H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 23 Are there any outstanding requirements from the last inspection? 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 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 Good Practice Recommendations Hillcrest-Vernon H60-H11 S14568 Hillcrest-Vernon V247284 191005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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