CARE HOMES FOR OLDER PEOPLE
Hillcroft Residential Care Home 16-18 Long Lane Aughton Ormskirk L39 5AT Lead Inspector
Pauline Randles Announced Inspection 1st November 2005 09:45 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 Hillcroft Residential Care Home DS0000063777.V252026.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. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hillcroft Residential Care Home Address 16-18 Long Lane Aughton Ormskirk L39 5AT 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) 01695 422407 01695 420866 Raycare Limited Mrs Susan Valentine Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 29 service users in the category of OP - (Old age, not falling within any other category). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. The registered manager must undertake training on the prevention of abuse for vulnerable adults within the 3 months of registration. 7th September 2005 4. Date of last inspection Brief Description of the Service: Hillcroft is a home providing personal care and accommodation for 29 older people. It is a privately owned home and is situated in the village of Aughton just off a main road, which provides easy access to Ormskirk, where there is a range of community and leisure facilities. The home is a two storey building with a newer purpose built extension and provides a mix of single and shared accommodation. Eighteen bedrooms have en-suite facilities. There are two lounges, one of which has a combined dining room, there is also a separate dining room and conservatory. There is a passenger lift. The gardens are well maintained and easily accessible. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection at Hillcroft was announced and took place over a period of six hours. There were twenty- eight residents living at the home on the day of inspection and one residential vacancy following a recent death. During the course of the inspection the registered manager, deputy manager, cook, two care staff, three residents and three visitors were spoken to. A number of bedrooms, a bathroom and communal areas were viewed and records and procedures were examined. A pre inspection questionnaire and comment cards from three General Practitioners contributed to the inspection findings. What the service does well: What has improved since the last inspection?
The Statement of Purpose and Service User Guide had been updated to reflect current service provision. Formal risk assessments involving a district nurse had been introduced in relation to the installation of bed rails to ensure appropriate and safe use of such equipment. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 6 A complaint register had been established to ensure issues raised by residents are identified as complaints, suitably addressed and responded to. Outings and activities had been provided and a record maintained of the event, including who had participated. An improved form of care service reporting had been introduced to ensure records are factual and objectively written at all times. Consideration had been given to implementing a new and improved care planning system that will meet National Minimum Standards more effectively for the future. Arrangements had been made to provide foundation level training in moving and handling to enhance the skills learnt on induction, and further develop staff competence in this area. What they could do better:
An assessment of risk relating to falls must be introduced so that risk can be minimised and potential hazards removed. All written records must be maintained clearly and accurately to ensure that the health and safety of residents is protected. When money is held on behalf of a resident a written record of all transactions must be maintained to protect the resident from the potential of financial abuse. The adult protection policy must be further developed to include a procedure that provides best practice guidance for staff responding to a resident who presents as verbally or physically aggressive. Training relating to the protection of vulnerable adults should be provided to improve knowledge and skills in this area. A formal staff rota must be introduced so that it is clear which staff are on duty at all times and in what capacity. Volunteers working at the home must access Criminal Records Bureau clearance to ensure their suitability for work that involves direct access to vulnerable adults. To ensure safety requirements are met certification of compliance with gas and electrical requirements must be produced and a legionella monitoring system introduced. The new recording systems relating to complaints and activities should be extended to include fuller information and improve accountability. The medication policy and procedures should be reviewed against the Royal Pharmaceutical Society guidelines to ensure continuing compliance with recommended practice.
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 7 Residents should be involved in the care planning review process and, where practicable, sign to indicate their agreement to decisions reached. Greater consultation with residents should take place in regard to menus. A kitchen cleaning schedule must be introduced and a budget should be identified for new freezers to replace those that are rusting and worn. To ensure continuing competence and skills development the registered manager should achieve qualifications at NVQ Level 4 in management and care by 2007 and 50 of care staff should achieve NVQ level 2 by the end of 2005. 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. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Statement of Purpose and Service User Guide provides service users and their representatives with full details of the home’s services and facilities enabling an informed choice to be made about possible residency. EVIDENCE: The revision of the Statement of Purpose in order to reflect change in the ownership and management of Hillcroft, and to outline current service provision had been completed and a copy forwarded to the Commission for Social Care Inspection as requested. The complaint procedure, as described in the Statement of Purpose, was now reflected in practice through the recent introduction of a complaints register. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 10 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, 8, 9 and 10 The personal care provided for residents is guided by objective recording and planning. Health care needs are met through a multi disciplinary approach. Health care monitoring systems are not clear and could lead to misconceptions about the resident’s condition. Medication is stored, recorded and administered safely. Personal support in the home is provided in a manner that supports the privacy and dignity of the residents promoting their independence. EVIDENCE: Care plans of four residents that were examined illustrated a more factual system of recording had been introduced to ensure objectivity and guide good practice. Care plans, when established, had been signed by the resident. However the review system should be improved to evidence that there has been involvement of the resident. One resident said, “ a few years ago my key worker went through my care plan with me.”
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 11 A new format, to be introduced, provides a more detailed care planning and review system that involves the resident at all stages. This process must also include a falls risk assessment to ensure risk of falls is minimised and potential hazards removed. Discussion with residents and examination of records confirmed that there had been involvement of health care services as required, for example district nursing, optical, dental and chiropody services. A fluid intake chart examined was not clearly completed. There must be an improved clarity of record keeping to indicate for example whether a resident has passed urine and what, if any, further action had been taken. Examination of medication administration record sheets and sampling of medicines evidenced that suitable systems are in place to store, administer and dispose of medicines in a safe manner. Written policies and procedures should be reviewed against the Royal Pharmaceutical Society guidelines to ensure ongoing compliance. Residents spoken to said staff showed respect for their privacy and dignity. Comments made included, “staff are kind,” and “staff are polite and friendly.” Staff members were observed to speak courteously to residents and were able to explain systems that are in place to uphold dignity, for example in regard to safe and sensitive personal care and bathing. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 12 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, 14 and 15 Residents participate in a varied range of social and recreational activities. Personal support services provided by the home ensure that residents are enabled to maintain their dignity and independence. Improvements are needed to the systems for planning and preparing food to enable greater choice and increased safety. EVIDENCE: An activities log had been introduced, as recommended following the previous inspection, from which it was noted that a range of activities had been provided with several residents participating on each occasion. To evidence that activities are planned in response to the expressed preferences of residents and that satisfaction is monitored it is recommended that a note of consultation with residents is maintained. To improve accountability all entries should be signed and dated by the staff member completing the log. Residents who have the capacity look after their own financial affairs are encouraged to do so. Advocacy and legal advice is made available should it be required. Residents are encouraged to make informed choices. One staff
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 13 member said, “Independence is important” whilst another staff member said she always asks, “what level of care” is needed when assisting with personal tasks. A relative when spoken to said, “the care is brilliant.” When asked about the food provided, comments made by residents included, “only moderate, quality not too good, the problem is the menus, there might be a tight budget.” On checking systems it was found that menus had been drawn up by the manager, temperature check records were not totally adequate and were, on occasions, incomplete, there was no cleaning schedule, food was untidily stored in one freezer and both freezers were in a poor rusty condition. Menus should be prepared in consultation with residents and clearly displayed in advance of the meal to be taken to enable fully informed choice. Temperature records must be correctly maintained, a cleaning schedule must be introduced, food should be stored correctly and replacement freezers should be purchased to ensure food safety. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 14 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 The complaints procedure is consistent and includes clear information provision for service users to enable them to raise any concerns with confidence that these will be listened to and acted upon. The procedures for protection of vulnerable adults are not sufficient to guide staff in dealing with verbal or physical aggression. EVIDENCE: A complaints log had been introduced as recommended following the previous inspection. One complaint had been recorded that evidenced more attention was being given to listening, recording and responding to issues of concern. It was recommended that the log be developed a little further to include the details of who had responded and when, so the responsible person could be identified if any future reference to the complaint was made. An abuse policy had been drawn up, with reference to Department of Health guidance No Secrets, and a whistle blowing procedure was in place. To ensure the robustness of the policy a procedure for dealing with verbal or physical aggression must be introduced and protection of vulnerable adults training be provided. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 15 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 and 24 Refurbishment work is being undertaken that is resulting in significant improvement to the internal environment. Maintenance records are not adequately kept. Private rooms of residents are comfortably furnished and personalised. EVIDENCE: Within the premises a rolling programme of redecoration had commenced which was making a significant impact on the environment. Priority had been given to the internal décor but it was noted, and agreed, that the external fabric of the building was beginning to deteriorate. Maintenance records were incomplete at the time of inspection. On viewing the premises it was seen that outstanding tasks, for example a broken tap and installation of toilet rails had been completed but the log had not been updated. Records must be fully and accurately completed at all times to ensure safety of all who live and work at Hillcroft.
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 16 Four residents spoken to agreed to their rooms being viewed. All expressed satisfaction with their accommodation. One resident explained how arrangements had been made for her to bring in a chest of drawers and a wardrobe from home. A relative spoken to said how pleased her mother was with her room which is on the third floor and that she wouldn’t want her mother to be moved to a lower floor even though she is presently bedfast. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 17 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 Staff rotas do not provide the level of information required to evidence that the required number and skill mix of staff are on duty at all times. The home is working towards achieving the required number of care qualifications at NVQ Level 2. The lack of vetting procedures in the recruitment and retention of volunteers could result in a risk to the safety and security of residents. There is a strong commitment to accessing and undertaking training relevant to the role. EVIDENCE: There were sufficient staff members on duty to meet residents’ needs at the time of the inspection. Residents expressed satisfaction at the levels of care provided and staff members talked about being very busy on occasions but not unduly so. One care staff member said,” most of the time there are three staff on duty.” It was not possible to formally assess whether minimum regulatory requirements had been met previously as the staff rota examined was written in pencil and had only the first names of staff. In order to meet requirements a recorded staff rota showing which staff are on duty at any time during the day or night and in what capacity must be kept.
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 18 Four care staff members, approximately 25 of the total care team, hold NVQ Level 2 in care. Four more care staff members are undertaking NVQ Level 2 at present. As identified at the previous inspection recruitment policies and procedures for staff are in keeping with requirements. However from records examined on this occasion, it was identified that two volunteers who had provided support to the home for a number of years had not been police checked. To ensure safety of vulnerable adults all persons having direct contact with residents must submit a disclosure request to the Criminal Records Bureau. There continues to be a strong commitment to staff training to support development of additional skills. Ten staff had commenced an NVQ Level 2 in Dementia Care as a distance learning package on the 31st October 05. All staff involved in the administration of medication had undertaken appropriate training. Moving and handling training had been organised as previously required. It was recommended that staff undertake protection of vulnerable adults training to provide underpinning knowledge in relation to the policy that is currently being developed. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 19 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, 35, 37 and 38 The registered manager has relevant experience and is undertaking training to ensure ongoing skills development and managerial competence. The procedures for holding money for safekeeping on behalf of residents, does not protect them from the potential of financial abuse. Incomplete records that are completed in pencil and are unclear do not provide sufficient safeguards for residents or staff of Hillcroft. The health, safety and welfare of all persons at Hillcroft must be assured through the verification of a safe living and working environment. EVIDENCE: The registered manager is undertaking the Registered Manager’s Award and is aware that qualifications in both management and care at NVQ level 4 should
Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 20 be achieved by 2007. A short course “ Caring for People with Elder Abuse” had been recently completed. A comment card from a General Practitioner received pre- inspection said, “Lovely home. Caring staff team. Team cohesive and well organised. A pleasure to deal with.” Where residents did not have the capacity to deal with their own financial affairs small amounts of money had been held in a locked cabinet on behalf of the individual. Written records of financial transactions had not been maintained so there was not sufficient evidence to support that money had been handled correctly. The Manager must ensure that all money received and issued on behalf of residents is recorded in writing and open to inspection. As noted earlier, in this report records relating to property repairs, staffing rotas, food temperature checks and fluid intake had not been correctly maintained to ensure the health, safety and welfare of people who live and work at Hillcroft. Confirmation that the premises comply with the Water Fittings Regulations (1999) had been provided following the previous inspection. Moving and handling training had been organised. A process for monitoring the risk of legionella should be introduced. Certificates confirming electricity and gas compliance must be forwarded to the CSCI as soon as the current remedial work is completed. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 X X STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X 2 2 Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 22 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 OP8 Regulation 13 (4) (a) (c) Timescale for action A falls risk assessment procedure 15/12/05 must be introduced to minimise risks and remove hazards that may present a risk to an individual. Food temperature records must 01/12/05 be accurately maintained and a kitchen cleaning schedule must be introduced with records maintained. Food storage and food issue systems must be improved. A procedure for dealing with 15/01/06 verbal and physical aggression, towards staff, must be produced. A staff rota that shows the staff 01/12/05 on duty at any time during the day and night, and in what capacity must be kept. A copy of the revised rota must be forwarded to the Commission for Social Care Inspection by the date indicated. The recruitment and selection 31/12/05 procedure for any volunteer in the home must be thorough and include clearance through the Criminal Records Bureau. Written records of all financial 01/12/05
DS0000063777.V252026.R01.S.doc Version 5.0 Page 23 Requirement 2 OP15 16 (g) (i) Sch4 (13) 2 3 OP18 OP27 13 (6) (7) 18(1) (a) Sch 4 (7) 4 OP29 19 (1) (b) 5 OP35 17(2) Hillcroft Residential Care Home 7 8 OP37 OP38 Sch4(9)(a )(b) 17 (3) (a) (b) 13 (4) (a) (c) 9 OP38 13 (4) (a) (c) transactions must be maintained. Records must be accurately and 01/12/05 effectively maintained at all times. Certificates that confirm 31/12/05 compliance with gas, electrical and water safety regulations must be forwarded to the CSCI by the date indicated or sooner if available. (previous timescale of 15/10/05 not met) A system to reduce the risk from 01/12/05 the legionella bacteria should be introduced. 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 3 4 5 6 7 8 Refer to Standard OP7 OP9 OP12 OP15 OP16 OP28 OP30 OP31 Good Practice Recommendations The revised care planning system should be introduced in a reviewable format and the resident should where possible sign to indicate their involvement in the process. The policy and procedures relating to the handling of medication should be reviewed against the Royal Pharmaceutical Society guidelines. The activities log should be further developed to include a record of consultation and the signature and date of the staff member involved. The menu should be planned in consultation with residents. A budget for replacement freezers should be identified. The complaints log should be further developed to include the details of the respondent and date of response. 50 of care staff should hold NVQ level 2 by 31/12/05 Training in the protection of vulnerable adults should be sought for staff. The manager should hold qualifications at NVQ Level 4 in care and management by 2007. Hillcroft Residential Care Home DS0000063777.V252026.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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