Inspection on 26/06/08 for Hillcroft Residential Care Home

This inspection was carried out on 26th June 2008.

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

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

Other inspections for this house

Hillcroft Residential Care Home 30/11/07

Hillcroft Residential Care Home 07/02/07

Hillcroft Residential Care Home 23/06/06

Hillcroft Residential Care Home 01/11/05

Hillcroft Residential Care Home 07/09/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hillcroft Residential Care Home 16-18 Long Lane Aughton Ormskirk L39 5AT Lead Inspector Mrs Marie Matthews Unannounced Inspection 26th June 2008 09:30 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.V363543.R01.S.doc Version 5.2 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.V363543.R01.S.doc Version 5.2 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 sv22susan@aol.com Raycare Limited Manager post vacant 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.V363543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 29 service users in the category of OP - (Old age, not falling within any other category). 30th November 2007 Date of last inspection Brief Description of the Service: Hillcroft is a converted three-story building set within is own grounds. There is car parking space at the front and side of the building. Hillcroft is registered to provide personal care for up to 29 older people. The home is situated in the village of Aughton on the outskirts of Ormskirk where there is a range of community and leisure facilities. Accommodation is provided on three floors. Some double bedrooms are used for single occupancy. There are bathroom and toilet facilities on each floor. Communal space consists of lounges, of which one has a conservatory extension and there is a separate dining room. Both stairs and a passenger lift are available for access to the first floor. The secure, well-maintained gardens are easily accessible and there is a small courtyard and patio area at the back of the building. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £386.00 to £412.00. There were additional charges for newspapers, hairdressing, dry cleaning, private chiropody and personal toiletries. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key unannounced inspection, including a visit to the home, took place on 26th June 2008. Two regulation inspectors and a pharmacy inspector from the Commission for Social Care Inspection visited the home. There had been a number of serious concerns regarding whether people were experiencing poor outcomes. Since the last key unannounced inspection of 30th November 2007 a further random inspection was undertaken on 4th March 2008 where a number of extra requirements and recommendations were made. Hillcroft had also been monitored by social services in April 2008. The current manager had been in post from April this year and had supplied the Commission with an improvement plan based on concerns raised at the last and previous inspection visits. The inspection process included looking at records, a tour of the home, discussions with the proposed manager, deputy manager, and two care staff, four residents and two visitors. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were twenty-four residents living in the home on the day of the inspection. What the service does well: There was evidence to support that the appropriate health care professionals had been contacted when resident’s needs changed. One care staff said ‘we get the GP and district nurses if we are worried about anything’. Residents said they were well looked after. The menu had been changed following discussions with residents; meals were healthy, nutritious and varied and suited to resident’s individual preferences and requirements. Appropriate social and recreational activities were provided to meet resident’s diverse needs and expectations. Routines were flexible and residents were given choices about how to spend their day. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 6 People had access to an effective complaints procedure and felt they would be listened to and their concerns acted upon. Residents were protected from harm by staff awareness. A range of specialised aids and adaptations were provided to maintain resident’s comfort and safety and to help them to maintain their independence wherever possible. The staff team were experienced, well supported, competent and provided in sufficient numbers to meet resident’s needs. One care staff said ‘there are enough staff and we are getting new staff not using agency which is better’. Records supported that equipment and systems were safe and regularly serviced. Staff responded to residents and visitors in a positive and friendly manner. Residents made positive comments about staff including ‘the girls are great, you can approach them about anything, they are lovely’ and ‘I find the staff alright’. Visitors said ‘staff are very nice’ and ‘the girls are all great’. What has improved since the last inspection? The information about services available at Hillcroft had been improved and would help people to decide whether the home was the right place for them to stay. Information was collected about people before they were admitted to Hillcroft; this made sure staff had some knowledge about what care they would need. Prospective residents were sent a letter confirming whether staff at the home could meet their assessed needs or not. Residents and their relatives were given the opportunity to make decisions about the care they wanted and had been involved in the review of their care plan. Since the previous inspection the new manager has started work to try and make improvements to the way residents’ personal and healthcare needs were met. The improvements included changes to residents care plans and the management of resident’s medicines. The manager had developed records to show that different activities had taken place and whether residents had enjoyed the activities and entertainments or not. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 7 The new manager, who started in April 2008, had attended an interview to be the registered person in charge of the day-to-day running of the home. Staff made positive comments about her contribution to the home including ‘Margaret is doing wonders you can see the improvement’ and ‘she is very approachable’. One relative said ‘the new manager is doing a wonderful job she listens and if she says she will do it she does’. From a tour of the home it was clear that some areas had improved and work to respond to the recent fire safety visit and requirements and recommendations from the last Commission for Social Care Inspection visit had been undertaken. A number of bedrooms had been re decorated and fitted with new furnishings and a new call system had been installed to enable residents to summon assistance from staff. People were kept up to date and involved in decisions about the day-to-day running of the home. Reliance on agency staff had reduced as the manager had employed new staff; this would ensure residents received care from staff that were familiar with their needs The owner (registered provider) regularly visited the home to determine whether it was running well and whether people were happy with the standards of care. What they could do better: All residents were provided with contracts that explained their rights and responsibilities whilst staying at Hillcroft; however these need to be updated to include the room number, protocol for shared rooms and the correct commission contact information. The pre admission assessments were lacking in detail about people’s strengths and weaknesses; this could result in a lack of understanding of the current level of care needed. Care plans for each individual resident still did not consistently set out their personal, health and social care needs and how they are to be met. The care plans had not been updated to reflect any changes in residents needs; this could result in them not receiving the care they need. Changes are being made to the way residents medications were managed but further work was needed to reduce the risk of mistakes and ensure residents were protected. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 8 The safeguarding adults procedure was unclear and did not provide staff with appropriate guidance to help them to respond appropriately if abuse was suspected or reported. Not all areas of the home were safe, clean, comfortable or well maintained; records did not support that further improvements were planned to develop the home and provide a pleasant place for residents to live. The procedure to support staff with safe recruitment of staff did not provide safe guidance; as a result of this the manager had not made sure that new staff were suitable to work with older people and this could put residents at risk. 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. The summary of this inspection report can be made available in other formats on request. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 9 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.V363543.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the services available at Hillcroft had been improved to help people to decide whether the home was suitable for them. People’s needs were assessed prior to admission to determine whether their needs could be met although the lack of assessment detail could result in a lack of understanding of the current level of care needed. Written confirmation that people’s needs could be met was sent. EVIDENCE: The statement of purpose had been reviewed and contained clear and accurate information about the services available at Hillcroft; this was available in the entrance as the guide to the home and would help people to decide whether Hillcroft was the right place for them to stay. The service user guide had not been reviewed and the complaints information was still incorrect in terms of Commission for Social Care Inspection contact information. Service user guides Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 11 were seen in resident’s rooms. The information needs to be reviewed to make sure people had the correct information. Each resident had a contract that explained their rights and obligation whilst living at the home; these need to be updated to include the room number, protocol for shared rooms and the correct commission contact information. The records of two recently admitted residents were looked at in detail; information had been collected about them before they were admitted to help staff to determine whether they could be looked after properly. The assessments completed by the home were lacking in detail about people’s strengths and weaknesses; this could result in a lack of understanding of the current level of care needed. The manager stated she has already added sections to the document for additional information for use at the next assessment. There were copies of letters assuring residents and their relatives that their needs would be met at Hillcroft. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information regarding resident’s health and care needs had improved but was still not recorded in sufficient detail in the care plans which could result in residents care needs not being met. Since the previous inspection a new manager has come to the home and started work to try and make improvements to the way peoples’ medicines are managed. Changes are being made but further work is needed to reduce the risk of mistakes and ensure people are best protected by the homes arrangements for handling medication. EVIDENCE: There had been serious concerns raised at previous inspection visits that the standard of record keeping could put residents at risk of not receiving the care they need. The old style care plans had not improved but a new care plan format had been introduced as part of the improvement process; the manager advised the inspector that this was ongoing but slow progress had been made. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 13 Each resident had two care plan files; there was a lot of duplication of information resulting in most areas being completed in inadequate detail. Advice was given regarding recording residents needs and strengths and detailing what support they needed. The records still did not completely reflect the care that was being given. The detail in the care plans varied. There was some good information about residents likes, dislikes and preferences although there was insufficient detail informing staff of what action they need to take to ensure residents needs were met. Examples of this included a resident with a history of mental health problems had no recorded instruction on how staff would support her when she becomes agitated or how to monitor the effect of specific medicine, another care plan did not detail how staff were to monitor and respond to changes in residents health caused by low blood sugar levels and a resident who had a dry and sore mouth did not have details in the care plan to direct staff with monitoring or care although the GP had been informed and had prescribed medication. The lack of detail could result in residents not receiving the care they needed. Records showed that reviews of care plans had taken place each month although there was little evidence that plans were amended when residents needs change or when new information came to light. An example of this was one resident’s behaviour had changed; this was referred to in the daily notes but the care plan had not been changed. The daily notes needed to be recorded in more detail to show what care residents had received and how they had spent their day. There was evidence to support residents or their relatives had been involved in decisions about care; this gave residents some control over their lives and ensured they received the care they wanted. There were risk assessments in place but these were lacking in detail in terms of risk factors and did not always include assessments for falls, pressure sore risk, and nutrition, Moving & Handling and bed rails. The level of risk had been determined by the care staff and not by any set criteria; this could lead to inconsistency and lack of appropriate intervention. Further advice was given to the manager to assist with improvement. Risk assessments had been introduced to support the use of bed rails although the assessment does not meet good practice guidelines and the manager was given advice to assist with developing a detailed assessment. The manager said the assessments were temporary as they were waiting for the district nurse to complete appropriate assessments. Assessments should support that bed rails are appropriate for the resident and the bed they are to be fitted to, Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 14 have been maintained and regularly checked and that consent for use has been obtained. A set of weigh scales had recently been purchased which would enable staff to monitor whether residents were nutritionally at risk. There was evidence to support that care staff had contacted health care professionals when resident’s needs changed. One care staff said ‘we get the GP and district nurses if we are worried about anything’. Residents said they were well looked after. Since the previous inspection a new manager has come to the home and started work to try and make improvements to the way peoples’ medicines are managed. Changes are being made but further work is needed to reduce the risk of mistakes and ensure people are best protected by the homes arrangements for handling medication. Staff have completed training in the safe handling of medicines and advice has been sought from the community pharmacist, who has visited the home and observed the medication round. The medicines policy has been updated and is available to staff, for reference as needed. All medicines are now safely locked away. Regular audits (checks) of medicines handling are carried out, but these have not always been effective in identifying some of the concerns we found in the handling of medication at the home. We observed part of the morning medicines round. Medicines were administered with care. Patient support was offered where people needed help with taking their medicines. Care was taken to ensure any special instructions such as ‘before food’ were followed. But, it was of concern that some people had their medicines quite late in the morning. This means that where medicines are repeated later in the day, there is a risk that the time left between doses may be too short. The times that medicines are given should be monitored to ensure they are given at the right and best times. We looked a sample of medicines records and found that there was sometimes a lack of clarity, which could place people at risk of medication errors. We saw that discontinued (stopped) medicines often remained listed unmarked on the current medication administration records. Records of communications with and advice from, health care professionals such as doctors were not always clearly made, so it was not always clear when medicines had been changed or ‘stopped’. This made it difficult or impossible to tell what medicines were currently prescribed for each person. We saw one example where both a ‘stopped’ and a ‘new’ painkiller were included on someone’s medication administration record. Both medicines were in the medicines trolley and the staff member spoken with said they would not know which one to give, increasing the risk that the ‘stopped’ medicine would be given by mistake. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 15 Records showed the same person had an eye drop applied every day until the new monthly medicines delivery. Current records showed three bottles of the eye drop had been received, but none could be found, and none was recorded as administered. It was not possible to confirm whether or not the eye drop was still prescribed. Records for a second person incorrectly showed that a ‘calcium tablet’ was regularly being refused; checks showed that there were none in stock to give. Staff initially thought the ‘calcium tablet’ had been ‘stopped’ but a record was later found saying that GP advice had been sought. There was no record of the response. There was a lack of information about the correct use of medicines prescribed ‘when required’ and about the use of prescribed creams. To help ensure consistency, there should be individual guidance about when these medicines should be given and where creams should be applied. Most medicines were packed into a monitored dosage system and this was used correctly, showing medicines were given as prescribed. But, where medicines were supplied in traditional ‘boxes’ we saw some examples where records showed medicines had been given, when the quantity remaining in stock indicated that the doses had actually been ‘missed’, or vice-versa. We also saw one example where a medicine prescribed ‘two daily’ had been incorrectly given ‘two, twice daily’. We saw that doses of medication were automatically missed if people were out, but staff said suitable arrangements were being considered with advice from the community pharmacist. Suitable leave arrangements need to be considered, assessed and recorded to help ensure –where possible- continuity of treatment when people are away from the home. There was a procedure to support staff with privacy and dignity and most staff had covered this as part of their training. Staff were seen responding to residents and visitors in a positive and friendly manner. Resident’s privacy was respected in a number of ways, including knocking on doors and waiting for permission to enter, privacy screens in shared rooms and appropriate locks on doors. One visitor said her relative was ‘always dressed nicely and clean’. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities met resident’s diverse needs and expectations. Residents received a healthy, varied diet that was suited to their individual preferences and requirements. EVIDENCE: The home did not employ an activities co-ordinator and the care plans did not detail much in the way of social information that would help staff to provide suitable activities. However records supported that a range of activities had taken place; activities included bingo, dominoes, board games, quizzes, hairdressing, reminiscence, sing a longs, church services and a weekly luncheon club at the local church. A visitor said ‘sometimes they have a game going on when we come in’. On the day of inspection visit a small group of residents were watching a reminiscence DVD although staff running the group were regularly called away to do other tasks which was quite disruptive. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 17 Staff said routines were flexible and residents were given choices about how to spend their day. One resident had said she had been allowed to make choices. Visitors were welcomed into the home and offered refreshments. One visitor said ‘they are always welcoming, we always get a cup of tea’. The menus had been reviewed and were still under review in consultation with the residents. From observation and looking at records it was clear that residents were offered a varied and nutritious diet and there was always an alternative available. One resident said ‘ the food is very good, I am fussy and I’ve never had to send anything back’. The manager was advised that the records needed to be dated and completed in detail where possible. The cook was aware of residents’ dietary likes, dislikes and preferences and staff were seen given patient and sensitive support where necessary. Dining areas were bright and clean and tables attractively set although the place mats were stained and need to be replaced. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had access to an effective complaints procedure and felt they would be listened to and their concerns acted upon. Residents were protected from harm by staff awareness although procedures did not always provide clear guidance to support staff. EVIDENCE: People had access to a clear complaints procedure although the contact information for the commission needs to be accurate. The manager had commenced a record for complaints; there had been one complaint since the last key inspection and this had been responded to appropriately. Two visitors said they had no complaints about Hillcroft. The safeguarding adults procedure was unclear and did not provide staff with appropriate guidance; the procedures need to be revised to include the contact information of local agencies. However there had been two recent incidents referred under the safeguarding procedures and both had been dealt with appropriately. Only two staff had received recent safeguarding training although other staff had covered abuse as part of their NVQ training; the manager was arranging further training for staff to provide them with the skills and knowledge to respond appropriately if abuse was suspected. Records showed that adult protection had been discussed at staff meetings and two Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 19 staff were able to discuss types of abuse and how to respond to any suspicions. There were procedures to support staff with dealing with resident’s finances, restraint, whistle blowing, and dealing with verbal and physical abuse although a number of these were being updated and reviewed. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all areas were safe, clean, comfortable and well maintained and records did not support that further improvements were planned to develop the home and provide a pleasant place for residents to live EVIDENCE: From a tour of the home it was clear that some areas had improved and work to respond to the recent fire safety visit and requirements and recommendations from the last Commission for Social Care Inspection visit had been undertaken. However improvements were still needed to ensure residents were provided with a safe, clean and comfortable place to live in; there were no records to support further improvements were planned. A maintenance book had recently been introduced but this did not include all areas requiring attention as noted during the tour of the home; it was Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 21 recommended that a senior person conducts a tour of all areas to establish the work that was needed and to record a plan of improvement with timescales for completion. The residents had access to safe and secluded garden and patio areas; residents said they enjoyed sitting in the gardens in the warmer weather. Communal areas consisted of two lounges, a conservatory, a dining area and a number of quiet seating areas around the home; furnishings were comfortable and rooms bright and airy. The manager said new carpets were planned for the lounge and conservatory. All bedrooms had en-suite facilities and there were clearly marked toilets and bathrooms located on each floor. The upstairs ‘pink’ bathroom now had frosted ‘privacy’ glass in place and the manager said blinds were to be ordered. It was again recommended that liquid soap be provided in communal wash areas in order to reduce possible cross infection as a number of personal toiletries were still being left in some bathrooms. It was also recommended that a suitable lock be applied to the downstairs toilet/shower room door. There were a number of commodes in residents bedrooms for use during the night; many of these were stained or damaged and need to be replaced to reduce the risk of cross infection. Steradent tablets were seen in resident’s bedrooms and should be locked away to remove the risk of ingestion by other residents; this had been brought to the previous managers attention (see standard 38). The manager said they would be providing residents with lockable storage and options were being considered. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. A new call system had been installed and extra call leads had been ordered; this enabled residents to summon assistance from staff. Wheelchairs were stored in the stairwell and a number of these did not have footrests attached, which could result in injury to residents; this had been discussed at the last key inspection with the previous manager. A number of areas around the home, including stair wells, porches and bedrooms were ‘cluttered’ as they were being used for storage of dressings, packages, walking frames and wheelchairs etc; arrangements should be made to store equipment appropriately to reduce the risk of fire and injury to residents. All bedrooms had door locks fitted but not all rooms had a lockable facility for storage of resident’s personal items. A number of bedrooms had been re decorated and fitted with new furnishings; however the majority of the bedrooms in the main part of the building were still in need of improvement. Areas noted included damaged or stained carpets (the carpets in rooms 1 and 17 had still not been replaced), rusted or damaged bed tables, stained and dirty armchairs, uneven flooring on the first floor corridor which could lead to a Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 22 trip or fall, frayed net curtains in a number of rooms, curtain rail hanging from the window and stained ceilings where previous leaks had occurred. The practice of marking bedding with the room number should be reviewed as this detracts from the homely feel of the home. One resident said he was happy with his room another said ‘my room is very good’. Radiators were covered to protect residents from burns although there was some debris noted behind them. Most windows had restrictors in place to reduce the risk of injury to residents; however two of the first floor bedroom windows and a bathroom window did not have restrictors in place. A number of extractor fans were unclean or out of order and needed attention. The laundry was situated in the basement and was accessed by a key coded lock as recommended at the last inspection visit. The laundry was fitted with one washer and one dryer although the manager said she had been authorised to purchase new equipment. The laundry flooring was untidy and all areas needed to be cleaned; it was again recommended that liquid soap and paper towels were made available to reduce the risk of cross infection. There were two bedrooms noted with an odour although one visitor said the manager ‘has got rid of the smell’. There were areas around the home that were unclean including windowsills, commodes and behind radiators; the manager should conduct a regular audit of all areas to ensure cleaning standards were maintained. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were experienced, well supported, competent and provided in sufficient numbers to meet resident’s needs however safe recruitment procedures had not consistently been followed and this could put residents at risk. EVIDENCE: The manager had introduced clearer staffing rotas that indicated who was on each shift. Reliance on agency staff had reduced as the manager had employed new staff; this would ensure residents received care from staff that were familiar with their needs. Staff said there were sufficient numbers of staff to meet residents’ needs. One care staff said ‘there are enough staff and we are getting new staff not using agency which is better’. Residents made positive comments regarding staff including ‘the girls are great, you can approach them about anything, they are lovely’ and ‘I find the staff alright’. Visitors said ‘staff are very nice’ and ‘the girls are all great’. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 24 There was a recruitment procedure but this was out of date and did not provide senior staff with clear and safe guidance; failure to follow a safe procedure could put residents at risk. The employment files for two recently employed staff and one long-term staff member were looked at in detail. It was clear from the two recently appointed staff files that a safe recruitment process had not consistently been followed as not all checks were in place prior to employment and gaps in the employment history had not always been considered. The reference needed to include the printed name and role of the referee to support that the reference was appropriate. Staff had not completed health questionnaires and it was difficult to determine what the employment start date was as the contract of employment did not include this. Good practice included a record of the interview had been maintained which showed an equal opportunities selection process and new staff were issued with handbooks informing them of their employment rights and obligations. All new staff had regular supervision at planned intervals to identify whether they needed any extra support or training. One to one support for existing staff was ongoing and staff said they were able to raise any concerns for discussion with the manager. The manager was advised that an audit of all staff files was needed to ensure correct checks were in place. Most of the care staff had achieved a recognised qualification in care (NVQ) and other staff were currently working towards obtaining the NVQ; this qualification provided them with the skills and knowledge to do their jobs. The training matrix and training certificates showed a range of appropriate training had been provided to give staff with the skills and knowledge to meet residents’ needs. The manager had identified some gaps in training and was meeting with a training organisation next week to arrange training for the next twelve months. The manager was advised that the matrix should include the dates of when staff attended the training. The two new staff had completed a basic induction within their first week to familiarise them with the safe routines and key procedures of the home. One of the new staff, without any appropriate qualifications in care, was due to commence a more in depth training programme linked with Skills for Care. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall management of the home had improved although further improvements were needed to ensure people’s health, safety and welfare were protected. People were involved in decisions about how the home was run. EVIDENCE: Mrs Margaret Sutcliffe is the manager; she has worked at Hillcroft for the past three months and her application to register as manager with the commission was being processed. Mrs Sutcliffe has experience at management level in care homes and has the registered managers award (RMA), which would support her with her role of manager. There was evidence that she had updated her skills and knowledge. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 26 Mrs Sutcliffe joined the management team at Hillcroft at a difficult time, as there were a number of serious concerns regarding how the home had been managed in the past. Mrs Sutcliffe has made a number of improvements in a short period of time, has responded to the outstanding requirements and a number of the recommendations and provided a plan to support further improvement. Mrs Sutcliffe has made contact with the commission and other agencies for support and advice to assist her with further improvements. At the current time she does not have the support of a deputy and is reliant on senior staff to assist her with development of policies and procedures. Staff made positive comments about her contribution to the home including ‘Margaret is doing wonders you can see the improvement’ and ‘she is very approachable’. One relative said ‘the new manager is doing a wonderful job she listens and if she says she will do it she does’. The home had achieved the Investors In People Award (IIP), which is a recognised quality award that monitors various aspects of the management of the home and training and development of staff. An annual development plan to support planned improvements was not available but the manager was given advice on how to develop this. Residents and visitors had completed surveys to determine whether their needs and expectations were being met although the results of this had not yet been collated or made available; some issues had been discussed at resident and staff meetings to bring them to people’s attention. New residents completed a questionnaire that asked ‘How was your first week at Hillcroft?’ to help determine whether they had been given enough support to settle into the home. The registered provider (owner of the home) visited Hillcroft each month and details of his visits had been recorded and made available for inspection; the reports showed that he had monitored practices and standards within the home. Systems to check whether staff were following policies and procedures and meeting people’s needs were to be introduced; the manager said checks on care plans, cleaning and kitchen standards had recently commenced and these would be developed further. Policies and procedures were being reviewed to reflect current practice and provide staff with safe guidance. Staff meetings were held regularly; staff said that any issues they raised were responded to. Staff were kept up to date with any changes to routines and Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 27 practices and there had been some discussion about abuse and feedback from survey information. Resident meetings had been well attended each month; records showed that residents were kept up to date with any changes and improvements and were able to have a say in how the home was run. Financial records were looked at; the manager had improved the way in which residents monies were managed to ensure resident’s finances were safeguarded. Records supported that equipment and systems were safe and regularly serviced; random checks on service dates were done. A fire risk assessment was in place following a fire safety visit and work had been completed as required; the manager had responded to the report to ensure the home was safe. Ongoing training in safe working practices had been provided for most staff and further training was currently being planned; this would ensure staff and others were not at risk from bad practices. It was recommended that all staff attended a refresher for Moving & Handling as two staff were seen ‘lifting’ a resident inappropriately. Infection control procedures were available. Cleaning materials were generally stored safely although there were still no risk assessments to support safe storage of ‘steradent’ denture cleaner; this was discussed with the manager as residents could be at risk she said that alternative storage measures were being considered. The procedures for the reporting of accidents and serious incidents affecting resident’s well-being and safety had improved. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 28 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 2 X 2 2 2 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement Care plans for each individual resident must clearly set out their personal, health and social care needs and how they are to be met. Timescale of 31/08/06 not met. The care plan must be amended to reflect when resident’s needs change or when there is new information. Risk assessments for health care issues such as falls, tissue viability, nutrition, mobility and use of bed rails must be completed in sufficient detail to ensure residents are safe. To help ensure people’s medicines are safely administered as prescribed there must be a complete, clear and accurate record of currently prescribed medicines and the time and date of administration for each person The registered person must ensure window restrictors are fitted to all first and second floor DS0000063777.V363543.R01.S.doc Timescale for action 11/08/08 2. OP7 15 11/08/08 3. OP8 12 11/08/08 4. OP9 13(2) 28/07/08 5. OP25 13 11/08/08 Hillcroft Residential Care Home Version 5.2 Page 30 6. OP29 19 windows unless a risk assessment determines that they are not a risk to residents. The registered person must 11/08/08 develop and operate a thorough recruitment procedure at all times. Timescale of 30/11/07 not met. 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should be reviewed to include the information in standard 1 and Schedule 1. The service user guide should be issued to residents and prospective residents and their families. The contract or statement of terms and conditions should include a room number and the correct contact information for the Commission for Social Care Inspection. The pre admission assessment information should be clear and detail resident’s strengths and support needed. The care plan format should be reviewed to reduce duplication of information. The daily progress notes should contain accurate information about the care provided. The registered manager should contact professionals to take advice on nutritional and tissue viability assessment. The bed rail risk assessment should meet good practice guidelines and support that the use of rails are appropriate for the resident and the bed to which they will be fixed and have been maintained and checked. The use of bed rails should be discussed with the residents and their next of kin and consent should be recorded. Wheelchairs should be fitted with footrests to reduce the Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 31 2. 3. 4. OP2 OP3 OP7 5. OP8 risk of injury to residents. 6. 7. 8. OP9 OP12 OP15 A criteria should be shown when required/variable medication is administered. These should be recorded. Detailed social information should be obtained about residents to assist with the planning of suitable activities. The records of meals served should be dated and completed in detail to reflect that all residents have received a nutritious diet. Consideration should be given to replacing the badly stained placemats. The correct contact information for the Commission for Social Care Inspection should be updated in the complaints procedure. The safeguarding adults procedure should updated and include the contact information of local agencies to which incidents of poor practice would be reported. A tour of all areas of the home should be undertaken to identify areas (including those noted during the inspection) needing improvement, repair or replacement. Areas in need of attention should be included in the maintenance book or recorded in a programme of improvement with clear timescales for completion. Liquid soap and paper towels need to be supplied in all communal bathing and WC areas. Personal toiletries need to be moved from communal bathrooms in order to prevent cross contamination. A suitable lock should be in place on the downstairs toilet/shower room door. Commodes should be checked to ensure they are clean and fit for use. The practice of storing items in stairwells, porches and on empty beds should be reviewed to reduce the risk of fire and injury to residents. There should be a lockable facility available in resident’s rooms. Bedrooms 1 and 17 need the carpets to be replaced, as there is a risk of trips and falls. Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 32 9. OP16 10. 11. OP18 OP19 12. OP21 13. OP22 14. OP24 Resident’s bedrooms should be checked to ensure they are safe, clean and comfortable. Any damaged or stained furniture or furnishings should be removed. The practice of marking bedding with room numbers should be re-considered. The laundry areas need to be cleared of debris. A regular audit of all areas should be undertaken to ensure the home is clean and hygienic. The reference form should clearly indicate the name, role and contact information of the referee. All staff should complete a medical questionnaire. Employment start dates should be clearly indicated on staff files and contracts. All staff files should be audited to ensure the required checks were in place. The training matrix should include the date that training was undertaken. The results of residents and relatives’ surveys should be collated and made available to interested parties. Policies and procedures should be reviewed and updated to reflect current and safe practice. Audit systems to monitor whether staff were following policies and procedures and meeting people’s needs should be introduced. 19. OP38 Moving & Handling training should be provided for all staff to remove the risk of ‘lifting’ residents inappropriately. There should be risk assessment to support safe storage of ‘steradent’ and reduce the risk to residents. 15. OP26 16. OP29 17. 18. OP30 OP33 Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Hillcroft Residential Care Home DS0000063777.V363543.R01.S.doc Version 5.2 Page 34 - 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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