Inspection on 22/01/08 for Hillingdon House

This inspection was carried out on 22nd January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillingdon House 29/07/08

Hillingdon House 13/03/07

Hillingdon House 24/11/05

Hillingdon House 24/11/04

Hillingdon House 21/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hillingdon House 31 Salisbury Road Farnborough Hampshire GU14 7AJ Lead Inspector Christine Walsh Key Unannounced Inspection 22nd January 2008 09.45 Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 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 Hillingdon House DS0000011866.V355941.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillingdon House Address 31 Salisbury Road Farnborough Hampshire GU14 7AJ 01252 542148 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) hillingdon@regard.co.uk The Regard Partnership Ltd Post Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2007 Brief Description of the Service: Hillingdon House provides care and support to younger adults, who have learning disabilities and complex needs. The home is part of a large number of services owned and managed by The Regard Partnership Ltd. The people who use the service are given help with all aspects of their lives but are encouraged to be as independent as possible. There are nine bedrooms, a kitchen, lounge, dining room and laundry facilities. Additionally the home has a conservatory backing on to a large garden creating more communal space. Hillingdon House is situated in a residential area, close to the main shopping centre in Farnborough. The home is close to public transport as well as having its own transport. Fees range from £1,323 per week to £1,668 per week. These fees do not include the purchase of personal requisites, chiropody and hairdressing services. Hillingdon House DS0000011866.V355941.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 0 star. This means the people who use this service experience poor quality outcomes. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh and Mrs K Sutherland-Dee, regulatory inspectors. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident, staff and relatives comment cards were received. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, speaking with the residents, visitors and staff and observing care and support practices. A tour of the home took place and documents pertaining to health and safety were viewed. What the service does well: Hillingdon House does well to assess the needs of prospective residents to ensure they can meet their needs and supports them to become familiar with their new surroundings and others living in the home by supporting regular visits prior to moving in. Residents living at Hillingdon House who are able to verbally communicate their needs are living active lives and encouraged to make choices and decisions about how they wish to spend their days. These residents are involved in a range of community-based and social activities. The home does well to support residents to maintain contact with family and friends and will when possible provide transportation. The staff do well to ensure the physical and psychological needs of the residents are being met, providing the residents with support to access health care professionals such as GP’s, dentists, speech and language therapist and psychologists and support them with their medication. A relative was complementary of the staff and their hard work and general caring attitude towards the residents. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 6 “The staff at Hillingdon House are usually very caring and want to do their best for the clients”. The home undertakes appropriate recruitment checks on staff before they start working in the home. What has improved since the last inspection? What they could do better: Despite the manager identifying in the AQAA areas for improvement 11 requirements have been made following this visit to the service one of which includes a repeated requirement and some of which place the resident’s health and welfare at risk. The homes current Service User Guide and complaints procedure has not been written with the residents communication needs in mind, therefore preventing them from understanding the role of the home and their rights to make complaints if they wish. Despite reviews and in some cases changes to the residents care plans they still require further work on them to ensure they provide specific detail on how the residents need and wish to be supported including making staff aware of the importance of recognising and responding to residents alternative communication needs, their rights to be treated with respect, and have their dignity, privacy and right to confidentiality upheld at all times. To ensure the resident’s needs, wishes, goals and aspiration are met in the way that the residents prefer then the home must ensure that that there is sufficient numbers of competent, skilled and supervised staff on duty throughout the day. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 7 Residents care plans and risk assessments are not followed by staff including staff who have returned from long term leave and agency staff. Residents and staff are at risk from trying to move or be moved to various areas of the home that are restricted by different level flooring and space. A number of other areas in the home present a tripping hazard to both residents and staff. The practice of not asking visitors to the home for identification, which includes agency who go onto, provide personal care with out supervision places the residents at risk. The homes current infection control measures and lack of training for staff place residents at potential risk of infection, the home is not free from unpleasant odours despite attempts to eradicate them. To prevent the potential risk of harm coming to the residents the home must ensure that it is satisfied that all agency staff assigned to work in the home have the appropriate recruitment checks in place such as criminal record bureau (CRB) and protection of vulnerable people (POVA) checks. The home is currently without a registered manager and has been since April 2007, the number of changes to managers and insufficient support to the home in this period has had a detrimental effect on the smooth running and quality of the service provided the residents. 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. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home currently does not provide people who are intending to use the service with an accessible Service User Guide. To establish if the home can meet the needs of people wishing to use the service they undertake an assessment of their needs prior to them moving in. EVIDENCE: The AQAA (The Annual Quality Assurance Assessment) informed us that the service offers transition plan visits as agreed in a formal transition plan, which includes inviting the prospective service users to make choices in relation to decoration of their own bedrooms and would include advocate opinions in that area. Viewing assessment documentation and speaking with the manager tested this. The service user guide was also viewed at this visit. The latest version of the Service User Guide was asked for, the ones viewed were found to be held in the residents personal files, these were found to be lengthy, written in small print and complicated language. This reads as though the Service User Guide has not been designed for the resident. The home Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 10 should seriously consider providing each resident with a Service User Guide that meets their communication needs and is made accessible for them. Documentation in respect of admissions was viewed for four current residents and discussion took place with the manager on how the process of referral, assessment and admission is carried out. The assessment documentation includes obtaining information from social services before the assessment undertaken by the home. The assessment documentation viewed provided evidence that the home looks at the strengths and the needs of the residents including their physical, personal and psychological needs. The manager spoke of the process for new admissions which includes meeting with them in their current environment, meeting with their representatives, inviting them to visit the home prior to admission to meet with residents, staff and familiarise themselves with their new environment. The placement is reviewed after a trial period. This confirms what is recorded in the returned AQAA document. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures there are care plans and risk assessments in place; the risk assessments identify how those risks should be minimised, however the people who use the service are currently at risk of not having their health, safety and care needs carried in a consistent manner and in the way they wish as the care plans and risk assessments are not consistently followed by staff. There is evidence that the people who use the service are able to verbally communicate are encouraged to make choices and decisions, however people who use the service who are non speaking have limited choices and opportunities to make decisions. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that each resident has individualised care plans and risk assessments which generally reflect the residents needs. It informed us that the home holds weekly service user meetings, where the service users can express their needs and wants. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 12 This was tested by viewing four residents personal files, care plans, risk assessments and daily records. Observing practice in the home, speaking with some staff and the manager. Each resident has individualised care plans and risk assessments, which are generally reflective of their needs. It also informed us that there are weekly residents meetings where some individuals participate in expressing there needs and wants. The manager however recognises that current care plans and risk assessments are in need of review. The AQAA stated that all of the plans would be reviewed by the end of February 2008, however the manager said that as they were leaving it was unlikely this target would be met. The manager informed us that he was aware that the residents hadn’t had an annual review of their care and the service provided to them for over a year and was on the process of arranging these. There was evidence in the four personal files that the manager has written to the residents care managers and relatives inviting them to an annual reviews. Four residents personal plans were viewed as part of tracking process and although there was evidence of a standard document for care planning there was inconsistencies of the quality of the information documented, such as identified areas of concern raised in the assessment process did not have a care plan to support them. Parts of the care plans were incomplete or not dated, therefore making it difficult to know whether the information was up to date and relevant to the residents who use the home. Care plans did not describe how to undertake specific tasks with residents such as bathing. Agency staff are not made aware of important information in the residents care plans such as how to support the resident with personal care, this could be detrimental to the welfare of the resident/s and place both the resident and the agency member of staff at risk. A member of staff returning from long term leave had not been re inducted into the home and made aware of all of the residents current needs and was observed undertaking a task that could have placed a resident at risk. The plans lacked evidence that a person centred approach is taking place, residents’ goals, dreams and aspirations are not being recorded. The manager confirmed that the home is preparing to introduce this aspect of person centred planning soon. There are mixed views from staff regarding the information provided to them about the residents, some indicated in their “Have Your Say “ comment cards that they are sometimes provided with information where as others confirmed they received information from the senior staff and information was provided at handover. However the agency member of staff whose first time it was to Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 13 work in the home said he never received a handover or an opportunity to gather information about the residents he was supporting. A relative said: “The care staff at Hillingdon are usually very caring and want to do their best for the clients”. The majority of the residents living at Hillingdon House have limited verbal communication and verbalise through gestures, behaviours and the use of communication tools, there was some evidence of systems in place to assist the residents to express their needs such as a pictorial diary that had been developed with the support of a speech and language therapist. The picture menu diary that is in place to assist residents to make a choice about what they would like to eat was not completed for the day of the visit and a member of staff admitted that the menu board was not always completed and hadn’t been for a number of days. This could be a good communication tool but needs to used consistently to provide visual clues in order to make an informed choice. The home also lacks other communication tools which may enable residents to move around their home more independently and provide those who are able to verbalise with information about their home and the service, such as signs to indicate where toilet, bathrooms and individual bedrooms are, notices that are developed in an accessible format and accessible to view, such as the Service User Guide and complaints procedure. On the day of the visit staff were observed interacting with residents in a friendly manner and offering a range of choices to those who are able to verbally communicate and state their preferences such as what they would like to do, where they would like to go and what they would like to eat. These choices were not available to people who could not verbally communicate. One resident said she is able to choose when she wishes to get up and go to bed and was involved in choosing the colours for her bedroom. The staff were also observed assisting the same resident to make a choice about what colour carpet she would like to have in her newly decorated bedroom. In the AQAA the manager has identified this as an area for improvement and is currently implementing regular house meetings where he said the residents will be encouraged to fully participate and be involved in decision-making processes. A relative answered the question does the care service support people to live the life they choose: their reply was “usually” but went onto say “It is not really possible with the amount of staff at Hillingdon House, especially drivers for the house vehicle. Most clients at Hillingdon House need 2 – 1 to access Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 14 the community, this leaves them short in the house, so outside activities are very difficult to access”. Linked to the care plans are risk assessments that identify the area of risk and action to be taken by staff to minimise the risk. There was evidence that the manager had reviewed some risk assessments and he confirmed that this was work in progress. As for care plans there was evidence that risk assessments were not being followed, on the day of the visit a resident whose risk assessment stated he must be supervised whilst eating and have food cut up into bite size pieces was given a snack at lunch time that consisted of toast and a topping, this meal was neither cut up into bite size pieces or was the resident supervised but left to stand and start his meal alone. This could have potentially placed the resident at risk and was inconsistent with his risk assessment and care plan. Another resident was observed requiring support from three members of staff to access the kitchen. This practice is unsafe, placing the residents and staff at risk and restricts access to the kitchen when they wish if there are not enough staff around to assist. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of the people who use the service are involved in age, peer, culturally, social and community based activities, and the majority of the staff are aware of the values and importance of supporting people to live independent lifestyles and ensuring their rights to dignity and privacy is respected, however these areas can be improved upon especially for those people with limited communication. The people who use the service are supported to maintain links with family and friends. The people who use the service are involved in the day to day practice of planning and preparing drinks, snacks and choosing what they would like to eat, however the home must ensure that meals times are enjoyable and safe experience. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 16 EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the people who use the service have access to a number of areas that enhance lifestyle, including community-based activities (e.g. horse riding and day services). The majority have regular contact with family and friends and where necessary the home will assist with transportation for home visits. The AQAA also informed us that the service recognises that further improvements can be made in this area and staff have been assigned to look at alternative forms of in house and community based activities. This was tested by viewing four residents personal plans, daily records, viewing comment cards from residents, staff and relatives and observations made throughout the visit. The manager stated that the home is looking at a range of activities and learning opportunities and there are plans for these to be introduced in the very near future. Two residents who were able to verbally communicate spoke of the variety of activities they are involved in including, attending college, going horse riding, dancing and shopping. A care plan viewed, detailed the support hours provided by a voluntary agency to support the resident to access the community and how these hours are used. This was observed on the day of the visit where a resident was supported to attend a day service activity. The residents who were present in the home at the time of the visit were observed playing board games and another was supported by staff to do a puzzle. One resident was observed to wander around the home for most of the day, the resident did not engage in any meaningful activities apart from occasional interactions with staff whilst they were passing. A month of daily records were viewed for the same resident and recorded on everyday that they had spent their day wandering around the home. This demonstrates that this resident is not engaged in appropriate age, peer, and cultural and social activities and must be reviewed with the resident using a person centred approach. The same resident has restricted access to their bedroom as they are unable to open and close doors, this is an area where the resident could gain access to personal items and relax if he so wishes, however inaccessibility to his room prevents this, a review of this situation must take place. Each resident has a file in their rooms that give lists of their likes and dislikes and what they like to do. It was established by speaking with a staff member and the manager that these ideas had come from the staff and they did not reflect a person centred approach, they have not been reviewed since they Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 17 were written in 2006. A carer said they understood person centred planning and the manager agreed that this approach had not been used fully. The four residents’ personal files viewed hold letters received from family members, a list of family contacts and birthdays and letters sent from the home inviting families and friends to attend events in the home, the latest inviting them to a Christmas party. A resident spoke about their visits to their family. The AQQA informed us that the home supports the residents to maintain contact with their families and where possible assist with transportation. This was supported by a relative who was complimentary of the staff and the support they provided in assisting her to maintain contact with her daughter. “The staff do their best meeting me from work sometimes and encouraging my relative to talk to me on the phone when I ring”. The staff were aware of their roles in supporting the residents to develop and maintain their independence and gave examples of how this is done, including supporting the residents to clean their bedrooms and do their washing and shop for personal items. At the time of the visit a member of staff was seen changing bedding for a resident who was observing what was happening. Two residents were happy to show us their rooms and they said they keep them tidy. The residents meeting book was new and it had meetings in December and January and residents’ contributions were recorded. Throughout the course of the visit the role of the staff to respect the resident’s dignity and privacy was brought into question, staff spoke about resident’s personal details in front of other residents and did not always knock on bedroom and bathroom doors before entering. The home supports residents with the planning and preparation of mealtimes, there is evidence that residents are offered choice and asked to choose one meal a week for the menu plan. The staff appeared to know the likes and dislikes of the residents and these are recorded in the resident’s personal files. A staff member when checking the menu board referred to a resident who was really going to enjoy this particular meal, as it was their favourite. Residents were observed during the day to have access to the kitchen and supported to make drinks and snacks, one resident made a cup of tea for the inspectors. A record is kept of what the residents have eaten and the processes of ensuring foods are stored and served safely are regularly monitored and results recorded. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service who are able to verbalise what, where, when and how they would like to spend their day are supported to do so, however for those who are not able to verbalise are not given the same opportunities to express their wishes. The home ensures the people who use the service receive the range of health and medical care they are entitled to and is getting better at recording the visit the outcome and treatment required. The home supports the people who use the service with their medication, however not all medication is given at the prescribed times. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home has good working relationships with health care professionals, however the home recognises it could do better to evidence that regular checks such as hearing and eyesight are taking place in a timely fashion. The plan for the Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 19 next twelve months is to ensure that regular checks are scheduled into health action plans. This was tested by viewing four residents health care support plans, written records and viewing comment cards, checking the medication system, observing practice and speaking with the manager and some staff. The manager spoke of a typical day for residents not attending social and community-based activities, describing how the residents can choose when to get up and get dressed and choose what to do with their day. This was observed during the course of the day for some residents, especially those who are able to verbally communicate what they would like to do, however an agency member of staff who arrived on duty at 07.30 said he had been asked on entering the home to support two residents who are non speaking and unable to communicate their wishes to get up. Both these residents remained at home during the day one of which was observed to spend a large amount of his time wandering around the home with limited quality contact with staff. Care plans and residents daily activity plans provide little detail of how staff need to support people to undertake daily activites such as getting up, personal care and how they would like to spend their day. An example of this was, a care plan stated that a resident dislikes having water over his head or face but the care plan did not provide staff with guidance on how they should support the resident to wash his face and hair to avoid or diminish his anxiety. The agency staff stated he had showered the resident that morning and a permanent member of staff was not aware of the residents dislike for water on his head. This demonstrates that the resident is not receiving support in the way that he wants, wishes and likes. It was established through reading a care plan that the resident who’s plan it was is unable to open and close doors, the residents was observed to remain in one specific area of the home. The door to the resident’s bedroom was closed which restricted his access to his bedroom. The home must consider what arrangements need to put in place to support the resident to access his room freely and independently. Each resident’s personal file contains information on the resident’s health care needs, historically and currently. There was evidence in all health care plans viewed that residents are receiving support and have access to various primary and specialist health care professionals such as GP’s, dentists, psychologists and community psychiatric nurses. For one resident there was evidence that the manager has taken steps to ensure the resident receives the appropriate dental treatment and records from October 2007 demonstrated that the home was now recording contact with all professionals and recording outcome of visits. A relative said: Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 20 “I am aware the staff have received support from outside agencies to help them support and understand my relative who has a specific disorder”. The relative went on to say that the home always informs her of any urgent issues, but she is not always given feedback about assessments, GP and dental appointments or provided with information about the home and management. Staff confirmed that they had received training in various health care conditions and behaviours such as epilepsy, managing continence and managing challenging behaviour. The home has systems in place for the administration of medication. The home uses a monitored dossett system which is supplied by a well-known high street pharmacy and who provide training for staff. Medications are received, stored, recorded and disposed of using systems as stipulated in the Royal Pharmaceutical Guidelines. The visit to the service was started at 09.45 and medications were observed being administered, the standard time and standard medication administration records give the time of 09:00 for medications to be given. A senior member of staff said that occasionally the residents get their medication late because they refuse at the prescribed time, so the staff give the resident up to half an hour and then offer again, if the resident continues to refuse their medication then their G.P is contacted. A recent medication error was reported as required the persons GP, care manager and to the Commission for Social Care Inspection. The staff concerned have since been retrained and the resident concerned did not suffer any long-term ill effects from the error. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home fails to provide accessible and up to date information on how the people who use the service can have their views listened to and acted upon. The home is aware of the procedures for referring allegations of abuse to the appropriate authorities however it continues to place the people who use the service at risk by not taking appropriate checks of visitors or temporary staff. (agency). EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that since the manager commenced working in the home in September 2007 there have been a number of concerns that have been referred to social services under the safeguarding procedure, the manager also identifies that there is little evidence that a complaints procedure is in operation. This was tested by speaking with staff and the manager, viewing the homes current complaints procedure and establishing how many staff have received adult protection training. The personal plans had a copy of a complaints procedure in symbols. This was out of date and was not displayed in the home. Therefore the residents who live in the home may not have the knowledge or information they would need to make a complaint. One resident had a ‘speaking up’ form in their file, in Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 22 picture symbols, but they were not aware of this or how to use it. The home should consider if the complaints procedure in its current format meets the needs of all the residents especially those with limited or no verbal communication. Comment cards received from staff informed us that they knew how to deal with complaints, stating that they would tell a senior member of staff and record the concerns raised. The manager stated that all staff have been informed that they must read the home policies and procedures regarding complaints and there was evidence in the policies and procedures house file that staff are starting to read and sign they have read it. Since September 2007 the service has made four safeguarding referrals to social services and informed the Commission for Social Care Inspection. The service with the advice of social services and the police have taken appropriate action to minimise further risks to the residents in respect of the allegations referred to social services. 80 of the staff had abuse awareness training in 2006, since then 3 new staff have been employed and adult protection is part of their induction. Staff who were spoken with were aware of their responsibilities in protecting the residents and reporting any concerns that they may have about their health and welfare. Concerns still remain; on the day of the visit the inspectors were invited into the home without being asked for their identification or being asked to sign in. Later it was established that an agency worker who had never worked in the home before had not been asked for his identification or asked to sign in. When asked what he did as part of his shift he stated that he had assisted two male residents with their personal hygiene. The failure to take appropriate checks to establish the identification of people visiting the home and working in the home for the first time places the residents at potential risk of harm. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Hillingdon House is a comfortable and homely house, however attention to minor maintenance and environmental hazards must be addressed for the safety of the people who use the service and the staff and adaptations and changes to the environment must be made to support the people who use the service to move safely around their home. The home continues to have an unpleasant odour, and staff actions may allow the spread of infection. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home needed environmental improvements and this was identified immediately the manager came into post and the objective was to seek improvement quickly by identifying priorities. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 24 This was tested by touring the building, seeking permission from residents if their bedrooms could be viewed, viewing maintenance documents and speaking with residents and staff. Hillingdon House is a two-storey building and still retains some of its unique features such as ornate fireplaces and ceilings. The home is decorated and furnished in keeping with the needs of the residents; there are warm subtle colours on the walls, and easy clean furniture. Carpeted flooring in some communal areas have been replaced with easy clean laminate flooring, the manager said this has assisted in supporting with continence issues and has eradicated unpleasant odours. The manager was informed that on entering and in parts of the home unpleasant odours could still be detected. The kitchen is moderate in size and has the necessary equipment to plan, prepare and serve meals. Residents are encouraged to use the kitchen with support from staff, but the kitchen is not easily accessible for all residents especially those who use wheelchairs. The garden is enclosed and provides additional space of residents wishing to relax or have free time, there is an area for BBQ’s, which staff said, had occurred during the warmer months. The residents spoken with said they liked their home and had been involved in choosing decorations and soft furnishings. Resident’s bedrooms are comfortable, clean, furnished with quality furniture and furnishings. The bedrooms are personalised to reflect the resident’s personality and individuality. Residents who are able to hold their own key have a key to their bedroom. Some minor defects were noted whilst touring the home, which included blown light bulbs and curtains in need of re hanging. A senior member of staff said he would see to these. There remain a number of environmental hazards, these include the steps up to the kitchen, the step into the small office, the step onto the raised area from the conservatory, the dropped matting area just inside the conservatory door and the the step up from the laminate hall onto the carpeted hallway. The steps to the kitchen and the step from the hallway to the communal area was identified as a hazard during the last visit to the service and a requirement was made, it does not appear that the requirement has been met and therefore will be repeated. The home had an odour of urine throughout, but particularly in the entrance hall. The manager explained the steps that had been taken to eliminate odours, these included replacing carpet with hard floors, hiring an industrial cleaner, having a spot cleaner available for staff use, employing a cleaner. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 25 Referring the resident concerned to a continence advisor. The service must consider what other steps it can take to eradicate the unpleasant odours. There is liquid soap and paper hand towels to minimise the risk of infection and the home has a semi industrial washing machine that has a sluice action and washes to high temperatures. The practice of carrying soiled laundry and clinical waste through the home and not in the appropriate containers raises the risk of cross contamination and infection, this practice included clinical waste products being placed in a bin without the appropriate waste bag and a lid. Staff stated they had not received infection control training. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32. 33,34. 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home currently does not have sufficient, qualified, competent suitably supervised staff to meet the needs of the people who use the service, however plans are in place to recruit new staff. The home undertakes appropriate recruitment checks on new staff prior to working in the home to safeguard the people who use the service from potential risk of harm, however it must have a system in place for checking agency staff’s credentials. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that they do well to ensure staff are recruited with appropriate checks in place before they start, staff have access to a robust training programme and ensure staff are supervised and where there is specific guidance required this is assigned and monitored. However the AQAA identifies that it could do better to supervise staff more frequently and assign clear and measurable objectives. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 27 This was tested by viewing the duty rota, staff personal files, which include recruitment, training and supervision information, viewing comment cards received from staff, speaking with some staff and observing their practice throughout the course of the practice. The manager stated that there are normally four staff on duty plus the supernumery manager throughout the day and two waking night staff. On the day of the visit there was a senior on duty with a member of staff who has recently returned from long-term leave and an agency member of staff who had not worked in the home before, plus the manager. It was evident from the number of staff on duty and the duty rota that shifts take place with three staff. One member of staff said this could be one permanent member of staff and two agency staff, who may not know the people in the home. The manager stated that the home is in the process of appointing new staff and had recently appointed a cleaner, which has relieved care staff of this responsibility. The agency staff member and a member of staff returning from long-term absence were spoken with and both confirmed that they had not received an induction into the home other than where fire exits and fire safety equipment were located. The agency member of staff has not been made aware of the needs of the residents but asked to assist two residents to get washed and dressed. A failure to provide information about the residents prior to carrying out care places the residents at risk of not having their needs carried out in a consistent manner and a way in which they wish and which is safe. An example of this was the failure to support a resident to eat his meal as detailed in his care plan. A member of staff said: “Usually we have enough staff, but at the moment we do not have enough staff to meet individual needs” The company supports staff to undertake a national vocational qualification (NVQ), currently 13 of the staff team have achieved a NVQ, the manager is aware that the national minimal standards state the home should be achieving at least 50 . However staff receive required training such as moving and handling, first aid, fire safety and food hygiene, in addition they receive training specific to the needs of the residents such as communication, managing challenging behaviour medication and epilepsy. The manager stated that the home is well supported by specialist health care teams who assist with specific training where required. However records confirm that staff have received little training in the last year. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 28 A relative said: “The staff do their best to meet the complex needs of the residents and will seek help to acquire the skills in order for them to meet the needs of the clients”. Staff recruitment files were viewed and found to hold all appropriate documents required when employing staff to work with vulnerable people. Evidence of an application, two references, criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks were in place. The agency member of staff stated that he had not been asked for identification on entering the home and it was his first visit to the service, he had not received an adequate induction and he was not aware if the home undertakes recruitment checks on agency staff. The manager confirmed that this was not common practice. Records of supervision and appraisal were viewed, there was evidence that supervisions had not been taking place regularly and the documentation to record supervision was extremely brief with no useful or measurable information. The senior staff who supervises a small number of staff said that senior staff had received training. The supervisions documents seen were over a year old and the appraisal had not been completed. A senior carer said that when the home was without a manager they did not receive adequate support from senior managers in the company. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current manager is working towards improving the standards in the home to provide a well run home for the people who use the service to live in, and where they are provided with opportunities to share their views and improve the quality of the service, however the lack of a consistent manager and support from the company continues to effect standards in the home. The home has systems in place to promote and protect the people who use the service from potential health and safety hazards, however the lack of attention to fire safety drills and testing of fire safety equipment compromises their health and safety. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 30 EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that the home has taken necessary steps and appropriate action to notify authorities of the difficulties the home has encountered over the last couple of months including allegations of abuse, demonstrating transparency. It identifies that the home needs to be more aware of possible issues before they have reached a level of concern and plan to do this by setting specific targets for staff that will help determine suitability for the roles they perform. This was tested by speaking with the manager and staff and viewing documents relating to health and safety. The home has been without a registered manager since April 2007; in this time several senior staff have taken up acting positions. The Commission for Social Care Inspection expects the service to appoint a manager and make application to register them in a timely fashion. A relative said. “No real information reaches us unless specifically asked for, especially about management, a lot of questions are answered by that’s confidential”. A senior member of staff and the manager both stated on different occasions during the visit that they had recieved very little support from senior managers in the company and rarely saw them. There was evidence in documentation viewed throughout the course of the visit that the manager had attempted to improve standards in the home but has spent the majority of his time dealing with staffing concerns. The manager’s office is currently the back portion of the garage in the garden, which leaks; it is small and does not have adequate space to hold important information. The room is damp and electrical items are reported to short circuit because of this and documents have also become damp. At the time of the visit arrangements were being made to house the office in a vacant bedroom but this is a temporary arrangement. The company undertakes regulation 26 visits to its registered services as required, this is a quality audit of the home care practices and which must take place monthly and unannounced. There was evidence that these visits had taken place but not monthly and information recorded in the report contradicted the information gathered through out this visit, such as the standard of the care plans. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 31 The manager stated that the service plans to develop and implement regular residents meetings, notes of a recent meeting were seen, which included an agenda and topic of discussions. This demonstrates that the home is geared to ensuring the residents have a say about how their home is run. Consideration must be given to those who have limited communication on how their views and wishes can be sought. Fire records were viewed and were observed to be up to date apart from gaps of 2 weeks in November 2007 when the delegated member of staff was on leave (no one else had taken on testing). The fire alarms were tested at the time of the visit and there was evidence that fire safety equipment had been tested. On entering the building a senior member of staff showed inspectors where fire exits were. The last fire evacuation drill was out of date showing the 6th November 2006 as the last recorded drill. This potentially places residents and staff at risk and does not meet with fire safety regulations. Health and safety documents were viewed, the document indicates where the manager has asked for environmental items to be replaced and whether this has been achieved. There are a number of tripping hazards in the home, which could place residents, staff and visitors at potential risk of harm. These were identified during the last visit to the home and have not been addressed. These include the step from the hall to the main communal area, the steps to the kitchen and a tripping hazard identified during this visit the step from the conservatory leading to the garden. The requirement will be repeated and a further failure to comply will result in further action being taken. Substances hazardous to health (COSHH regulations) are kept in a separate lockable cupboard, however on the day of the visit the cupboard was found to be unlocked, the cleaner when asked was aware that it must be kept locked at all times. All serviceable utilities including small electrical appliances are regularly checked to ensure they are in goods working order. Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 32 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 Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEED AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 1 30 1 STAFFING Standard No Score 31 2 32 1 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 1 X Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 33 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 YA6 Regulation 12(2)(3) &(4)(a) Requirement The service must detail and demonstrate how they will ensure the people who use the service have their needs met, including their goals, aspirations and choices and their communication needs whilst ensuring their rights, dignity, privacy and independence is respected. The service must detail and demonstrate how they will ensure the identified risks of people who use the service are minimised and how they will ensure staff are aware of those risks such as those related to mealtimes and choking. The service must detail and demonstrate how the people who use the service who have limited or no verbal communication are given opportunities to engage in meaningful community, social and leisure activities of their choosing. Timescale for action 31/03/08 2. YA9 13(4)(b)(c) 12/03/08 3. YA12 16(2)(m) 31/03/08 Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 34 4. YA22 13(6) The service must detail and demonstrate how they will ensure the people who use the service will be protected from potential abuse at all times. This includes all staff checking visitors’ identification for authenticity, including agency staff. The service must detail and demonstrate how the people who use the service will gain access to all areas of the home safely, and where it is safe to do so. This includes: Their bedrooms, the kitchen and hallway to dining room. This requirement in part has been repeated from the previous inspection, a further failure to level floors as previously required will result in further action. 12/03/08 5. YA24 23(1)(a) (2)(a) 30/04/08 6. YA30 16(2)(j)&(K) The service must detail and demonstrate how the people who use the service will be supported to live in a hygienically clean, and odourless free environment and protected from the risk of cross infection. The service must detail and demonstrate how the people who use the service will be supported by sufficient numbers of skilled and competent staff to meet their needs and wishes. The service must detail and DS0000011866.V355941.R01.S.doc 31/03/08 7. YA32 18(1)(a)(b) & (c)(i)(ii) 31/03/08 8. YA34 19(1)(a) 12/03/08 Page 35 Hillingdon House Version 5.2 demonstrate how the people who use the service must be protected from the risk of potential harm by the home employing robust recruitment procedures that includes checking the authenticity of agency staffs credentials such as CRB and POVA checks before they work in the home and provide personal care. 9. YA39 26(3)(4) The service must detail and 12/03/08 demonstrate how it will ensure monthly quality audits will truly reflect and respond to quality outcomes for the people who use the service. The service must detail and demonstrate that the people who use the service live in a home where their health, safety and welfare is promoted and protected. This includes the ensuring fire safety equipment and training for staff is undertaken as per the fire safety regulations. The service must detail and demonstrate how it will ensure the people who use the service will be protected from potential hazards in the home. Therefore the service must address and make suitable arrangements to minimise or eradicate the tripping hazards identified in the body of this report. 12/03/08 10. YA42 23(4)(c)(ii) & (e) 11. YA22 23(2)(a) 12/03/08 Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 36 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 YA1 Good Practice Recommendations The people who use the service should have access to a Service User Guide and complaints procedure that has been developed in a format of which they can understand. The people who use the service would benefit from a wellrun service with a registered manager in post. The people who use the service would benefit from staff receiving improved and qualative support and supervisions in order to undertake their roles and responsibilities appropriately and professionally. 2. 3. YA31 YA36 Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Hillingdon House DS0000011866.V355941.R01.S.doc Version 5.2 Page 38 - 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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