Inspection on 29/07/08 for Hillingdon House

This inspection was carried out on 29th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillingdon House 22/01/08

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 08/11/2008.

CARE HOME ADULTS 18-65 Hillingdon House 31 Salisbury Road Farnborough Hampshire GU14 7AJ Lead Inspector Chris Walsh Unannounced Inspection 29th July 2008 09:30 Hillingdon House DS0000011866.V367502.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.V367502.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.V367502.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 Manager post vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd January 2008 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. Service users 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.V367502.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 “2 star ” This means the people who use this service experience Good quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector. A manager seconded from another service within The Regard Partnership and the deputy manager, assisted with the inspection visit. The seconded manager is referred to as the manager throughout the report. The Commission for Social Care Inspection had already received an Annual Quality Assurance Assessment (AQAA) prior to the inspection in January 2008, therefore the home did not have to complete one for this visit. The manager has been managing the home since January 2008, following the resignation of the previous manager. The manager has managed concerns raised following the last inspection visit in January 2008 and issues of concern dealt with through Social Services, under Local Authority Safeguarding Protocol. Following the last visit to Hillingdon House in January 2008 the service was asked to complete an improvement plan. The improvement plan is required when there have been poor outcomes for service users, they must tell us how they are going to improve standards. The plan was used as part of the inspection process to measure improvements. The AQAA informed us that the service ensures the race, gender identity, disability, sexual orientation, age, religion and beliefs of the residents are promoted by ensuring that each have an ongoing assessment to evaluate the care they require, their personal preferences and social requirements. It went on to tell us that the ethos of care is introduced to staff at the recruitment stage, and there are plans in place to support staff to receive diversity and equality training. The information obtained to inform this report was based on viewing the records of service users and staff. Two residents’ records were looked at in depth and of staff who work for the service. The day-to-day management of the home was observed, and discussions with residents and staff took place. The people who use this service are referred to as service users. What the service does well: The steps taken by The Regard Partnership to second an experienced manager to the service for six months has been beneficial to the running of the home, Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 6 and supporting service users and staff. Significant improvements have been made since the last visit to the home, these are detailed in the section “What has improved since the last inspection?” Service users are encouraged to take part in day-to-day life activities such as cooking, cleaning and laundering their own clothes. They are also supported to make choices and decisions about what they want to do and when they want to do it, such as getting up and going to bed. The home supports service users to maintain contact with family and friends, by the use of telephone, visits and when possible the home will provide transport. The continued input from health care professionals, such as general practitioners, occupational therapists and speech and language therapists has assisted staff to have a better understanding of service users’ needs and the support required to meet those needs. There are good systems and safe practices in place for supporting service users with their medication, this ensures that the health and welfare of service users is maintained. What has improved since the last inspection? Following the last visit to the service eleven requirements and three recommendations were made. All requirements and recommendations have been met. Service users and staff now appear happier, relaxed and organised and the environment is improved. Steps have been taken to improve the quality and accessibility of information service users receive, which tells them what facilities are available to them, their rights and how they can speak up if, or when, they are unhappy. The development of person centred care plans and risk assessments for service users, holding regular keyworker meetings, handovers and staff meetings have assisted the staff in providing care and support to service users in the way that they prefer. Service users are offered a range of activities and opportunities to participate in daily, including community based activities. Service users are encouraged to develop new skills and maintain their independence. Staff have attended numerous training sessions to minimise risks of harm to service users, these included abuse awareness, fire safety, health and safety, moving and handling, first aid, infection control and training specific to the needs of service users such as epilepsy and communication. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 7 Improvements have been made to the home such has replacing flooring to minimise unpleasant odours, placing signs on doors to assist service users to move independently around the home and service users are involved in making decisions on how they would like communal and individual rooms decorated. Working practices are now centred on service users, their needs and wishes, and a consistency of care is now being provided. Staff believe this is because of increased staffing levels, having a clear understanding of their roles and responsibilities and receiving regular support and supervision. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillingdon House DS0000011866.V367502.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.V367502.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the people who use the service with a Service User Guide that has been developed in an accessible format. The Service User Guide tells them about the home and the services it provides. The home is currently not admitting new people to the service. EVIDENCE: At the time of the previous visit to the home it was established that the service user guide did not appropriately meet the sensory and cognitive needs of the people they support. A recommendation was made that the home consider an alternative way of informing service users about their home. The newly revised document has been developed using picture symbols and large print and a copy is in each service users file. The Service User Guide is displayed on service users notice board, where they can view it at their leisure. The manager informed us that they are in the process of developing the Statement of Purpose further which, will include the input from service users. The seconded manager informed us that the service has temporarily placed a hold on admitting new service users to the home following concerns raised by social services and the Commission for Social Care Inspection. The home is currently Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 10 supporting a service user whose needs they can no longer fully meet to move to another service. The manager informed us that the service user, relatives and staff have been fully involved in the process. The manager went onto say they would be providing support staff from Hillingdon House to work in service users new home to assist with the settling in period and provide support and information to the new staff team. Hillingdon House DS0000011866.V367502.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 this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has made good progress in developing personal plans that reflect people’s individual needs and tell the staff how the people who use the service wish to be supported. By using a person centred approach the home has made good progress in developing systems to support the people who use the service to make decisions about their lives. The home has made good progress in identifying and recording individual risks for the people who use the service and what staff must do to minimise those risks. EVIDENCE: Following the visit to the service in January 2008 the home two requirements were made in respect of personal plans and risk assessments. They were Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 12 required to detail how they will ensure service users have their needs met including their goals, aspirations, choices and communication, whilst at the same time ensuring their rights, dignity, privacy and independence is respected. They were also required to tell us how they will ensure the identified risks for service users are minimised, and how they will ensure staff are made aware of those risks. Two service users personal plans were looked at in depth. These provided evidence that their care plans and risk assessments had been reviewed and revised. They provide specific information on how service users wish to be supported with their every day needs, and includes how they communicate and make decisions. The seconded manager informed us that all service users personal plans and risk assessments had now been reviewed but they are now planning to take this development one step further by using a comprehensive document that centres around and covers the individual holistic needs of the service user. The implementation of this new documentation is in progress and includes working with the service user, family members, staff, advocates and others who are part of the service user’s life. The seconded manager gave examples of the valuable information they have already gathered from relatives regarding service users’ past history, hobbies, interests and likes and dislikes. The risk assessments provide specific detail of individual risks, some of which are extensive and include internal and external activities the service user may be involved in. They inform the reader what the risk is and the actions they must take to minimise the risk. It was established during the visit to the home in January 2008 that staff did not appear to know the risks of some service users. Both the manager and staff were asked how this information is now passed on to ensure continuity of care and risks are minimised. The three staff who were spoken with confirmed that the home has developed good systems for communicating and handing over information about service users. The home has a communication book, which directs staff to read certain plans if changes have been made, handovers are carried out between staff at every shift, and the manager holds regular team meetings. Minutes seen for one of these meetings discussed the importance of clear communication and reading information about service users. A newly appointed staff member informed us: “As part of my induction I was asked to read all service users care plans, so I could get to know them and know their likes and dislikes”. The member of staff went onto say that he has found the information in the care plans good and easy to read. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 13 Another staff member said: “Communication between staff and the managers has really improved”. Evidence in service user’s individual personal plans tell us how to support them to make decisions about their everyday needs and lives and communication tools are in place to assist with the decision making process. The manager informed us that the community team had been involved in supporting the home to establish specific communication tools with some service users, and all staff have attended a two-day communication workshop. Two of the staff who attended the workshop informed us that the it had been very informative and provided them with a better understanding of the intricacies of communication and behaviours, and provided them with ideas on how they could support service users to make decisions. She also stated that it is also hoped that the work that will be carried out to implement person centred plans will also provide staff with a better understanding of how service users make decisions about their individual goals and aspirations. A keyworker system is in place and monthly meetings are held with service users to evaluate if previously set goals and aspirations are being met, and to discuss with the service user what further interests, hobbies and goals they would like to pursue. An example of how this worked was tracked from an annual placement review, which the service user had been involved in. The review asked the service user what their goals were for the next twelve months; these were listed as action points. Evidence that these goals were being pursued was found documented in the keyworker meetings and provided information if the goal had been met and if it had not been met an explanation had been recorded. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. The home is making good progress to support the people who use the service to be involved in age, peer, culturally, social and community based activities. The home has made good progress in providing staff with the understanding of their roles and responsibilities in respect of supporting the people who use the service to live independent lifestyles, and ensure their rights to dignity and privacy are respected. The people who use the service are supported to maintain links with family and friends. People who use the service are involved in the day to day planning and preparing of drinks, snacks and choosing what they would like to eat. EVIDENCE: Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 15 Following the visit to the service in January 2008 a requirement was made to ensure the people who have limited or no verbal communication are given opportunities to engage in meaningful community, social and leisure activities of their choosing. By viewing service users’ weekly activity records, daily notes, speaking with service users and staff and observing activity on the day of the visit it was evidenced that the home has made progress in this area. The manager informed us that the home has taken great steps in reviewing service users current activities by using a person centred approach. This was evidenced in personal plans and monthly keyworker meetings demonstrate that the home is regularly reviewing these. The manager also stated that progress has been made with certain service users in encouraging them to participate in activities of their choosing. This has been achieved with the support of a speech and language specialist and developing individualised communication tools. Weekly plans provided evidence that service users are involved in a range of activities. These include community based and social activities and activities that develop personal skills. On the day of the visit arrangements were being made to support several service users to try out a new college with the agreement that if they didn’t like it they could return. The trip included lunch out. On return service users happily showed of their craft items they had made and excitedly said they would like to return. The manager informed us that staff are now more confident to try new activities with service users. A member of staff said: “We now have a range of activities up and running and service users are more contented, having more drivers has also made a difference”. A service user indicated in a comment card that they are able to choose what they want to do and when they want to do it. The service user also told us that they had enjoyed their visit to the college. The service user also indicated on the comment card that they regularly see a member of her family. Information in personal files and discussion with the manager provided evidence that contact with family and friends is maintained and supported by the home. There was evidence that family members have attended reviews and been involved in developing person centred plans. The manager said the information provided by the relatives had been valuable and provided staff with a better understanding of service users. Each personal plan holds the contact details, birthdates and special dates of service users family and friends. We were informed that the staff support service users to write and telephone their friends and family. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 16 Following the last visit to the home it was evidenced that staff were task orientated, provided little time for service users and did not respect their dignity and privacy at all times. Through observation and discussion with three staff it was established that they have changed their working practices and have a better understanding of their roles and responsibilities. Staff knocked on doors before entering, provided choices, supported service users to engage in activities and when asked, provided evidence that they understand the principles and values of care. A new member of staff said: “I feel confident that I respect service users’ individuality and dignity and privacy”. The staff member went onto say: “The home is orientated around service users”. A service user answered “Always” in their comment card to the question, “Do the staff treat you well”. The home supports service users with the planning and preparation of mealtimes. The home has a picture menu board to provide information to service users who have limited or no verbal communication. They are offered a choice and asked to choose one meal a week for the menu plan. Service users are supported to use the kitchen to make drinks and snacks and at the time of the visit a service user who had chosen to remain in the home was supported to prepare their lunch. The manager said there are plans in place to support a service user to take their keenness for cooking one step further and enrol them on a college course where the process of planning, buying and preparing meals is carried out. A record is kept of what service users have eaten and the processes of ensuring foods are stored and served safely are regularly monitored and results recorded. The manager informed us that staff now eat with the residents providing support where necessary and an opportunity to socially engage in a relaxed environment and this was observed at the time of the visit. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The home has made progress in providing all the people who use the service with care and support in the way that they prefer and require. The home ensures the people who use the service receive the range of health and medical care they are entitled to. The home ensures the people who use the service are supported with their medication using safe practices. EVIDENCE: The review of personal plans, the implementation of a person centred approach and guidance from the manager, is assisting staff to support and care for service users in the way that they prefer. The care plans tell us in detail how to support service users throughout the day from getting up and going to bed. It details their strengths, their likes and dislikes and their weekly plans reminds service users when they have agreed to help with daily tasks around the home, such as washing, cleaning their rooms and shopping. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 18 A service user who told us that she could do what she wanted, when she wanted, and a member of staff who said that the service is orientated around service users. During the visit in January 2008 it was noted that the atmosphere in the home was tense and a number of service users were exhibiting challenging behaviour. On this visit it was observed that the home was relaxed, organised and service users appeared at ease. Reports from the manager and staff told us that for some service users behaviours had decreased and they were positively engaging in day-to-day activites. The manager said she felt this was because service users were now receiving a consistency of care, being empowered and provided with opportunities to explore new and varied activities. A member of staff said: “I really enjoy coming to work, the atmosphere is more relaxed and vibrant” Another said: “I can’t believe some of the changes in some of service users, I think it’s because we now provide seamless care”. A concern was raised at the last visit to the home in January 2008 regarding the restriction placed on a service user who was unable to access their bedroom during the day if they wished. An appropriate door prop has rectified this, and the manager informed us that the service user regularly visits his room on his own accord. Each service users personal file contains information on their health care needs, historically and currently. There was evidence in all health care plans viewed that service users are receiving support and have access to various primary and specialist health care professionals such as GP’s, dentists, psychologists and community psychiatric nurses. An individualised emergency seizure plan is in place fro service users who have epilepsy and are at risk if seizures are not managed correctly. A nurse specialising in epilepsy has devised these with support from the staff and there is evidence that all staff have been trained to administer medications used when a service user is experiencing a seizure, “as required” medications. Daily records and monthly keyworker meetings detail when contact had been made with a health care professional and the outcome of that visit. The manager demonstrated that she has a good understanding of specific illnesses and genetic disorders that effect the health of service users, and said she has an interest in finding out about these conditions to support staff to have a better understanding. Information on specific conditions was found in the personal files of service users tracked for the purpose of the visit. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 19 Staff said they are made aware of any changes to service users health care needs from regular handovers and reminders to read specific service users notes. A staff member said: “The communication between staff has really improved and we know what is happening for each service user and when”. The new person centred documentation the home plans to implement in the very near future includes a comprehensive health action plan, which includes well women and well men documentation. This plan is developed in an accessible format. The home has systems in place for the administration of medication. The home uses a monitored dossage 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. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home has made improvements in how they support the people who use the service to raise concerns and/or make complaints. The home has taken steps to minimise the risk of abuse, neglect and self-harm to the people who use the service. EVIDENCE: Following the last visit to the home in January 2008 it was established that service users had limited ways of expressing their concerns other than through behaviours. This was especially significant for service users who are unable to verbalise how they are feeling. The home has developed an accessible complaints procedure, which is held within service users’ personal file and displayed on a communal notice board. Symbols, pictures and large print are used to provide service users with information about what to do if they are unhappy. The manager stated she recognised that this still will not meet all service users needs, but the support of a speech and language specialist, signs on doors and a positive approach to how the service users are now supported has decreased inappropriate behaviours. The home has a keyworker system and monthly meetings take place with service users. They are given the opportunity at these meetings to express any concerns they might have. The manager informed us that she has an Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 21 open door policy and welcomes service users to share any concerns they might have. A service user indicated in a comment card that she would speak to the manager if she was unhappy and staff “always” take the time to listen to her. Three staff who were spoken with demonstrated that they know what to do if a service user or a member of their family should make a complaint. The home has a corporate complaints policy and keeps a record all complaints; this includes the nature of the complaint, the action taken and outcome. Following the last visit to the home in January 2008 it was required to tell us how it would ensure service users will be protected from potential abuse. The home provided evidence that they have taken steps to minimise risks to service users. The home has ensured all staff have been made aware that they must ask visitors sign in and show identification and this was confirmed in the minutes of the staff meeting held in March 2008. The inspector was asked to sign in and show identification on this occasion. Training records and information from three staff spoken with at the time of the visit confirmed that staff have received abuse awareness training. The staff were able to say what they would do if they witnessed or suspected a service user was being abused. The home supports a number of service users who at times can challenge the understanding of staff. The home has received support from psychologists and psychiatrists to develop a better understanding of these behaviours and how to support the service users when they become unsettled. Each service user has a behavioural management plan that details triggers, the behaviours and how they must be managed to prevent escalation. There is evidence that behaviours are monitored and evaluated regularly. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 22 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, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Hillingdon House is a comfortable and homely house that has made improvements to support the people who use the service to move safely and independently around the home. The home has made improvements to its cleanliness and the risk of cross infection has been minimised by better hygiene practices. EVIDENCE: 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. Carpeted flooring in some communal areas have been replaced with laminate flooring, the manager said this has assisted in supporting with continence issues and has eradicated unpleasant odours. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 23 Following the last visit to the home in January 2008 two requirements in respect of the environment were made. These included providing a hygienically clean and odour free environment and providing safe access to all areas of the home. This included access to the kitchen and dealing with tripping hazards around the home. The manager informed us that she has worked with an occupational therapist and physiotherapist to assess the issues of service users accessing the above areas of the home and tripping hazards. The manager agreed she would send us a copy of the report and assured us that all areas had been assessed and recommendations put in place to minimise risks to service users and staff. The home has now placed signs and symbols on toilet and bathroom doors and each service user has a photograph or picture of their choice on their bedroom door, identifying it as theirs. The home was observed to be tidy, cleaner and smell fresher, although a slight unpleasant odour could be detected. The use of powerful scented fresh flowers assist to eradicate the smell. The manager spoke of the services’ intention to replace the carpet in the lounge, which is where she believes the odour is. Staff and training records told us that they have received infection control training and are provided with suitable equipment to minimise the risk of cross infection. Minutes of a meeting held earlier in the year informed staff of the importance of carrying out strict infection control procedures. A member of staff said: “The deputy manager is very hot on infection control and makes sure we are doing things that involve personal care and dealing with waste that we do it properly”. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 24 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): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are now supported by sufficient numbers of skilled and qualified staff. The home ensures the people who use the service are safeguarded from potential harm by adopting robust recruitment procedures, however the manager must establish what system is used to hold information. The home ensures staff are provided with the required and specific training they need to appropriately support the people who use the service. The staff now receive regular and meaningful supervisions to assist them in developing their skills and performance. EVIDENCE: The manager informed us that the home has recruited to all staff vacancies with the exception of one. She informed us that the home no longer employs agency staff to cover shifts. She said this is because service users needs are Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 25 very complex and they need staff who are fully aware of their needs and can provide a consistency of care. The duty rota provided evidence that the home has sufficient staff on duty to meet service users needs. It was further evidenced that the home is sufficiently staffed as service users were observed to do what they wanted. A service user who did not wish to go out was supported on a one to one basis by a staff member, the staff member was observed to involve the service user in varied activities throughout the day. The manager said: “We have a stable staff team who are happy to cover shifts when needed”. The home has implemented a daily plan which informs staff what their responsibilities are for the day, including who they are providing personal care to, supporting with various activities, diary events such as GP appointments and who is responsible for administering medication and checking equipment such as fridge and freezer temperatures. The staff who were spoken with spoke of a more organised and relaxed environment where they work as a team and openly communicate with one another and the manager. The company supports staff to undertake a National Vocational Qualification (NVQ). A member of staff just promoted to a senior position confirmed that she has undertaken an NVQ and the newly appointed member of staff said he was aware he would be undertaking this qualification. The service uses a system to record staff recruitment details known as Annexe B, this is a system which has been agreed by the Commission for Social Care Inspection to provide evidence that staff have been correctly recruited. A performance relation manager (PRM) employed by the Commission authorised the use of this system. The recruitment records of all staff employed since January 2008 were viewed and found to hold all the information required to demonstrate that the home has recruited correctly, including obtaining two references and carrying out checks such as FirstPoVA (Protection of Vulnerable Adults) and CRB’s (Criminal Records Bureau). The manager must however decide what system she is going to use to demonstrate that all recruitment checks have taken place as original documents and details of staff were found in their files and gaps were found on the Annexe B form. The manager agreed that she would deal with staff files immediately, following the organisations’ newly revised recruitment policies and procedures. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 26 Newly appointed staff are inducted into the home using a buddy system. This is where the new member of staff is supported by a member of staff who has worked in the home for a significant period of time and knows service users and routines. A new member of staff confirmed that he had been inducted into the home using this system, which allowed him to get a good idea of the homes routines and get to know service users. He said he felt well supported by the staff and the manager and there was always someone on hand to answer any questions he may have. Following the homes induction new staff are supported to complete “The Skills for Care” induction programme, (this is a recognised national care sector process). There is evidence of staff completing this tool with the manager. Workbooks are completed on various subjects including the principals of care and abuse awareness. Following the last visit to the home in January 2008 it was required to ensure there are sufficient numbers of skilled staff to meet the needs of service users. As stated above the home has recruited to vacant posts and provided evidence that staff have received up to date and required training to meet the needs of service users. This was confirmed by evidence in staff training records and by a member of staff who said they had received training in communication, medication, epilepsy, health and safety and infection control. The deputy manager said: “The two day communication course was very good, informative and in depth, it gave us an insight to subtle behaviours and indicators that could be a form of communication”. Staff confirmed that they are now receiving regular supervision, which looks at positive aspects of their performance and identifies areas where extra support it required, each supervision ends with setting objectives, which are reviewed at the next supervision. The manager said that when the deputy manager and senior staff have received training will be taking on the role of supervising other staff. She went onto say that all staff will be appraised in August 2008. The staff who were spoken with said they felt well supported and the manager approachable. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 27 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 good. This judgement has been made using available evidence including a visit to this service. In the last six months there have been significant improvements to the management of the home. However the service must be able to demonstrate maintence of current standards once the seconded manager returns to her substantive post. The people who use the service are now benefiting from a well run service that listens to them, seeks their views, and provides them with a safe place to live. EVIDENCE: Following the last visit to the home it was recommended that the home would benefit from the appointment of a registered manager as it had been without a registered manager for approximately seven months. The Regard Partnership seconded a registered manager from another service to Hillingdon House. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 28 Twelve requirements and two recommendations were made following the last visit and the home was required to complete an improvement plan. The improvement plan stated that all requirements have been met. In addition to seconding an experienced manager the home has appointed a deputy manager. We were informed the service has appointed a new manager who will be starting work in August 2008. The manager advised that she will remain in post for a short period to provide support and a handover. Through discussion with staff, viewing comment cards and observing interactions between the manager and others it was found that the manager is respected by the staff team and has developed positive relationships with service users. A member of staff said: “The care service has improved a lot and I am happy to be working here”. Another said: “The communication between staff and the managers has really improved, the office door is always open and it has made a difference having the manager in the house rather than a shed in the garden”. The same member of staff went onto say: “The manager is really focussed on service users and she makes you feel empowered to make decisions”. The home has systems in place for monitoring the quality of the service they provide. The Regard Partnership nominates a service manager to make an unannounced visit to the home unannounced to carry out an audit of the home, this is to ensure it is meeting National Minimum Standards and the Care Homes Act 2000. The home holds regular service user and staff meetings which provides an opportunity to share information and plan future events. The manager said she is planning to use alternative communication tools in service user meetings, such as pictures to support service users with limited communication to take part. The manager informed us that The Regard Partnership are currently planning to survey their services including Hillingdon House and are in the process of sending out quality questionnaires to all stakeholders, such as service users, relatives, placing authorities and health care professionals. The manager told us that quality questionnaires for service users will be in an Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 29 accessible format. Fire safety records viewed as part of the inspection process told us that improvements have been made to ensure all fire safety systems are checked as advised by the Fire Safety Service and staff are now receiving fire safety training including in house fire drills. Concerns were raised following the last visit to the service that the cupboard holding substances hazardous to health was unlocked and could be a potential risk to service users. The risk has now been minimised as the keys to the cupboard are held with the shift leader or manager and the cupboard kept locked. The home has recently had an inspection from the Health and Safety Executive. The manager informed us that the officers thoroughly looked at policies and procedures, risk assessments, general health and safety and water testing. Although the home has not yet received a report detailing the outcome of the visit, the manager informed us that the Health and Safety Executive were happy with the outcome, they had taken away a specific policy in respect of testing for Legionella. The home can evidence that they have regular checks on gas and electrical appliances to ensure they are in good working order. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 30 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 3 x 3 x Version 5.2 Page 31 Hillingdon House DS0000011866.V367502.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations It is recommended that the home establish one system for holding staff recruitment information, to avoid confusion and the risk of information being left out. Hillingdon House DS0000011866.V367502.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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.V367502.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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