CARE HOMES FOR OLDER PEOPLE
Hillingdon House 170-172 Ashby Road Burton On Trent Staffordshire DE15 0LG Lead Inspector
Rachel Davis Unannounced Inspection 30 January 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hillingdon House Address 170-172 Ashby Road Burton On Trent Staffordshire DE15 0LG 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) 01283 510274 01283 510274 Mrs Jean Ann Miles Miss Joanne Louise Miles Mrs Jean Ann Miles Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1 PD minimum age 60 yrs Date of last inspection 29th June 2005 Brief Description of the Service: Hillingdon House is a residential care home offering 21 places for older people, with a variation for one service user to be under 65 with a physical disability. There were no vacancies at the time of inspection. Hillingdon House consists of two neighbouring Victorian properties; one accommodates 14 service users, the other 7. It is situated in a residential area of Burton-upon-Trent, affording service users the opportunity of maintaining links with the neighbouring community. It is well placed for the town centre and has the facility of a main bus route. Both the exteriors and the interiors of the properties are well maintained; they are both very clean and the décor is set to a good standard. The service users are offered easy access to all areas of the home by the use of grab rails and a lift. All bedrooms meet the required sizes set out by the national minimum standards and are equipped with suitable fixtures and fittings. The bathrooms and toilets are well located and offer appropriate equipment and facilities. Communal areas are spacious and comfortable; patio areas with seating are available and easily accessed. Satisfactory car parking is also available. Mrs Jean Miles is the registered manager and the proprietor, responsible individual. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over 3 and a half hours by one inspector who used the National Minimum Standards for Older People as the basis for the inspection. This visit only covered a small number of the national minimum standards. To ascertain a full picture this report should be read alongside the unannounced inspection held on 29th June 2005. The inspection included an examination of records, indirect observation, discussions with service users, the deputy manager and staff. The home continues to meet the majority of national minimum standards; four requirements were made as a result of this visit. What the service does well:
Staff at the home generate a friendly, professional and consistent approach, this is both comforting for the residents and welcoming for visitors. Being quite small in registration and size, the home is able to provide a homely and friendly environment. People who use the service said that they were very happy with the care they received: “We are all friends, we don’t isolate ourselves” “ The carers are good” “We are really well looked after” were some of the comments service users made. Privacy and dignity are upheld within the home, direct observation, service users comments and staff practice confirmed this to be so. Staff were heard offering choice and enabled the service users to make decisions and as many choices as they were able in their daily lives. The home is kept exceptionally clean and is a credit to all the staff. Service users said:
Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 6 “It is always spotlessly clean here” Hillingdon House has a commitment to National Vocational Qualification (NVQ) and training for the staff. Over 50 of staff have the award, all staff have received the necessary mandatory training and training in specialist areas is being put in place. The management team work in partnership with other professional bodies to ensure the best outcome for the service users. What has improved since the last inspection? What they could do better:
Presently, the registered person does not hold a record of complaints made by service users or representatives or relatives of service users, or by persons working in the care home about operation of the care home. This must be introduced without delay with written evidence of the action and outcome of each complaint. This was also a requirement of the previous inspection. Risk assessments must be continually considered and implemented as and when required, this ensures the safety of staff and service users is always improved upon and maintained. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 7 The home must ensure that all information required at the point of employment is in place. 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. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The statement of purpose and service user guide provided adequate information for permanent and prospective users to enable them to make an informed decision about the suitability of the home. EVIDENCE: The revised Statement of Purpose and Service User Guide was examined and it was clear that further work had been undertaken to provide an informative and detailed document that would assist potential service users when considering moving into the home. Suitable information regarding emergency admission procedures has also been included in the statement of purpose and the following has been added to the service user guide as required at the last inspection: • The terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees. • The most recent inspection report. • A summary of the complaints procedure established under regulation 22. • The address and telephone number of the Commission.
Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 10 The Commission was advised that a copy of the above is provided to all service users residing at Hillingdon House. A copy of the new guide needs to be sent to the Commission also. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 10. The assessed health and personal care needs of service users are well documented and were being met, good standards of care continue. Service users are treated with the utmost respect and their wishes regarding privacy and dignity are upheld. EVIDENCE: Following the inspection of records and discussion with the deputy manager, staff and service users it was revealed that service users received a wide range of health care services according to their need. One service user revealed: “There’s no problem, the doctor comes if we need them”. The inspector observed that there was suitable and appropriate information for staff in service users bedrooms regarding daily routines and lifestyle. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 12 Service users feel they are treated with respect, their comments include: “ I am well looked after, never rushed” “The staff are good and helpful” “I like it very much, so does my family, they can visit anytime”. Care plans are well written and contain robust and meaningful information. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 There is a range of activities open to the service users to meet their needs and family and friends are encouraged to visit. Service users were supported and enabled to exercise their right to make their own decisions and choices. EVIDENCE: A structured activities programme is in place and records of who attends these sessions has been implemented since the last inspection. Hillingdon House also provide the service users with a quarterly newsletter, these are also sited on the notice boards for visitors to peruse. Information within the newsletter included; new staff and residents to the home, birthdays, menus, staff training, reference to the inspection and new policies and procedures. Throughout the inspection service users confirmed to the inspector that they were able to see their friends and relatives any time they wished. Some service users were actively involved with the running of the home and washed up the dishes, set the tables, engaged in light domestic duties and tidying up. One service user commented that they “ worked as a team”.
Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 14 Catering standards were good and all the documentation regarding food probe temperatures and fridge and freezer temperatures were seen to be up-to-date and correct. Lunch was served during the inspection and appeared to be well presented, nutritious and balanced. A choice of menus was available and the cook was knowledgeable about the needs of the service users and spoke to them on a regular basis to find out their likes and dislikes. Food storage areas were clean, tidy and suitably stocked. All areas of the kitchen were well presented; crockery and cutlery were of a good standard. Comments made by service users included: “The food is good” “We get enough to eat”. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home has an appropriate complaints procedure in place; the home must however hold a written record for all complaints made. EVIDENCE: The home has an appropriate complaints procedure and each service user had a copy of this within the Service User Guide. Service users spoken with knew that if they wanted to complain they could speak with the manager or a member of staff. A Complaints Book was not in place and must be kept by the home, this should include the nature of the complaint, when and by whom (if known) the complaint was made, how the complaint was dealt with, including the outcome. This is the only outstanding requirement made at the last inspection held in June 2005. Hillingdon House has introduced a ‘comments and compliments’ book to enable individuals to informally pass comment if they so wish. Comments within this included: “ Excellent service” “Homely environment” “Cheerful and friendly staff”. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. All staff were suitably trained to carry out their duties and the home’s recruitment practices are, in the majority of instances, in line with the National Minimum Standards. EVIDENCE: Hillingdon House has a robust recruitment procedure that ensures that their staff are suitable to work with vulnerable people. Staff files examined showed that in most instances thorough pre-employment checks are carried out. There was one file seen that contained one written reference rather than two. A requirement to rectify this situation was made. Criminal Records checks had been undertaken in all instances and the home also ensures there is evidence to confirm that the staff are both physically and mentally fit for purpose. Discussions with some service users revealed that at times they were not always sure if enough staff were on duty. It is vital to establish the difference between what people would like ideally, and what is legally acceptable. The Commission require one month’s rosters to ensure that the staffing ratios at Hillingdon House are as required. The manager provided rosters to confirm that the home was staffed at all times by a sufficient number of personnel. Discussions with the deputy manager revealed that staff training was ongoing and requirements made at the last inspection have been met. Staff working in the kitchen all have the necessary basic food hygiene, some staff have now
Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 18 completed training in the recognition of abuse, this is also covered at induction. A workbook on infection control is being completed by the staff and the new (TOPSS) induction will be implemented shortly. Two staff have a National Vocational Qualification (NVQ) 3 in care, and 5 have NVQ 2. Two staff are also presently undertaking the award and another will soon be registered. The home meets the 50 target requirement. A training matrix has also been introduced by the manager but unfortunately was not available on the day of the inspection. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38. The management team have a clear vision for the home, this is effectively communicated to the service users, staff, relatives and significant others. EVIDENCE: Service users spoken to were aware of who the manager was and were positive in their responses. Staff too felt that the management team “respond well.” and that “ team work was better.” The home must continue to improve their risk assessment records. The manager should audit the environment and ensure all generic assessments are in place. The health, safety and welfare of staff and service users are protected as far as is reasonably practicable however, the home must liaise with the fire officer to ensure compliance with using door wedges.
Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 20 The registered manager ensures that all maintenance work, repairs, annual checks, mandatory training, testing of equipment and regular fire drills are undertaken. Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 4 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation Requirement Timescale for action 06/02/06 2. OP29 3. 4. OP38 OP38 17(2) SCH The registered person shall keep 4 (11) a record of all complaints made by service users or representatives, or relatives of service users or by persons working in the care home about the operation of the care home. Records of the action taken by the registered person in respect of any such complaint must be in place. Previous requirement. 18(4)(b)i The registered person must ensure all members of staff are in receipt of two written references. 13(4) The registered person must complete risk assessments as required. 23(4)(v) The registered person must 13(4)(c) contact the fire officer to ensure the suitability and acceptance of the use of door wedges throughout the home. 06/03/06 13/02/06 06/02/06 Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hillingdon House DS0000004958.V281023.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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