Inspection on 17/01/06 for Hillport House

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Hillport House 18/11/09

Hillport House 03/08/07

Hillport House 12/09/06

Hillport House 11/08/05

Hillport House 22/02/05

Hillport House 27/06/04

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

CARE HOMES FOR OLDER PEOPLE Hillport House Porthill Bank Newcastle under Lyme Staffordshire ST5 0AE Lead Inspector Irene Wilkes Unannounced Inspection 17th January 2006 10:00 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 Hillport House DS0000033345.V278929.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. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hillport House Address Porthill Bank Newcastle under Lyme Staffordshire ST5 0AE 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) 01782 635073 Staffordshire County Council, Social Care and Health Directorate Ms Pegi Wilde Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 Dementia (DE) - Minimum age 50 years on admission Date of last inspection 11th August 2005 Brief Description of the Service: Hillport House is a local authority care home, run by Staffordshire County Council. The home specialises in the care of older people who are mentally frail or who have mental health needs. The home is registered for 28 older people. The home is located in Porthill, providing good access to a wide range of local community resources. There are pleasant gardens, particularly an enclosed safe garden courtyard in the centre of the building that can easily be accessed by residents from each of the lounge areas, and which is much used during the summer months. Accommodation is provided on two floors, with access to the upper floor being facilitated by a shaft lift and stairs. There are three separate lounge-dining rooms, along with a small smoke room and quiet room/visitors room. There are three assisted bathrooms and a disabled access shower room, plus ample toilets throughout the building. The home is currently in the middle of a planned refurbishment programme to enable it to meet the national minimum standards for the environment. This commenced on 18 July 2005 and will be completed by the end of March 2006. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a part day in January 2006, and was undertaken by one inspector. The number of residents at the visit had reduced to 14, plus one person who was in hospital at the time, and they were all female. Vacancies have been kept in the home because of the refurbishment work that commenced in the middle of July 2005, and is due to be completed in March 2006. Due to this work part of the home was securely sectioned off to maintain the safety of service users, staff and visitors. The Registered Manager was on duty at the visit, supported by a Care Team Leader, three Care Staff, the Administrative Officer, the cook and her assistant, three Domestics and the Handyperson. The inspector spoke to most of the residents, but because of their dementia a long chat was not possible. Several staff were also spoken to about their work and how they were managing with the refurbishment work. The records of some of the service users were looked at, and staff files and maintenance records were seen. Medication was also seen. A tour of the premises was made with the manager. What the service does well: The service users at Hillport House have dementia and/or mental health needs, and the inspector could not find out their views about their care at the home. However, the way that staff cared for the residents was seen and they treated each person with respect and made sure that personal care was provided in private and that each person’s dignity was kept. The home keeps good information about each person so that they can properly meet their needs. They are very quick at getting the GP or District Nurse to see a resident if they are unwell, and are good at making sure that any equipment is provided that might make someone more comfortable if they are ill, such as a special bed or mattress. The home had enough staff to meet the needs of the service users, and there was other support staff on duty, such as domestics, who were keeping the home very clean in spite of all the building work that was going on. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 6 The home had given a lot of thought to any extra dangers that might be found because of the building work, and made sure that staff were taking extra care to keep people safe. The way that all of the staff team were working together to care for the residents during this difficult time was very pleasing to see. What has improved since the last inspection? 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. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 7 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 Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 8 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): 3 A full assessment of the needs of each person is undertaken prior to them moving into the home. This initial assessment enables the staff to identify that they are able to meet the person’s individual needs, and provides reassurance for relatives that the home will understand the support that the person will require. This is particularly important in a home such as Hillport House where people have dementia. EVIDENCE: As the home is in the process of being refurbished which has naturally caused some considerable disruption, there have been no new admissions to the home during the refurbishment period. The care files of three longer term service users were sampled on this occasion, and this evidence, together with that found from previous inspections showed that a care plan had been received from the local authority prior to admission in each case, and that a full assessment of needs had been undertaken by the home for each resident. Standard 6 does not apply to this home. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 The home ensures that full information about each resident is contained in their care plan, and any health needs are appropriately addressed. Medication procedures are generally sound, although some additional attention is required to procedures relating to controlled drugs. It is clear, however, that the welfare of the service users is at the heart of the service. EVIDENCE: The care plans of three service users were examined. Two of the three people had increased health needs at the time of the visit, and their care plans were particularly scrutinised. Each person had a sound plan of care in place that showed, as appropriate, the particular details of care required relating to these needs, in addition to all other aspects of their health, personal and social care needs and how these were to be met. There was good recording of the risks relating to the care of each individual, such as ‘wandering,’ the management of violence and aggression, the use of bed guards, etc. and the control measures in place to manage each area of risk. The records showed clearly the timely involvement of other health professionals, such as the GP and District Nurse, and that the advice and care regime instructions provided by these Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 10 professionals were being closely followed by the staff at the home. There was evidence that additional aids and equipment had been provided for each service user as necessary to make them more comfortable, such as a hospital bed, airflow mattress, etc. The care plans had been reviewed on a monthly basis. The home is reminded to ensure that the records that are kept for each person are appropriately monitored at this review. In one instance there was some duplication of paperwork regarding a risk assessment that presented different information relating to the same risk, which could lead to the confusion of staff. In all respects, however, records in the care files were appropriate and acceptable. As this is a home for people with dementia there is no one who self medicates. Appropriate policies and procedures were in place related to medication, and medication procedures for receipt, handling, storage and return are appropriate. There are sound stock control systems in evidence. Medication is provided in individual dosette boxes. Part of the medication round was observed and was conducted appropriately and safely, and a sample of MAR (Medication Administration Record) charts looked at was properly completed and there were no gaps in recording. A photograph of the service user was slotted into the side of the dosette box. In addition to the MAR charts, there was a Medication Profile in place for each service user setting out clearly their current prescribed medication. A separate coloured sheet showed when antibiotics were being taken, which was considered by the inspector to be good practice. At a previous visit the home were recommended to keep a Controlled Drugs Register in addition to double signatures on the MAR chart whenever controlled drugs were prescribed, and it was pleasing to note that this procedure was being followed. An examination of the register identified that on occasion some pain reducing medication had not been provided to a service user at the evening medication round. The home is required to maintain a record of all refusals for whatever reason, to enable an audit trail. The home is further required to always seek the advice of the GP regarding the omission of medication, such as when a resident is sleeping, and to record the outcome of the advice in the individual’s care plan to inform staff actions. However well intentioned it is not the responsibility of the home to determine the omission of medication that has been prescribed, without prior authorisation. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 11 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, 13 and 14 The home uses the initial assessment to find out about the previous interests of the service users and uses this information to provide activities to aid stimulation, and friends and relatives are encouraged to visit. In this way the home does its utmost to have a positive impact on the daily lives of the service users. EVIDENCE: The service users at Hillport House have dementia. The initial needs assessment is used to gain a good picture of the previous interests of each service user and this is used to enable the Activities Organiser, who works for three sessions per week, to involve each service user on an individual basis in various activities. Due to the refurbishment work there was naturally some disruption for the service users with various rooms in the home being used as temporary lounges and dining areas. Although this was causing some of the service users some confusion, the staff were observed throughout the visit assisting them in a kindly way and interacting with them very positively. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 12 There were no relatives visiting the home at this inspection visit. However, several have been spoken to at previous inspections and confirmed that they are made very welcome by the home. The ‘Visitors Book’ was looked at, and this showed that relatives had visited at numerous different times throughout the days and evenings of the previous weeks, confirming that visiting is encouraged at all reasonable times. The service users generally require support in decision-making. However, there was evidence to show that relatives are kept informed and are involved in all issues about their relation. Information is provided about advocacy services. Service users are encouraged to take personal possessions into the home with them, and there was evidence that bedrooms had been personalised to reflect the interests of the residents. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 13 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. They should view the one complaint received as an opportunity to improve their practice in some areas, which will minimise the chances of any further complaints being received in the future. EVIDENCE: The home has an appropriate Complaints Procedure in place. The service users needs are such that they would not be able to voice any complaint to the inspector, and no complaints have been directly received by the home, but one complaint has been received and investigated directly by the Commission. This complaint related to alleged poor care of a resident who was staying at the home on a temporary ‘short stay’ placement. The officer investigating the complaint did not uphold the alleged poor care of the resident, but a recommendation was made to the home that care staff should advise and update relatives regarding any change in the level of need of the service user. It was also recommended that there should be more accurate recording of District Nurse visits. This latter recommendation endorses comments made elsewhere in this report regarding the need to improve record keeping on occasions. The home is asked to seriously consider the recommendations made by the Commission in the outcome of the complaint investigation. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Full attention has been paid to securing a safe and clean environment during the extensive refurbishment work that is taking place. The staff are commended for their hard work in difficult circumstances. EVIDENCE: Extensive refurbishment work at the home has been on-going since mid July last year, and is expected to be completed by the end of March this year. The visit therefore found that parts of the home are blocked to access, to allow the works to proceed and to secure the safety of service users, staff and visitors. The inspector again reiterates that the thought that had been put into effecting the building works with as little disruption as possible for the residents is worthy of note, along with the risk assessments that have been undertaken to cover all areas of risk and possible hazards that the building work presents. The home is commended for this work. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 15 The home is operating under difficult conditions at the moment, but all accessible areas were clean and hygienic, with suitable procedures being followed for the control of infection. The cleaning staff are commended for their hard work in maintaining the environment to the standard found. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 16 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): 28 and 29 Staff are competent and the recruitment procedures employed by the home ensure that service users are appropriately supported and protected. Greater attention to record keeping is required, however, to enable a suitable audit trail of necessary information. EVIDENCE: Previous inspections have identified that the home has a continuous programme in place to ensure that a minimum 50 of staff are qualified to NVQ 2 or equivalent. However, the training records that were seen on this occasion did not afford easy identification of the current position relating to this standard, or to Standard 30, about mandatory and other specialist training. The manager agreed that the individual training records were not completely up to date, but was confident that the appropriate training was in place and up to date for each individual. The inspector recommended that a training matrix be kept to easily identify the current position for each staff member regarding their training, and to show dates whereby any updates would be required. Following this inspection the home is required to provide the Commission with information about the percentage of staff who are qualified to NVQ 2 or above, and the plans in place to secure a minimum of 50 who are qualified if this has not been reached currently. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 17 The home has appropriate recruitment policies and procedures in place. Three staff files were sampled and whilst these generally contained overall evidence to show that there was an understanding of what records needed to be kept for each individual, there were individual different items of information missing in each file. The home is required to maintain all of the information as stated in Schedule 2 ‘Information and documents in respect of persons carrying on, managing or working at a care home’ of the Care Homes regulations 2002. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 18 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 From the records sampled at the visit, and observation throughout the day, it is considered that suitable procedures and systems were in place to promote and protect the health, safety and welfare of service users and staff. EVIDENCE: The Registered Manager of the home has been in post for some time now, and has considerable experience in running the home, with appropriate qualifications and an excellent understanding, informed by study, of the needs of people with dementia. She leads a senior staff team who are also familiar with the conditions/diseases associated with old age. There are clear lines of accountability within the home and with the hierarchical structure put in place by the local authority. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 19 Standard 33 regarding quality assurance, and Standard 35 about service user monies, although not inspected at the last visit were also omitted at this inspection. Due to the refurbishment work and the additional pressures being placed on the home, the decision was taken to limit the extent of the inspection at this visit. In terms of quality assurance it is known from past experience that relatives are regularly consulted about their views of the service, and the refurbishment work is evidence of the development plan in place for the home. In terms of service user monies, the inspector is aware that robust procedures are in place, and that regular audits are undertaken by the local authority. It is considered that the service users are safe from any financial abuse. Records relating to the health, safety and welfare of the service users and staff were sampled. The home’s fire records were seen relating to weekly and monthly checks of the fire alarm, automatic door release systems, emergency lighting etc. These were all in order. Staff fire drills had taken place at regular intervals and names were recorded. It is recommended, however, that an over-view list be maintained to easily identify that all staff have taken part in the appropriate number of fire drills, rather than just showing the names of staff related to each drill. COSHH (Control of Substances Hazardous to Health) data sheets were seen in place and temporary arrangements for the storage of COSHH products were seen and found in order. Servicing records for hoists and the passenger lift were seen and were up to date. Environmental risk assessments have been put in place for the period of the refurbishment, as mentioned earlier. Individual risk assessments were also in place for the service users, both those normally in situ for each person, and any additional ones needed during the building work. Further good practice was evidenced in the list of information available for contractors regarding their interactions with the service users whilst at the home. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 20 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 21 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. 1 2 Standard OP9 OP9 OP28 3 Regulation 13 (2) 13 (2) 18(1)a Timescale for action Ensure that complete records are 31/01/06 maintained on every occasion in the Controlled Drugs Register. Record authorisation from the GP 28/02/06 for any variation in the administration of pain relief. Provide the Commission with 31/03/06 information regarding the numbers and percentage of staff who have achieved NVQ Level 2 or above, and the plans in place for the training of other staff as applicable. Ensure that all of the information 31/03/06 as stated in Schedule 2 is maintained in each staff file. Requirement OP29 4 19 (1) b Sch 2 Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP32 OP37 OP29 OP38 Good Practice Recommendations Maintain good communication channels with relatives regarding issues affecting the well being of individual residents. Ensure that record keeping is reviewed at each review of care Maintain a staff-training matrix to more easily identify staff training needs. Maintain an overview list of staff attendance at fire drills to more easily identify that staff have been present for the appropriate number of drills. Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 23 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 © 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 Hillport House DS0000033345.V278929.R01.S.doc Version 5.1 Page 24 - 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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