Inspection on 16/05/05 for Hillscourt

This inspection was carried out on 16th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillscourt 19/09/06

Hillscourt 30/01/06

Hillscourt 07/01/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hillscourt 8-10 Pennsylvania Road Exeter Devon EX4 6BH Lead Inspector Rachel Doyle Announced 16 May 2005 th 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 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. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hillscourt Address 8-10 Pennsylvania Road Exeter EX4 6BH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01392 431662 01392 433406 GT Care Services Ltd. Mrs Jenny Harry CRH N Care Home with Nursing 27 Category(ies) of OP Old Age [27] registration, with number of places Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Notice of Proposal to Grant Registration for staffing/enviromental conditions of registration issued 7/6/94 Date of last inspection 7th January 2005 Brief Description of the Service: Hillscourt is a 27 bedded Home which is registered to provide nursing care for those aged over 65 years. It is an older property situated in Exeter close to amenities. There is a pavement ramp and wheelchair access. At the rear there is a level patio reached by a conservatory. The Home provides nursing care for 27 residents in individual rooms, which are divided between two floors with the upper floor split into two levels. There is a convenience store opposite, which is open 24 hours. There are no car-parking facilities but there is a multi-storey car park only 5 minutes walk from the Home and two hour parking in surrounding roads. The Home does not provide intermediate care. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Announced inspection took place on Monday 16th May 2005 at 11.00. The inspector was welcomed by the Registered Manager, Mrs Jenny Harry and the Registered Provider, Mr Graham Thornton. There were 27 residents at the Home, some in the lounges and conservatory and others resting in their rooms. The inspector spoke to 7 residents, 4 relatives and 2 staff. Four residents’ care files were looked at and case-tracked. CSCI also received 2 comment cards from relatives; one commented that they ‘could not fault Hillscourt on any issue’ and another said that ‘they could not praise Hillscourt enough’. A number of records were inspected including the pre-inspection questionnaire, training and fire log records, accident book and the complaints book. The inspector was also able to freely tour the Home. What the service does well: What has improved since the last inspection? The staff team manage the new activity programme well and document individual social care in detail. Activities are reviewed and well thought out including video nights, indoor exercises, quizzes, current affairs and sherry sing-songs. Outings and visiting entertainers are also organised. There was evidence that this was having a positive effect on residents. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 6 The Home is well organised with systems in place to ensure that care needs are met. A new infra-red call bell system ensures that all residents are able to access staff from all areas in the Home and response times and staff whereabouts are monitored. There has been extensive investment at the Home including a beautiful permanent covered gazebo so residents can sit outside safely, general cosmetic decoration throughout, new storage areas, a quiet room for residents and relatives and a staff room. The Home has an excellent maintenance man, who ensures that the garden and building are well cared for. The Registered Provider, who took over the Home in July 2004, and the manager are obviously familiar with residents’ care needs and there is now a stability and continuity to the staff team with a clear sense of direction. 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. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 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 standard(s) 1, 3, 6 The Home provides prospective residents with information, which enables them to make an informed choice about an admission to the Home. Residents benefit from a good admission and assessment process, which ensures that the Home can meet their needs. EVIDENCE: The Statement of Purpose and Service Users Guide are comprehensive and include a clear flow chart of the staff team and organisational structure. The owner said that residents’ views will be included. The owner said that the Home rarely has an empty bed and was clearly aware of the importance of good assessment to ensure that the Home could meet prospective residents’ needs. The manager visits prospective residents at home or in hospital and all four assessments looked at were detailed. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10, Detailed documentation and staff knowledge ensures that residents’ health, personal and social care needs are met. The administration of medication system does not always promote good practice, which could put residents at risk. Residents’ privacy and dignity are met and promoted by staff and the management team. EVIDENCE: Four care plans showed good detail and direction on how to meet residents’ needs, especially about wound care. One staff member is responsible for auditing plans. There is excellent documentation of the daily delivery of physical and social care by the care staff team with clear guidance from the manager; this includes pampering sessions for residents. Care plans were regularly reviewed and some re-written if complex. The manager and staff liase frequently with the GP, Tissue Viability Team and other health care professionals. Specialist needs are clearly researched and documented and staff work in key-worker teams. Medication is stored appropriately. Medication with use-by-dates are not labelled when opened although regularly changed. There are no controlled Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 10 drugs in use at present. Medication must be dispensed and signed as administered one by one not from a tray holding multiple unlabelled pots. Handwritten transcriptions should be signed by two staff and there should be photographic ID not room numbers to identify residents, consent allowing. All residents felt that their privacy and dignity was respected. This was seen. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, 15 Social activities and meals are well managed for residents and they are encouraged to maintain contact with their families and friends as they wish. EVIDENCE: The Home has devised an excellent activities programme. Activities are flexible and a trip to the supermarket was recently arranged following chats between staff and residents. One resident was more stimulated in the lounge and increasing their independence in some areas. The Home facilitate phone calls daily for one resident and four other relatives said that they felt welcome and involved. The Home is looking into utilising befriending schemes. The Home uses individual notebooks for relatives to ensure that relatives and staff maintain good communication about residents’ progress. All residents confirmed that they were offered choice and that there were lots to do. Residents had chosen how they would like to arrange their rooms and the Home had facilitated electrical changes. The inspector ate with residents in the lounge. This was a congenial affair, many choosing to sit at the new dining table, others preferred their chairs or in their rooms. Residents said that meals were good, varied and well presented. Later home-made cakes were served. Fluids were always available. Staff wear tabards when handling food and assisted residents with feeding in a sensitive manner. A recent food safety inspection did not raise any concerns. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16, 18 Residents and relatives are confident that they are listened to and their concerns acted upon. Residents are protected from the risk of abuse or harm although the use of lap tables needs reviewing. EVIDENCE: Protection of Vulnerable Adults training is booked with external trainers. All staff will attend. The Practical Guide was visible in the office. Many residents had lap tables pushed closely to them in their chairs. This practice should be reviewed to ensure that there is no restraint issue. All four relatives and the residents felt that they could approach any staff, manager or owner if they had any concerns and felt that they would be listened to. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 22, 24, 26 Residents are provided with safe and comfortable surroundings giving residents an attractive and homely place to live. A written routine maintenance programme is unavailable to ensure that this continues. The use of some specialist equipment does not ensure the safety of residents and staff. EVIDENCE: The standard of the environment within the Home is excellent. Residents said that they were pleased with the ongoing decoration and recent improvements and felt involved in any changes. The owner discussed in detail the ongoing maintenance and a tour of the Home confirmed this. It is recommended that a written maintenance programme is implemented in the future. Residents’ rooms are personalised and suit their needs. Residents’ needs are regularly reviewed and appropriate equipment provided as needs change. However, wheelchairs are not all being used correctly with footplates and one resident was distressed being tipped backwards. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 14 Privacy locks have been fitted on all doors and one resident has chosen to use the key. Lockable facilities are planned within the next budget. There is an excellent call bell system using infra-red mobile units and response times and staff location can also be monitored. Residents said that they were glad to be able to call staff in all communal areas as well as their rooms. All areas of the Home smelt pleasant and were cleaned to a high standard. This is commendable. All rooms have individual supplies of gloves and handwashing equipment. Appointed laundry staff run an organised laundry, which has been refurbished with new equipment. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Residents benefit from having skilled, experienced and friendly staff who have a good understanding of their needs. EVIDENCE: Relatives’ comments about staff included that a resident was treated with the utmost patience, that they were updated continually on progress and medical condition and that staff are all happy and very good. The owner and manager praised the current staff team and commented that management expect a high quality of care. Competencies are monitored and disciplinary processes used appropriately. There is a low staff turnover. Staff are encouraged to learn and teach others. Previous experience is appreciated whilst job descriptions adhered to. There was a jovial atmosphere and staffing levels were sufficient to meet residents’ needs. Staff education needs are well met, varied and documented. Files contained the relevant documents. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36, 38 Residents benefit in general from the continuity and stability of the management and staff team but there are no quality assurance systems in place to ensure that residents receive consistent care. The health and safety of service is protected by the Home’s systems but wheelchairs are not being used properly to ensure residents safety. EVIDENCE: The inspection poster was clearly displayed and comment cards sent out. The owner is in the process of devising the quality assurance system and has purchased a package. This requirement is carried over from the previous inspection. Staff supervision sessions take place regularly and staff all felt well supported by the manager and owner who is very visible at the Home. Supervision includes staff competency reviews. The owner and manager attend Regular Nursing Home meetings locally to discuss issues and keep up to date. Staff attend regular meetings and were involved in various home decisions. The Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 17 owner has reviewed and changed some systems to enable staff to be more effective and spend more time with residents. The current business accounts were seen and satisfactory. Accident forms were seen to be audited, risk assessed and practice changed as necessary. Bed rails are inspected weekly by allocated staff. Although there is very hot water from basins, there are caution signs and a general risk assessment. The owner said that no resident is able to use the basin unaided and new admissions would be assessed. All mandatory training was up to date. The Home has a manual handling assessor in-house. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 1 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x 3 1 3 x 3 x 2 Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 (2) Requirement You shall make arrangements for the handling, safekeeping, safe administration of medicines in the home. You shall provide facilities to residents such as appropriate wheelchairs including the use of foot rests. You shall establish and maintain a system for reviewing and imporoving the quality of care including nursing care. You must supply to CSCI a copy of the report and make it avilable to residents. Timescale for action 16/06/05 2. 22 16 (1) 16/06/05 3. 33 24 16/07/05 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. Refer to Standard 18 19 Good Practice Recommendations It is recommended that the use of furniture is reviewed to ensure that it is not a form of restraint; for example lap tables. It is recommended that a written routine maintenance programme is devised and implemented. D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 20 Hillscourt 3. 4. 38 9 It is recommended that Manual Handling Training includes the correct use of wheelchairs and that any individual risks are assessed and documented. It is recommended that medicine administration is aided by photographic ID and that all handwritten transcriptions are signed by two staff. Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY 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 Hillscourt D54 D06 42993 Hillscourt 214962 160505 Stage 4.doc Version 1.30 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!