Inspection on 08/05/07 for Hillside

This inspection was carried out on 8th May 2007.

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

Hillside 27/02/06

Hillside 22/11/05

Hillside 21/11/04

Hillside 10/08/04

Hillside 07/10/03

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Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

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Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Hillside Cranbrook Road Hawkhurst Kent TN18 5EF Lead Inspector Mrs Ann Block Key Unannounced Inspection 8th May 2007 9:00 Hillside DS0000037946.V334210.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 Hillside DS0000037946.V334210.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. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Address Cranbrook Road Hawkhurst Kent TN18 5EF 01580 752124 01580 752140 chislehurstcare@totalise.co.uk 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) Chistlehurst Care Ltd Mrs Irene Brown Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate two learning disability service users whose dates of birth are: 21 December 1925 and 29 August 1934. Care to be provided to a service user whose date of birth is 27 January 1961 27th February 2006 Date of last inspection Brief Description of the Service: Hillside is registered for 20 clients with a learning disability. Due to limited space the home usually accommodates 18 clients. There is a separate house on the same site which caters for more independent clients and is not subject to registration. Hillside is a large detached property on two floors standing in its own grounds. The home has designated smoking areas. The majority of bedrooms are for single occupancy. Hillside is located in a rural area within walking distance of Hawkhurst main centre, which has a small high street where there are the amenities of a large village including pubs, chemist, cottage hospital, bus terminus, bank and supermarket. There are local bus services to the larger surrounding towns. Car parking is available on site. The home is staffed by a manager, senior carers and carers who between them provider 24 hour care. There is one wakeful and one sleep in person on duty at night. At the time the report was written there were vacancies for a cook and domestic staff. Charges for clients at the time the report was written ranged from £450 per week to £950 per week. Additional charges are made for hairdressing between £6 and £12 per visit, chiropodist at £13 per visit, magazines, holidays, transport at 30p per mile, incontinence pads, aromatherapy at £5 to £10 per visit and personal toiletries. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block which included an unannounced visit to Hillside on Tuesday 8th May 2007. This is the first inspection of 2006/2007 and will determine the frequency of visits/inspections hereafter. The day was spent talking to clients, the senior in charge and staff and looking at a sample of records including clients care plans and daily records, concerns records, staff recruitment and training records, accident and incident records. The manager was on leave at the time of the inspection. Judgments have also been made using observation of practice as a number of clients find it difficult to verbalise their opinion of the service. Feedback was given to the senior in charge during the visit. Information from a pre inspection questionnaire completed by the manager was also used to inform judgments of service provision. Where judgments made at previous inspections remain the same, these have been included in the assessment of standards in this report. To further obtain views of the service comment cards and survey forms were sent to a sample of clients, relatives and professionals. Comments made included: Good food and staff. (Client) Nice home, I like my keyworker and the manager. Good food. (Client) Its fun and I like being with the people there and the staff. I like (the manager) (Client) Lots of nice things going on, nice area to live. I like having my own bedroom. I like my friends and staff. (Client) They treat everyone as one big happy family, when our relative comes home for a few hours always ready to go ‘home’ again to ‘family’ & friends which is as it should be. (Relative) They look after the residents who live there, always very well presented all dressed well. Kept clean and always going to different interesting places. (Relative) (My son) is well looked after. He is always clean and he has a very nice room and all the staff are all very kind people. (Relative) Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 6 A very caring home. My daughter can go out when she likes. They take them out and about on outings. I would like to praise all the staff at Hillside for a wonderful caring staff. (Relative) Hillside is always very well run and constantly refurbished when the need arises. (Relative) The manager has turned this home around. Always has my clients’ best interest to the forefront. Always finds a way to help client with any problems Liaises well with care management. (Professional) Home always communicates any change of need or health problems. I am always kept up to date. (Professional) Staff are always friendly and seem very relaxed and natural in their communication with my client. (Professional) What the service does well: What has improved since the last inspection? Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 7 Clients have staff with the skills and knowledge to support them as acquired brain injury and core training has been provided and references for new staff specifically relate to employment at Hillside. The environment is more suitable for clients as there is a plan for ongoing repairs which includes relaying the first floor kitchen flooring, fitting alarms to external doors, and providing screening for privacy in the shared bedroom. 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. Hillside DS0000037946.V334210.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 Hillside DS0000037946.V334210.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): 1,2,3,4 & 5 Quality in this outcome area is excellent Clients are supported through good admission processes to move into a home which suits them This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed and comprehensive statement of purpose and service users guide is readily available to interested people which gives clear detail of the home and the service it provides. A pictorial copy has also been produced. These documents are updated as necessary. For those clients who have limited understanding of written information, staff will talk to them about the home and show them what Hillside can offer. Each client is only admitted following a thorough assessment process, this will include a reassessment when a client has been admitted to hospital and it is thought needs may have changed. One client does not have a diagnosis of leaning disability. His needs are being met at the home with staff having had specific training, development of personal communication systems and attendance at relevant support services. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 10 One client was admitted recently and the process of admission was discussed with the senior in charge and a sample of associated records was seen. The client herself was unable to fully communicate her opinion of the process although she indicated that she was now settled in her new home. The assessment process included liaison with professionals and a visit by the manager to the client’s former home. The senior said that the manager had been careful to ensure that the client’s needs could be met at the home before an offer of a placement was made. A system is in place for clients with their supporter to visit the home and meet other clients and staff where this would benefit them. During this visit they can stay for a meal and see the vacant room. Clients start the placement on a trial basis as stated in their contract. Each client has a contract. Contracts give good detail of the rights and responsibilities of the organisation and the client. The contracts have space to record personal contract detail such as room and fees and to be signed by the client or advocate. Supporting information is also held on the social service placement agreements. Hillside DS0000037946.V334210.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): 6,7,8,9 & 10 Quality in this outcome area is good. Clients live a life where they can make decisions and take risks whilst being properly supported to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each client has a folder containing information about care needs, current goals, risk assessments and supplementary information. The aim is to present information so that staff have easy and understandable guidance for each client in key aspects of their care. The files are well set out and regularly reviewed. The system is built up from the time of admission and evidenced development of skills and independence for the client. Clients observed and spoken with as part of case tracking confirmed entries written in their care plan. Observation of practice showed that staff had a good understanding of individual care and support needs and evidenced that equal opportunities are Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 12 promoted in all aspects of the clients care. The care planning system is being reviewed. Currently care plans use both the corporate system and a pictorial system which is worked on in direct conjunction with the client. Information about each client is very well personalised and would assist anyone working with the client to respect likes and dislikes. One client is on bed rest due to a significant deterioration in health. The client is no longer able to verbalise his own decisions hence staff use previous knowledge of his likes and dislikes and involve professionals and family. Whilst a high level of care is now needed, staff believe that the client has the right to be looked after in his own home for as long as possible with the support of health and social care professionals. Each client has a keyworker who takes a particular role in working with the client, assists in the care planning process and is involved in setting up information for any formal review processes. As far as possible clients are involved in setting up their care plans where able and interested, where this is not practical staff make sure they use observation, discussion with others who know the client and previous history to identify the client’s strengths and needs. There was evidence in care plans seen as part of case tracking that the clients had taken a key role in saying what they wanted included in their personal history, likes and dislikes. Clients meetings are held. Issues discussed and raised are taken forward and acted upon for the benefit of clients. Staff are excellent in recognising clients rights to be the decision makers. Everything possible is done to ensure that clients’ wishes are identified. Where others have made decisions on the client’s behalf, this has been done in conjunction with others and in the clients best interest. Clients have access to advocates through the West Kent advocacy service. A number of clients have families who also act on their behalf. The senior in charge did not have access to clients’ financial affairs. She said that if clients wanted any money when she was on duty she would be able to take it out of petty cash. A client said that she was able to get money from the manager to take with her when she went shopping. Another spoke of having a card to get money ‘out of a machine’. In once case a client pays for personal hygiene supplies to maintain his comfort and dignity. The pre inspection questionnaire records two clients handle their own finances, the Kent County Council financial affairs officer is appointee for the remaining clients. Staff are aware that clients have the right to take responsible risks. Risk is well managed and recorded in a risk assessment process which includes potential risks whilst on holiday. Risk assessments are normally carried out in response to individual need and to events which indicate risk management processes are needed. In one recent situation a risk assessment should have Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 13 been updated to reflect an incident. Although staff knew what action to take and had talked it over with the client concerned, it had not been recorded. Personal information about clients is well maintained, staff are expected to follow the principles of confidentiality and data protection. Information is shared only on a need to know basis and wherever practical with the clients agreement. All staff are required to sign a confidentiality policy as part of the recruitment procedure. Hillside DS0000037946.V334210.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): 11,12,13,14,15,16 & 17 Quality in this outcome area is excellent Residents live a full and varied life which is recognised as their right This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clients have access to educational and recreational facilities. The pre inspection questionnaire recorded that clients variously attend horticultural and animal welfare projects, bible study, BBQs, a beautician, gentle exercise and computers at an adult education centre, day services for adults with disabilities, various recreational facilities in Tunbridge Wells, Maidstone and Hastings and local pubs. Clients have a schedule of their weekly activities. The home has its own transport including a mini bus and people carrier. On the day of the site visit a number of clients were coming and going. Some clients returned from their day activities having made cakes of which they Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 15 were very proud and looking forward to eating. For those clients remaining at Hillside during the day, staff are expected to arrange activities during the afternoon by asking what clients would like to do. One client responded in their survey that they liked to be near the church so they could go to church every Sunday. A number of relatives and professionals remarked in the surveys that since the new manager has been in post clients have had many more opportunities than ever before. Where possible clients have an annual holiday. Not all clients had a holiday during the previous year and it was hoped that arrangements for this year would be made fairly soon to get availability during the summer months. Photos were displayed in the dining room of recent holidays. One client said how much she liked her holiday to the Isle of Wight. Clients pay for their own holidays, the organisation pays for staff to accompany clients. Where it is felt achievable clients are supported to move towards more independent living. Goals are then set to help the client achieve the necessary skills. On the first floor there are kitchen and laundry facilities which can be used to support clients training and self-management. Since the separate supported living house has been opened in the grounds, one client has moved out of Hillside to live there. She was very pleased with her new independence. Relatives can be involved in the clients care if that is the client’s choice. Many relatives responded in the surveys how welcome they felt in the home and how clients had become like ‘friends’. Some clients make regular visits home, where necessary facilitated by staff taking the client home. Personal relationships are supported whether this be friends made whilst living at Hillside or previous contacts. Client’s rooms are seen as private and entry to the house is by secure systems. Each client has a key to their room, some choose not to use it. Clients deal with their own mail and are supported as necessary. Cordless phones give availability to be used in private. One relative responded that ‘the phone is always taken straight to (my son) when I ring’. The home does not currently have a designated cook, meals are prepared by staff. The senior in charge said she had trained as a chef hence took a lead responsibility for menus and food stocks. Menus are planned with clients choosing what they like to eat. Clients have a choice of food for each meal. Clients thought the food was good and food served during the site visit was eaten with relish. There is a good awareness of healthy eating. Drinks were being made throughout the site visit. Aids to eating are provided and staff are sensitive when assisting someone to eat. Lunch and supper is offered in two sittings to meet the needs of those who wish to eat quickly then leave the dining room and those who wish to eat at a slower pace. Clients can eat in the upstairs kitchen/dining room or in the ground floor dining room. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 16 A record of menu choices is kept and weight is monitored. Where necessary special dietary needs are discussed with relevant professionals. One client is diabetic and spoke of how she had ‘special food’ as she wasn’t allowed anything very sugary. Hillside DS0000037946.V334210.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): 18,19,20 & 21 Quality in this outcome area is good. Clients’ health and care needs are well met, promoting rights, choice and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are aware of the rights of clients to be treated with dignity and to be respected. This was evident in the way clients were spoken to, had care provided and were supported during meal times. Detail of how this will happen is recorded in the care plans and discussed at handovers and team meetings. Various methods of communication are used such as Makaton and pictorial formats. Care is taken that not only do clients present themselves as they would wish including clothes preferences, but they will also be encouraged to maintain good personal hygiene. One client likes a bath when they come home from day activities and this was being provided. One relative commented that ‘ he is always clean and well cared for’ another commented Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 18 ‘the home is good at looking after the residents who live there, always very well presented, all dressed well.’ Both male and female staff work at the home. Staff are aware of any specific preferences clients have regarding gender issues when being given personal care. Care records indicate there are good relationships with local health services. Survey responses recorded that the home works well with professionals, listens to their advice and meets clients’ health and care needs. A care manager responded that ‘my client’s particular health needs are well met using professionals, including a speech and language therapist’. Staff take care that clients’ health needs are recognised and appointments are made with general practitioners and specialists as required. A system is in place to record detail of such appointments so that healthcare can be monitored. The home has a small room for medication storage which is shared with some general storage. Secure locked facilities are used for medication and a drug trolley is used when taking medication to clients. The senior in charge said that clients on the first floor come down to collect their medication. Medication is dispensed mainly through a monitored dosage system. The preferred method of administering medication to each client is recorded. Records of administration are kept and those records seen evidenced medication being administered as directed by the prescriber. Only staff who have received medication training are permitted to administer medication. A record is held of receipt and disposal of medication. Creams and drops are dated at the time of opening. Systems are in place to support clients who wish to self medicate or for absence away from the home. Staff receive training in special procedures including where invasive medication may be needed in emergency. Clients are well cared for where their mental or physical health deteriorates. The home aims to take care of clients for as long as their needs can be met there. Where death of family, friends or another client has occurred staff said support is given to help clients to deal with the loss including arranging for bereavement counselling. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is good. Clients’ rights to make comment about the service and be protected from the risks of harm or abuse are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaint procedure is available and includes detail about both internal and external processes and contacts. How to make a complaint is displayed in a pictorial and written format and contained in the service users guide. A system is in place to record any complaint, investigation and outcomes. The pre inspection questionnaire recorded one unsubstantiated complaint had been received since the last inspection, the commission has received no complaints. Some clients responded in the surveys that they would use staff to make a complaint, others didn’t know who they would complain to. Clients are more likely to use their keyworker or family to express any dissatisfaction verbally or by actions, following which a note will be recorded in the care plan. In this way minor niggles don’t escalate into full blown complaints. As already mentioned, clients have access to advocacy services. Staff have had training in adult protection issues. There is a good awareness of how adult protection is managed including liaising with other professionals whilst supporting the client and others who may be affected. Staff recruitment Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 20 includes criminal records bureau and protection of vulnerable adults (POVA) checks carried out on all staff. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 & 30 Quality in this outcome area is good. Residents live in a clean, homely and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hillside was converted for use as a residential home from a large family home on the outskirts of Hawkhurst. Recently a purpose built house for supported living clients was built in the grounds. Currently there are three clients living there with some overseas staff who work at Hillside having accommodation on the first floor. To the rear of the main house is a separate building which recently reverted to its former use as a workshop. Clients have a garden which they can use where there is an ornamental pond. Quotations are being obtained to fence the pond for safety. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 22 Bedrooms are well personalised. One room is shared by two clients who both were stated as having made a choice to share. Fixed screening has been fitted for privacy when needed. Aids and equipment as needed by clients are provided such as grab rails, hoists including an in bath hoist, pressure mattress and mobility aids. The ground floor dining room has been rearranged to give more space for wheelchair users. Showering and bathing facilities are provided on each floor. At the time of the site visit the home was very clean. There are currently no domestic staff employed and care staff are required to include cleaning in their daily duties. The manager recorded that a fire risk assessment had been carried out and she has received training in the fire risk assessment process The home has been awarded a silver award for kitchen standards by the Environmental Health Officer. The standards of cleanliness in the kitchen were very good but it was noted that the wall to the left of the cooker where wipe clean wall coverings have been fitted has warped due to the heat. The owning company carry out monthly visits and record maintenance deficits. At the time of the site visit a number of deficits recorded following the last visit had been actioned including new kitchen flooring to the first floor kitchen. Other work is planned including fitting of alarms to external doors and repair to the external fire door from the first floor kitchen. Renewals and redecoration is carried out in a planned manner. A maintenance person is employed. As noted in past reports, there are no suitable facilities for staff to sleep in as they use a bed settee in the first floor lounge. Washing facilities are shared with clients and there is no designated space to store belongings or change clothing. Staff said that they wouldn’t go to bed until the last person had left the lounge, also they could hear any clients who have rooms on the first floor and needed help during the night. At one time the building to the rear of the home had been turned into a staff sleep in area with toilet, but none of the staff felt comfortable using it as it was detached from the main house. No alternatives could be found without reducing client numbers. There is a laundry on the ground floor with a washing machine and tumble driers and racking for clothes storage. Following the removal of a wall cupboard, the wall surface hasn’t been made good and hence cannot be properly cleaned. A washing machine and tumble drier are also situated in the kitchen/dining room on the first floor. Other than the laundry walls, systems are in place to prevent the risks of cross infection when using either laundry. Staff and clients were aware they mustn’t do any laundry on the first floor Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 23 before or during meal preparation and serving. Staff have protective clothing to use when needed. Staff practices seen during the site visit showed they were conscientious in reducing the risks of cross infection. Hillside DS0000037946.V334210.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): 31,32,33,34 & 35 Quality in this outcome area is good Clients have motivated, interested and dedicated staff who provide good care and support This judgement has been made using available evidence including a visit to this service. EVIDENCE: Survey responses commented positively on staff who people felt were knowledgeable and well trained. A comment from a professional said that ‘the home provides a good standard of care, staff are aware of service users individual needs. A good quality of staff are employed.’ Throughout the site visit clients appeared relaxed and comfortable with the staff on duty. Staff knew how best to communicate with each client. There was a good balance between encouraging clients with their day and recognising when they needed time and space to themselves. Conversation and activities were inclusive and gave clients time to express themselves. In speaking to staff they understand they are there to work for the benefit of Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 25 clients. Staff said they are continually reminded by the manager that it is the clients home, therefore the home must be run for the clients benefit, not the staff. The duties staff are expected to perform are recorded in a job description. There has been a change of staff since the home was taken over by the current providers. Three staff and the manager had worked together in another home and have been at Hillside since the change of ownership. Following difficulties in recruiting locally a number of staff have been recruited from overseas. Currently agency staff are not being used although they would be used to cover any shortfalls in the roster. There remains vacancies for domestic and catering staff with care staff covering those duties as part of their rota. The senior in charge said the home had been advertising for ancillary staff for some time but hadn’t had any positive responses. No administrative staff are employed. A planned staff roster that shows which staff are on duty and in what capacity. Staff felt they worked hard and were able to carry out the duties they were required to do. During the morning there are 5 staff on duty with 4 in the afternoon and one wakeful and one sleep in person at night. A senior is on call. There was a position for care coordinator but the post holder had not been replaced. One of the senior staff is allocated shift leader. The senior in charge will delegate who is to carry out specific duties during the shift. Duties will cover personal care, escorting clients to day activities, cleaning, cooking, laundry and activities in the home. The pre inspection questionnaire records that staffing hours provided are well below the guidelines set by the Residential Forum with an explanation given that many clients spend their day at external activities with only one person needing 1:1 support by Hillside staff whilst she attends her morning session. There no evidence during the site visit that jobs were being neglected due to staffing levels however since it appears difficult to recruit locally for ancillary staff consideration should be given to increasing care hours so that more time can be spent with clients, especially as one client needs a high level of personal care which requires two staff to carry out. New staff, including overseas staff are required to follow an induction process to ensure they are familiar with the routines of the home, know the clients and work in line with relevant policies. Out of the 11 care staff, 5 hold NVQ level 2 or above in care. Staff referred to training they had undertaken including core training such as moving and handling, health and safety, first aid, infection control and fire safety training. They said they also had training specific to clients needs such as managing challenging behaviour, dementia awareness and acquired brain injury. The pre inspection questionnaire records training as including bereavement & dying, risk assessment, diabetes for adults with learning disabilities, care planning, person centred planning, medication awareness and safe handling of medicines. Some training courses are provided via a DVD with questionnaire Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 26 to be completed and assessed by the manager, other training was by external attendance or by designated trainers providing in house training. Staff spoke of having handovers between shifts and regular team meetings. Recruitment records are maintained for each member of staff. Those files seen contained all required information to support a judgment that staff are properly recruited. Since the last inspection the referencing system has been tightened up so that ‘to whom it might concern’ references are not accepted. Information provided by the manager indicated that all staff hold criminal records bureau certificates and have had POVA checks. Staff are supervised on a day to day basis and there is a system to carry out 1:1 formal supervision and appraisals. Hillside DS0000037946.V334210.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): 37,38,39,40,41,43 & 43 Quality in this outcome area is excellent. Clients benefit from a well managed and safe service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post since shortly after the new ownership. She has many years experience in working in the care sector including as deputy manager in a service for adults with learning disabilities. She holds the registered managers award and ensures that she keeps up to date with current practice and maintains her own training and skills development. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 28 Survey responses referred highly of the manager saying how the home had ‘been turned around’ since she started. Staff felt that the manager had high expectations of them but recognised that this was in the interests of providing a high standard of life for clients. Staff felt that the manager wasn’t afraid to ‘get her hands dirty’ and in this way they had a good role model. Professionals responded that they had excellent working relationships with the manager and were kept informed of issues regarding their client/s. Systems are in place to ensure views of the service are obtained and incorporated into practice and planning for the service. Whilst formal feedback from each client is difficult, their needs are built into planning for their future. Client meetings are held regularly, relatives responded they are able to talk to the manager about their opinion of the service but in fact had nothing but praise for it. One family member commented that her son now referred to Hillside as ‘home’ which he had never done before, she felt this showed how settled he felt there. Information provided by the manager and staff said policies were available and accessible to staff within a procedures manual. Not all polices were inspected on this occasion, staff knew detail of key policies and worked in line with their guidance. Record keeping is good with records stored securely. Staff recognise the need to maintain accurate records. Staff said they have had core training and updates where necessary for moving and handling, adult protection, fire safety and food hygiene training, practice seen during the site visit was sound. Staff on duty knew the process for fire evacuation and spoke of fire drills being held. Records showed that fire points were tested weekly. Fire safety equipment servicing is carried out and the pre inspection questionnaire records dates for servicing of supplies and equipment. The senior in charge said that the owning company are supportive and visit regularly. Incidents and accidents are recorded in the correct manner using the principles of data protection. Incidents affecting the wellbeing of clients are notified to the commission under regulation 37. A current certificate of employers’ liability was seen on display. Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 29 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 4 2 3 3 4 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 4 4 3 3 3 3 3 Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 30 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 YA9 Good Practice Recommendations When an incident occurs which indicates that an existing risk assessment needs to be reviewed and updated, the revised risk assessment should be recorded in writing in addition to being verbally discussed. The laundry walls should be made good as a priority to ensure they are washable and reduce the risks of cross infection. 2. YA30 Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local 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 Hillside DS0000037946.V334210.R01.S.doc Version 5.2 Page 32 - 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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