Inspection on 17/12/07 for Hillside House

This inspection was carried out on 17th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillside House 26/09/06

Hillside House 28/12/05

Hillside House 17/09/05

Hillside House 01/02/05

Hillside House 07/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hillside House 1/2 Hillside Cotham Hill Bristol BS6 6JP Lead Inspector Kath Houson Unannounced Inspection 17 & 18 December 2007 09:30 th th Hillside House DS0000020335.V356254.R03.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 House DS0000020335.V356254.R03.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 House DS0000020335.V356254.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside House Address 1/2 Hillside Cotham Hill Bristol BS6 6JP 0117 9735784 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mr Ramani Thirunamam Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice dated 15/11/2001 applies Manager must be a RN on Parts 5 or 14 of the NMC register Date of last inspection 26th September 2006 Brief Description of the Service: 1 & 2 Hillside House is a listed Georgian house that provides accommodation that is arranged over three floors, for 17 adults with learning disabilities and mental health. The home has domestic style facilities, such as a kitchen, dining area, lounge bathrooms and toilets. The home is located in Cotham Hill, which is close to many of the amenities that central Bristol has to offer. The home can be found in a busy residential position and can be readily accessed by car or public transport. There is a shopping centre close by on Whiteladies Road local shops and coffee houses, pubs and restaurants within walking distance of the home. The home is staffed by a core of nursing staff and is supported by care support workers. The fees arranged according to resident’s individual assessment. Social services pay £688 for the total care package. This was discussed during the inspection on the 17th December 2007. The provider is Aspects & Milestones and Western Challenge is responsible for all repairs of the building. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate outcomes. The judgements that are in this report have been made from evidence collected together during the inspection. This unannounced inspection lasted over 2 days and involved a visit to the service. The registered manager, staff team and residents helped on the first and second day of the inspection. We did this done by: • • • • • Looking at the home’s written records. Tracking the care of four people living at the home to see how well their individual needs are being met. Talking with the manager, staff, pharmacist and residents. Walking around the home to look at how the accommodation meets the residents needs. Getting the views of relatives, residents living in the home and professionals such as the local Dr, work and employment agency, pharmacist and members of the staff team. The surveys and informal discussions also gave information that supported the inspection visit. 100 return response of the surveys were sent into the Commission and has been included throughout this report. What the service does well: The residents are well cared for in an individualised and consistent way. The staff are good at helping them to make choices. Residents said that: “ it’s a good service” “I have support to get there and back from church” “I have known the staff for a number of years.” A good core of long standing staff, a manager who has been with the service for several years and who has good knowledge of the residents all help with giving care and support. The service has a good support network in regards to resident’s activities and helping them to find paid work. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 6 The relatives and professionals were complimentary about what the service had to offer. 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. The summary of this inspection report can be made available in other formats on request. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 7 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 House DS0000020335.V356254.R03.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Potential residents have enough information to make an informed choice about where they wish to live. Resident’s goals and aspirations are well documented which focus on achieving positive and individual outcomes that promotes independence and builds confidence for people who live in the home. EVIDENCE: The home’s Statement of Purpose is pictorial and available to potential people who wish to use this service. Goals and aspirations are planned with a number of people from different organisations that are based on individual needs. Resident’s comments were “I come here for temporary care so I know what it was like.” The home has enough information for potential residents who wish to live there. Since the last inspection there has been no new admissions to the home therefore this standard has not been fully assessed. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 9 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, & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s individual needs and choices are regularly checked and are reflected in their care plans, which are well written and person centred. They are supported to take risks and are involved in the planning of their care. A good network exists which promotes an independent lifestyle and provides support for all residents. EVIDENCE: Four selected care plans were seen. These include medical records, daily notes, and activities programme and risk assessments. A number of residents who use the service were spoken with to find out what it is like to live at Hillside House. The staff team keep to the person centred planning approach (PCP). This method of writing about resident’s care needs considers the resident as the whole person rather than just their physical needs. This means that medical/clinical; mental health needs, family and important people in the resident’s life, social and educational goals and likes and dislikes are all taken on board. Care plans show resident’s interests, for example, a number of Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 10 residents take part in college courses and their certificates were seen to show their achievement and progress. This is a good outcome for all residents, as the staff team offer support to help personal goals to be reached. The care plans confirm that continual checks are being made. Residents are involved in planning how their needs are going to be met. Regular reviews take place and contain details about residents changing needs. The care plans were also well written and involve a number of health professionals. Each care plan is individualised and contains information about resident’s choices. Key workers play an important part in meeting resident’s needs. This support from the key workers enhances resident’s independence and encourages them to take part in events outside of the home. Residents comments were “I decide to go to college & Shirelink day centre which I like” Another person said that they follow their college plan and go to a day centre where they are helped to make life choices. Care plans show that resident’s routines and daily lives are also well recorded. For instance, resident’s likes and dislikes give clear guidance to the staff team on how to provide care. This is a good outcome for the residents as this shows that the person centred planning approach considers their needs and choices. The college course coordinator said “college staff are routinely invited by students to attend PCP meetings, and if unable to attend are asked to contribute and informed of relevant decisions and goals etc…” Relatives’ staff and residents work together to build and maintain positive relationships in all areas of the resident’s life whilst living at Hillside House. This was seen in the relative feedback response from their surveys. Relatives said that they were happy with staff and how people were being cared for. Other relatives said “ communication has always been excellent and the care my relative has received over the past 20years has been exemplary”. Another relative said that the staff “looks into the needs individually & very caring.” Residents are supported to take risks that enhance their independence and promote an independent lifestyle. For example residents talked about a project that they regularly take part in called “work mates.” This is a programme that was developed by the home and involves the residents to help out in their community. The tasks range from painting and decorating, window cleaning, clearing out rubbish and gardening. All tasks are checked for the risk so that people can be helped to complete tasks safely. The staff team help residents to find paid work and take steps to broaden their experiences. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 11 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 good This judgement has been made using available evidence including a visit to this service. Residents take part in activities that are personal to their needs and interests that promote a lifestyle that is independent and has strong links within the community they live. The home offers a balanced and varied menu that is based on choice and dietary needs. EVIDENCE: During the inspection residents were seen to have opportunities for personal development. The residents said that “I take my laundry down” “I go to the shops” “I clean my room.” It was evident from staff discussions and reading the resident’s person centred plans that they are supported with their personal development. This was seen in their daily records and their 1:1 monitoring sheets. For instance, the records showed residents “wishes to attend Weston College.” This idea was discussed with their key worker who made an entry in the residents personal Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 12 development plan and written in the 1:1 monitoring sheet. Other residents also said “they did not wish to live independently and enjoyed living as a group in the home.” This was also recorded in their care plans. This would mean that support is given to residents who wish to make choices about their lifestyle. Residents are encouraged to take part in what their community has to offer. For instance, residents were seen coming back from their activities and said “I travelled on the bus today.” “ I was at the day centre.” Their activities were seen in the home’s communication book, the diary and the resident’s activities chart. The residents each have their own travel passes that were also seen during the inspection. The staff team have good communication links with the local community. A recent letter written by the college confirmed this and the resident’s benefit from these contacts. For instance the staff said, “We support the residents to use the community services.” Comments taken from a recent survey sent to work and employment agency also said “the home provides an opportunity for people to take part in various activities outside and in the home.” The residents’ person centred plans also show that they are encouraged to take part in their local community based on their individual needs. Activities include, going to the local pub, music concerts having dinner at the nearby restaurants. Residents spoken with said, “ … I went to see a music concert Mama Mia.” The concert is based on the music from ABBA. Residents who use this service are involved in activities and hobbies that they enjoy of their own choice. For instance, there were a number of completed complex jigsaw puzzles seen during the inspection. The manager said that “some of the residents enjoy just sitting quietly doing jigsaw puzzles.” Educational and occupational opportunities are encouraged, supported and promoted. Accessing colleges and employment helps to keep and make positive friendships and relationships outside of the home. The residents daily routines are written clearly in their person centred plans. For instance, the daily records inform the staff about how often the residents attend Lanercost day centre. Another resident said “today is Monday its my day off, tomorrow I’m cleaning and working.” Staff were seen interacting with the residents and taking part in their conversations. For instance, the residents said where they had been on the bus and were seen sharing their day’s experiences. There is a varied and balanced menu with the choice of healthy options. The dietician and the homes own qualified chef had developed the menu. The letter from the dietician and input from the GP confirms this and was seen in the kitchen notice board. The meals are nutritional and cater for different dietary needs such as diabetes and those who are on weight reducing diets. The chef also has a list of the residents with special dietary needs that he follows which provide consistency in meeting their dietary needs. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 13 Residents on weight reducing diets had their dietary plans followed and had achieved their desired weight. This was documented on their weight chart and in their individual care plans. The lunchtime meal was attractively presented, relaxed and unrushed. The residents also said, “The food is good here” “I have a good cooked breakfast every Saturday it’s my choice.” The menu is based on a three-week rolling plan and has a number of food choices throughout the day. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 14 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): 19,20 & 21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents who use this service have access to healthcare and remedial services. The staff team support residents to be independent and the support provided is responsive, individualised and respectful. An end of life plan would ensure that resident’s wishes in regards to ageing; illness and death are handled with sensitivity. EVIDENCE: The home is using a new system of recording residents’ emotional and physical needs in the form of “OK health” records. By making a note of their health needs an action plan can be arranged. This would inform staff of how resident’s wishes can to be met. A selection of “OK health” records were seen and well written. For instance, notes were made of when residents were due to have their regular visits to the local Doctor (Dr) or Consultant Psychologist/Psychiatrist. For instance, the records also show that previous appointments with other health professionals are kept such as visits to the opticians. Regular support is also given to residents who wish to visit their relatives in hospital. Recent information provided by the homes Annual Quality Assurance Assessment (AQAA) also Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 15 confirms that residents receive regular emotional and physical support. Comments from the health professionals provide confirmation that residents are supported with their emotional and physical needs. Comments from health professionals were: “the home communicates and works in partnership with healthcare professionals.” The Drs comments were: “ongoing excellent care.” Evidence seen in the homes diary, and the communication book also ensure that residents’ appointments are not missed. The manager said “the home now uses the pharmacist dosage medication system where a monthly delivery of medications are made to the home.” The pharmacist later confirmed that the home has a monthly delivery of medication for the residents. All of the residents’ medication charts were look at and no omissions were found. The guidelines given by the pharmacist on the medication bottles are followed which is in favour of the residents’ wellbeing. This would also show that residents are able to take their medicine in a safe manner and in keeping with the homes policy. Comments from the pharmacist were: ”this is a good service and that the home always seeks advice when they need it.” The pharmacist went on to say: “the home looks into the needs of the individual & very caring, when ever I go to the home the clients that I see are always seem to be happy and cared for.” Protocols for residents who self- medicate were also seen with risk assessments. For instance, residents who look after their medicines know what to do if they missed a tablet. For an example, there was an entry date of August ‘07 in their file to show that staff do regular spot checks. This monitors that the residents are taking their medication regularly and is consistent with the guidelines. In addition residents who self medicate have regular reviews the most recent date was recorded for May ’07 which show that the residents who can self medicate can continue to do so safely. A number of the selected care plans showed that there was no End of Life Plan in place for residents approaching old age. Many residents are 50 years old with several years’ length of stay in the home. A discussion about the end of life plan took place during the inspection. It was suggested that an end of life programme would be helpful to residents and their families and would ensure that their wishes about illness, ageing and death is sensitively handled by the care home. The manager agreed that they would consider how families and relatives would deal with ageing, illness and death and will seek to put a plan in place. This would ensure that residents and their families can be confident that the care home will handle issues to do with death, illness and ageing with dignity and respect for their wishes. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 16 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 This judgement has been made using available evidence including a visit to this service. The home keeps a full record of complaints and includes details of the investigation and any action taken. The staff team need to have regular update in the protection of vulnerable adults to keep up with good practice and keep residents free from potential risk of abuse and neglect. EVIDENCE: The home has a complaints procedure that is in an easy to read format. This contains pictures and text that makes it user-friendly to residents. The complaint record-keeping book is also written well and was made available during the inspection. This document contained a number of residents’ complaints that show that their concerns are listened to and acted upon so that a positive outcome can be reached. Complaints were handled in a timely manner. Several complaints have been made to Western Challenge about the condition of the building and resident’s room. These entries were written in the complaints record-keeping book. The outcome to one recent complaint has been partially met and the issues about the building are still being discussed with Western Challenge and Aspects & Milestones. Resident’s views are listened to and they know when to make a complaint with support. 15 residents feedback from their surveys said that carers listen and act on what they say. The residents also said that the 1:1s with their key worker is important time spent. This confirms that the residents’ views and opinions are taken onboard and acted upon. Only 1 resident said, “sometimes Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 17 they know how to make a complaint.” Other resident’s comments were “I talk to my key worker if I have any worries.” Comments from residents were, “ I talk to staff and mum,” “ I talk to all staff,” “ I would tell staff that were on duty.” Feedback from the relatives surveys state that “ I cannot praise the staff of Hillside enough for their exemplary care of her over the years.” Residents meetings regularly take place and the notes from the previous meetings were seen to confirm that these meetings do happen. Residents and staff talk about a range of subjects for example, Christmas meal, holidays, college courses and menus. Several of the staff team were spoken with during the inspection, and they had a good understanding of protection procedures and the whistle blowing policy. Staff said that they “would talk to the manager and then the Trust.” The Alerter’s handbook was easily available for staff use. This document provides guidelines for staff to follow where issues of abuse arise. Although the staff showed good knowledge on the protection of vulnerable adults the staff updates had not been maintained. The staff-training file showed that in the protection of vulnerable adults (POVA). The records show that 10 members of staff had POVA training in 2004. It is important that the staff team are regularly updated in the protection of vulnerable adults to ensure that residents are protected from potential abuse and neglect. A random check of the residents’ finances was look at and found to be correct. The home has a policy and procedures about the handling of residents’ monies that had been followed. Residents’ financial information is kept in a secure place. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The physical environment does not fully meet the needs of the residents and the home is not comfortable and homely. The accommodation is in need of total refurbishment, which would bring the home up to a good standard for the residents living in the home. EVIDENCE: 1 & 2 Hillside House is a listed sizeable Georgian building that is situated in central Bristol. The home can be found in Cotham Hill and is close to Whiteladies Road in Clifton. The local community facilities include a number of pubs and shops, the Downs and restaurants are all close by The home has large rooms that far exceed the National Minimum Standards. The home has been made personal by a number of resident’s photographs and their own decorations can be seen throughout the house. The bedrooms are only shared in limited situations. Some residents currently share bedrooms and cope well with this arrangement. However, this is being reviewed and there are ongoing discussions with Aspects & Milestones that many of the rooms be rearranged into supported living quarters. Other residents have single rooms and enjoy Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 19 their independence. The plan for the future is to have single rooms with ensuite facilities. There is a private garden that is well looked after by the gardener. Residents have good views from their bedrooms into the garden and have limitless access. Western Challenge manages all the repair work. We found a number of concerns whilst looking at the premises and the environment: • • One of the residents’ bedrooms had a large hole in the wall and the doorframe. The house looked tired and shabby and could do with brightening up throughout. Some of the paintwork around the house is chipped which adds to the house needing major refurbishment. All aspects of the house needs decorating and made into a comfy homely place for residents of Hillside House. Hillside House could be made into a comfortable and homely residence. This could be achieved by the purchase of fixtures and fittings that would be make the residence more attractive for the residents. The hallways and corridors are poorly lit which could affect resident’s safety. Improved lighting would ensure that residents are protected from potential accidents. The carpets throughout the house in particular the stairwells and corridors are tired looking and in need of replacing. The carpets are worn and unappealing and lack a homely feel. Residents said that “ sometimes the home is not always clean and fresh.” During the tour of the premises a number of spiders webs could be seen in several corners of the house. This would confirm that the home is not always clean and tidy and supports that 3 residents said the “home is not always fresh and clean.” The manager said that “ there are regular domestics who do the cleaning.” However, the house was only adequately clean. • • • • The manager is in agreement that the property does need a complete overhaul. Discussions with the staff members said, “Aspects & Milestones could consider this as part of their refurbishment plan.” The manager was also able to share plans that dated back to 2006 from Western Challenge Housing Association. The refurbishment project plans outline the remodelling programme for Hillside House: Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 20 • Possible plan for House 1; is to become a 3 and 5 bedded flats that would provide accommodation for people in a supported living environment. Plans for House 2; will become a 9 - bedded residential care home which would offer people accommodation in the care home setting. There is still no indication to when the work on Hillside House would start, as this is not clear from the plans. The manager states that discussions were happening, as the house in its current state needs revamping. • Residents had keys to their own bedrooms rooms. This shows that their independence is encouraged and adds to the development of their living skills. New furniture had recently been bought, such as the leather suites and the home was decorated with Christmas trimmings. Even though a number of faults could be found with the premises an effort was made to make the house festive during the Christmas period. The home is in the process of buying an additional electric bath hoist for resident’s use. Relatives have also commented on the property “money needs to be spent on the building and maintenance and things like an electric bath hoist.” Hillside House has the potential to be a homely, comfortable place that meets the environmental needs of the residents. Creative solutions to issues with the environment would be of long standing benefit for the residents. The general upkeep of the home needs to be more robust and would keep the need for repairs to a minimum. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff team are skilled in their role and take onboard residents needs. Residents are protected by the home’s recruitment and selection procedures and are included in the selection of potential employees to the home. EVIDENCE: Several staff files were seen during the inspection. The staff team consists of nursing and care support team with a good skill mix of team members who care for the residents. Some of the staff team have the National Vocational Qualification (NVQ) level 3’s. The homes Annual Quality Assurance Assessment (AQAA) also state that the staff teams qualifications range from National Vocational Qualification (NVQs) levels 2,3,4 and nursing qualifications. Members of staff spoken with also said that there was encouragement for personal development and are given support with completing a NVQ level 4 in management. This shows that management is supportive and encouraging in helping their staff to develop and enhance their level of skills. The staff team showed that they had a good knowledge of their role and an understanding of residents’ needs. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 22 Many of the staff team are long standing and have been working at the home for over 10 years and have good knowledge of their needs. Some of the members of staff said “ I know the residents from the NHS hospitals.” The residents comments were, “I have a good relationship with the staff and have known them for a long time.” “I’ve known the staff for about 20 years.” “The staff looks after me well.” The staff team also describe being in the home “as one big happy family.” Relative’s comments were “The staff members relate well to my daughter and see her as a person with an individual personality.” Relatives also said “thanks to the help and dedication of the staff.” Residents have confidence in the staff that cares for them and this was evident during the inspection. Members of the staff team also involved the residents with the inspection and were seen speaking to them respectfully. This shows that the staff team are open and inclusive-involving the residents in all areas of their home. For example, residents were talking freely with the staff about their day’s events. A recent staff training programme show that updates in the following subjects had taken place; health and safety, manual handling, fire and epilepsy training were completed. This helps to make sure that the staff team have the skills to care well for residents. A good recruitment procedure exists and protects the residents living in the home. The personal files contained application forms and references. Staff files also contained job descriptions that give the staff the information needed to define their role and staff responsibilities. Criminal Records Bureau (CRBs) and the nurse’s Personal Identity Numbers are also checked. Residents are encouraged to take part in the interview process of potential employees. This means that the residents are included in the running of their own home and become involved in making sure that new staff fit in with the existing staff and residents. Staff meetings regularly take place and notes of the meetings were seen during the inspection. Comments from the work and employment team also said, “I am able to contact a qualified member of staff.” “Staff are often proactive in informing college if there are for example health issues affecting college attendance or support needs at college.” Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is well managed and include inclusiveness and choice. This service has a consistent record of meeting the health and safety needs for the home and the resident’s safety is well looked after. A meaningful monitoring system for the home would ensure that the service continues to provide a good quality of care for the residents who live there. EVIDENCE: The manager has been running this service for several years and showed that he has the ability and knowledge to deal with issues when they arise. The staff team said, “the manager is supportive in their development and were positive about how the service is being run.” The residents comments were, “ I would speak to the manager.” This shows that the manager is approachable and inclusive. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 24 There is an open culture in the home that is transparent and person centred. For example the manager was helpful with the inspection visit and was able to provide information when asked. He also actively challenges discrimination of any kind. For example he had recently spoken with the residents about the use of inappropriate language to members of staff. The staff team said, “Management are very supportive.” This shows that he works towards improvement of the service that is based on equality and diversity and shared respect for all those who enter Hillside House. For instance, making sure that the staff team are knowledgeable in matters of discrimination and support residents to attend places of worship. Resident’s comments were “I get support to go to church there and back.” The provision of support was seen throughout the inspection visit. He also says “by actively listening to residents, taking their views onboard and responding to raised issues gives residents their voice.” This has a good outcome for the residents who use this service and has been evident throughout the inspection and from discussions with staff team, residents and the feedback from other agencies. The manager also shared some ideas for the future of the service and the staff team. Ideas range from increased team building, all staff to be NVQ qualified, and in-house training. He also wishes to introduce a mentoring scheme that would give support to staff members following long absences from work. This information was discussed during the inspection and was also seen in the homes AQAA. Discussion with the manager regarding the home’s Quality Assurance (QA) procedures took place during the inspection. The managers said that Aspects & Milestones has their own QA system but there was no evidence to show that the home was taking part in their own self-audit. The main reason for this is to look into how well the service is performing and seek information from other sources such as from relatives, Drs and Community Learning Disability Team (CLDT). The aim is to ensure that the home continues to provide a good standard of care. A requirement was made from the last inspection about the lack of monthly visits that the provider carries out on the home. This is called a Regulation 26 and informs the Commission of any changes that happen in the home. The requirement has now been met and monthly reports are being sent into the Commission (CSCI) regularly. The home has regular health and safety checks and the certificates were seen as evidence. This shows that the home is a safe place for residents to live. Management continues to work towards a clear health and safety policy that is based on the Aspects & Milestones policies. This was made available on request during the inspection visit. The policies and procedures are in place and documented well. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 25 The kitchen also has been given a 4star rating from the Environmental Agency. This is a positive outcome for the residents who live at Hillside House and show that the preparation of food and the kitchen is clean and meet the Environmental Agency standards. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 26 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 1 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 2 3 X 2 X X X 3 Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 27 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 YA24 Regulation 23 (2,d) Requirement All parts of the care home are to be kept clean, reasonably decorated and in good state of repair. The registered manager shall establish and maintain a system for reviewing at appropriate intervals the quality of care provided at the care home including the quality of nursing where nursing is provided at the care home. Timescale for action 18/12/07 2. YA39 24 (1) 18/12/07 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 YA23 Good Practice Recommendations The Registered manager shall make arrangements by training staff or by other measures to prevent residents’ being placed at risk of neglect or abuse and to maintain best practice in the protection of vulnerable adults. In order to ensure this it is recommended that staff have regular refresher training in the protection of vulnerable adults. DS0000020335.V356254.R03.S.doc Version 5.2 Page 28 Hillside House 2. YA21 The registered manager shall have in place a written end of life plan taking to account residents wishes with respect to ageing illness and death. Hillside House DS0000020335.V356254.R03.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 House DS0000020335.V356254.R03.S.doc Version 5.2 Page 30 - 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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