Inspection on 17/09/05 for Hillside House

This inspection was carried out on 17th September 2005.

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 House 17/12/07

Hillside House 26/09/06

Hillside House 28/12/05

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 Sam Fox Unannounced 14 & 17 September 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hillside House Address 1/2 Hillside Cotham Hill Bristol BS6 6JP 0117 9735784 0117 9709301 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) Aspects and Milestones Trust Mr Ramani Thirunamam Care Home with Nursing 22 Category(ies) of LD Learning disability registration, with number of places Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice dated 15/11/2001 applies Date of last inspection 1 February 2005 Unannounced Brief Description of the Service: Hillside House is owned by Aspects and Milestones Trust and has twenty-two nursing beds, which are registered for adults with learning difficulties. The house is a converted Edwardian property providing single and double rooms on two floors, with communal space in five areas. The current occupancy is 17 which means all residents have been given the choice to have their own bedroom. There is no lift in the home and residents must therefore be independently mobile. Hillside House is situated in a busy surburban position and can be readily accessed by car or public transport. There is a shopping centre, local shops and coffee shops within walking distance of the home. Hillside House also has a mini bus which is used regularly by residents. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an annual unannounced inspection, the purpose of which was to ensure that residents were content and check the standard of the premises. Other key records were examined, including two care plans and health and safety documents. The inspection took place over two visits, the first of which included an inspection of the premises and discussion with senior members of the management team. On the second visit a number of residents were consulted with and opportunity was taken to join them with their lunchtime meal. Evidence was also gathered from observation and examination of records. What the service does well: What has improved since the last inspection? Staff have taken prompt action to address requirements identified on the first day of this inspection. The utility room in the basement was cleaned and pipe work was repainted. The chef has also obtained chemical data sheets for cleaning material purchased from a local supermarket. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 6 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. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected. EVIDENCE: The majority of these standards were not inspected during this visit and will be a focus of the next inspection. Hillside is a settled household and no new residents have moved in for a number of years. Therefore they rarely have needed to use their admissions procedure. It was noted that each resident has been issued with terms and conditions, which they have signed. This meets with requirements of the legislation. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 The home operates a “person- centred” approach to the care planning process. Risk assessments are limited and need to be reviewed and expanded. EVIDENCE: Opportunity was taken to view two personal files. The first contained good detail about the resident’s preferred routines, care plans and minutes of meetings. These were written from a “person-centred” perspective and covered emotional, social and physical needs. The information was up to date and it was evident that the staff team had included the resident and put a lot of thought into what was relevant and important to the person. In addition to this there was a recent review meeting, from which actions and wishes of the resident were translated into an action plan. For example, to become involved with cooking and to go swimming. It was apparent from daily records that these had been achieved. The second file was not as detailed and some of the information did not appear to have been recently updated. In addition to this, the last review was dated 10\4\04. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 10 The manager said that currently all files are being updated and action does need to be taken by the staff team to ensure the standard of record keeping is consistent. This will continue to be the focus of forthcoming inspections. One resident said that they were soon to have their care plan meeting and they had decided who they wanted to invite. In addition to this, one resident said they could look at what was written about them. This is good practice. There were detailed guidelines for one resident who requires support to make choices. This is good practice. Residents were also observed being offered choices by staff. There were some risk assessments on the files seen. These were written to good detail and provided clear guidelines to reduce identified risks. The scope, however, of those seen were limited. The manager was advised, for example, that they needed to include a risk assessment about road safety and high pain thresholds for one resident. This had been actioned by they time of the second visit. The home should review all risk assessments and ensure that they cover all identified risks. Some residents are able to go out on their own, whilst others require more support due to their heath and safety needs. It was apparent that levels of dependence vary greatly and that the home encourages residents, who are more able, to go out on their own and to take risks as part of fulfilled lifestyles. This is good practice. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 16, 17 Staff are supportive and encourage residents to lead active and interesting lifestyles – therefore residents know that they will take part in appropriate activities which are tailored to individual need and preference. EVIDENCE: It was very apparent that all residents are supported to lead active and fulfilled lifestyles. Formal activities throughout the week vary according to individual needs and preferences. On the day of the inspection four residents were attending Weston College, one went to Lawrence Weston Farm and seven others were going to two different resource centres. In addition to this, three residents participate in a group which provides work for Aspects and Milestones,for which they get paid. One resident does not like to go out so much and his choice is respected. It was apparent that some residents require more support than others to access community facilities. For those who are more able, however, there are no restrictions on when they go out. Residents explained that they liked to get out and about at the weekend. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 12 During this visit a group had gone to Patchway shopping and another group was due to go to Chepstow market on the Sunday. Discussion with the management team indicted that they were aware of the discrimination that some residents might receive when going out and of the need to support them to have a positive community presence. Residents are encouraged, with varying degrees of support, to take responsibility for the upkeep of their rooms and of the communal areas. It was apparent, from discussion, that this was important to some residents. They also confirmed that they had bedroom door keys and these were observed being used by some residents at the time of this visit. This provides them with a means to maintain their privacy and keep their personal possessions secure. Relationships between staff and residents were respectful and friendly and residents can choose to be alone or have company if they wish. Residents were observed being given their own mail. Opportunity was taken to speak with the chef, who explained how residents are afforded a choice at meal times. He had a good knowledge of their likes and dislikes and was aware of the need to provide special diets related to medical conditions. The kitchen was found to be cleaned to a satisfactory standard. There was however a utility room opposite, which had some ingrained dirt under the sink and rusty pipe work. Prompt action was taken by the second visit to rectify this. Opportunity was taken to join residents with their lunchtime meal. This was served in an unhurried and sensitive manner. Residents are encouraged to clear up after themselves and to get their drinks. The food was tasty, well presented and there was plenty of it. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Residents can be re-assured that they will be supported with their physical and emotional health needs. Records regarding the administration of medication need to be improved so that the system is safer. EVIDENCE: Personal care files provided good evidence of the needs and support required by residents with their personal care and hygiene. These were tailored to individual preferences and written to good detail. It was apparent from these that staff are sensitive to residents’ needs and that they try to promote independence. Records provided evidence that the home seeks the relevant specialist support for residents when they need it. A good example of this was for one resident who has had numerous input from different health care professionals. It was noted on one file that there were specific records for doctors’ visits. These are being filled out inconsistently and it was not easy to follow when such visits had been made. One resident recently had a serious accident which involved a scalding injury. The home has taken the appropriate steps to reduce the risk of this happening again and to obtain the appropriate health care. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 14 Records provided evidence that residents are supported to have regular check ups, including visits to the opticians and dentist. Opportunity was taken to inspect the medication system. The home dispenses tablets from bottles supplied by the chemist. These were not being booked on to the medication administration sheets, nor were stock checks being carried forward on a monthly basis. Action needs to be taken to rectify this. The home maintains stock checks of medication given on an as and when basis; two were spot checked, one was found to be inaccurate. The home must ensure that they are more accurate with their recording. Discussion took place with the manager about the possibility of using a monitored dosage system for the administration of medication. It is recommended that they consider this, as they are generally now regarded as a safer system to use. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Staff are sensitive to residents’ communication needs and they can be confident that their wishes will be listened to. EVIDENCE: The complaints procedure was displayed in the home and there were records to evidence that this had been discussed with each resident. This is good practice. Two complaints had been received since that last inspection and actions taken were fully recorded. This meets with requirements of the legislation. Residents spoke openly about their lifestyles at the home and they did not appear to be afraid to speak their minds. Aspects and Milestones have a protection of vulnerable adults procedure and have begun a rolling programme of providing training for staff about abuse. Training records indicated that not all staff have received this. The manager should audit who has had this training and ensure that courses are booked for all staff, as this is now statutory training. It was noted that there was a complaint made earlier in the year which could have resulted in a protection of vulnerable adults meeting. The reasons why this did not take place are accepted by the inspector. The manager however was advised that such decisions should not be taken in isolation. This will continue to be a focus of forthcoming inspections. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 30 Residents do not benefit from a homely environment. The premises however are cleaned to a good standard. EVIDENCE: Opportunity was taken to inspect the premises. Hillside House comprises two Edwardian houses that have been joined together. It is a listed premises and requires high maintenance. Aspects and Milestones have submitted plans to refurbish the premises and convert some of it to supported living. They have been waiting over two years for a decision and during this time there have only been limited amounts of maintenance to the premises. The house is not ideally suited to the needs of its occupants and requires significant refurbishment to bring it up to nationally recognised minimum standards. The stairwells and hallways are dark, poorly decorated and institutional in appearance. Some of the paintwork is chipped and jaded in appearance and some if the carpets are faded and stained. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 17 In addition to the above, the bathrooms and toilets are institutional in appearance and not homely. Due to the above issues an additional visit will be arranged to the home in December. Decisions should have been made by then as to whether conversion plans for the home can go ahead. If this decision does not go ahead then Aspects and Milestones will need to pursue a rigorous refurbishment programme to bring the home up to standard and an action plan needs to be agreed upon between them and the CSCI. The home does have some benefits. It blends in well with the local community and is close to local amenities and shops, which are used regularly by residents. The garden is private and well-maintained and residents have unlimited access to this. There is a toilet in the basement which has a ceiling that has caved in. At present residents are not able to use it. Action needs to be taken to repair and redecorate this room. There are five communal areas in the home which provide residents with plenty of space. A number of bedrooms were viewed. Staff have worked hard to ensure that these are personalised and that they reflect individual tastes. Some bedroom carpets appeared old and one was stained. This will be discussed during the additional inspection visit. The majority of the home was found to be cleaned to a good standard. The boiler area had some debris which could have represented a health and safety risk. Staff took prompt action to remove this at the time of the visit. It was noted that staff were using some cleaning products from a well-known supermarket chain. They obtained chemical data sheets regarding these by the second visit, thus meeting with the requirements of Control of Substances Hazardous to Health (COSHH) legislation. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 There are sufficient staff on duty to provide support for residents. EVIDENCE: The majority of these standards were not discussed and will be a focus of the next visit. Issues in relation to holding personnel records on the premises continue to be a source of discussion between Aspects and Milestones and the CSCI. A requirement made at the last inspection will not be carried forward until a decision has been made. At the time of this visit there were five staff on duty (one member of staff had called in sick). In addition to this, the home employs ancillary staff including a gardener, chef, and housekeepers. This appears to be sufficient to meet with the needs of those residents currently accommodated. One clinically trained staff member sleeps on the premises and two home support workers provide waking support. It was apparent through discussion with staff that qualified staffing numbers have been reduced, meaning that existing staff have to do more sleep-ins throughout the month. This has been the source of some anxiety and disgruntlement amongst the trained staff team. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 19 In addition to the above if the plans for the conversion of the home go ahead this will mean that the staff team will be re-organised, with some staff not having a job there. It has therefore been a time of uncertainty and staff should be praised for retaining their sense of enthusiasm and commitment. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 There are effective systems in place for safety so residents can expect their health and welfare to be protected. EVIDENCE: The fire logbook evidenced that tests and checks of the system take place at the appropriate intervals. There was a work place fire risk assessment in place. The manager should ensure this is reviewed annually. Electrical equipment has been tested this year and the gas system has been serviced. Fridge and freezer temperatures are monitored regularly. Aspects and Milestones have numerous policies and procedures in relation to health and safety. These were available at Hillside House but not looked at in detail at the time of this visit. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 21 There was an up to date insurance certificate. Training records provided evidence that staff receive statutory training in first aid, manual handling and basic food hygiene. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 2 1 2 x 3 Standard No 11 12 13 14 15 16 17 x 4 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hillside House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 23 NO 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. 2. 3. 4. 5. 6. Standard 9 20 23 6 27 Regulation 13(4)(b) 13(2) 13(6) 15 23 (2)(b) Requirement Expand the scope of risk assessments. Ensure all medication is booked on premsies and that acurate stock checks are maintained. Conduct an audit of all staff who have had abuse awareness training. Continue to develop care plans. Fix toilet room in basement. Timescale for action 30th October 2005 30th September 2005 30th December 2005 30th December 2005 30th November 2005 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 20 .19 Good Practice Recommendations Consider using a monitored dosage system for the administration of medication More clearly record visits to health care professionals. Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury Bristol BS32 4RG 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 Hillside House D56_D05_S20335_Hillside House_V246307_140905_Stage4.doc Version 1.40 Page 25 - 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. 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