CARE HOME ADULTS 18-65
Hillside House 31 Albany Street Ilkeston Derbyshire DE7 5AD Lead Inspector
Brian Marks Unannounced Inspection 2nd December 2005 09:15 Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 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 DS0000019915.V270287.R01.S.doc Version 5.0 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 DS0000019915.V270287.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hillside House Address 31 Albany Street Ilkeston Derbyshire DE7 5AD (01159) 300171 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) United Health Limited Vacant Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: This home offers care to 2 adults who have a learning disability, who may also have a physical disability. The home is built to a high design standard, and is spacious and comfortable, with a pleasant garden and patio area leading from the lounge. The bathroom is also spacious and offers a special design bath that will ease the arrangements for people who need help with bathing; there is an additional shower room. The staffing levels at the home have been set very high, with a minimum of 1 to 1 being employed. This enables staff to enjoy good mutual support, safe working and the opportunity to help residents develop new skills. The home is part of a larger organisation that is based in Lincoln, and is situated adjacent to another home in the group with which it is able to share some facilities such as the sensory room and fax machine. The home is situated in a residential part of Ilkeston, and is aimed at offering a community life for two people, who previously might only have expected a life in a much larger establishment. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. Apart from examining documents and records, time was spent looking around the home and speaking to staff who were on duty and to the manager. Because the 2 residents have a lot of difficulties expressing themselves in words, they were not able to contribute directly to the inspection process, but they were observed working with and being cared for by staff. The aim of inspection activity during the current inspection year is to assess a service against the ‘key’ National Minimum Standards and these are identified at the beginning of each section of the report. The majority of these keys standards were examined at the last inspection so, for a more complete picture of this service, this report should be read in conjunction with the report dated 14th June 2005. What the service does well:
Hillside is a small home that provides care within a domestic setting, using staffing levels that are set very high, enabling residents to enjoy a good level of individual support and human contact. Staff work in very flexible ways and activities take place both inside and outside the home with each individual’s needs in mind. People who live at this home have a high level of learning disability and some mobility problems and the physical layout of the home has been designed to make their lives as easy as possible. Furniture, fittings and decoration are to a high standard and this standard is maintained through the attentions of a maintenance man, who ensures that all activities are carried out in a quick and efficient way. He also oversees standards of health and safety matters at the home, and all activities are carried out properly. The staff group are committed to the job of resident care and those spoken to felt that morale continued to be high and people worked effectively and consistently to ensure that the health and welfare of the residents was maintained. Records indicated that staff training had continued on a regular basis. The staff from the company HQ in Lincoln supports systems of administration and management at the home. The home’s line manager is a regular visitor and she ensures that everything operates the way it should and that the residents are properly looked after.
Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 6 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. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 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 DS0000019915.V270287.R01.S.doc Version 5.0 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 the following standard(s): 1 and 5 The home now has the key documents required by law in place, and these contain the right information for residents and their supporters. EVIDENCE: The Statement of Purpose for the home has been amended as required at the last inspection so that residents and their supporters can now be given completely accurate information about the home, as is required by the law. Problems remain in obtaining written contracts from the relevant sponsoring local authorities, as is required by law, but the provider has made acceptable progress in doing so. For the full assessment of the key standard see the inspection report dated 14 June 2005. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: These standards were not specifically looked at this inspection. For the full assessment of the key standards see the inspection report dated 14 June 2005. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 17 Residents are assisted to enjoy a varied and healthy diet that is based on their preferences and individual needs. EVIDENCE: Examination of the menus at the home and discussion with the manager indicated that a planned approach to the provision of a suitable diet is made at the home. The main meal is usually at the middle of the day, and a light breakfast and afternoon meal, followed by a light supper are offered depending on the requirements of the residents; meals out are frequently taken as well. A record of individual resident preferences is maintained in the kitchen; these have been obtained form observation and discussion during the residents’ life at the home. These are then worked into the menu plan, which is based in principles of healthy family style eating. Fresh ingredients were in evidence in the kitchen and good stocks are maintained through regular food shopping, carried out locally by the care staff with the residents. Specific capabilities are reflected within the catering arrangements, with one resident requiring softened foods and full staff support while the other just needs a little supervision. The residents take their meals together in the dining area. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 11 For the full assessment of the other key standards see the inspection report dated 14 June 2005. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 12 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 the following standard(s): EVIDENCE: These standards were not specifically looked at this inspection, other than to discuss with the manager the general standards of medication administration and the way she makes sure that these are maintained. For the full assessment of the key standards see the inspection report dated 14 June 2005. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 22 and 23 The home has a comprehensive complaints policy and procedure and the residents have their interests supported by outside professionals and family members. Not all staff have received training in relation to protecting residents from harm and may be not aware of their responsibilities. EVIDENCE: The home has a comprehensive complaints policy and procedure that has been centrally developed by the company and regularly updated. A copy of the policy is included in the Service Users Guide, which is given to residents and their representatives, and a summary is also on display at the home. The manager reported that there had been no formal complaints made by anyone within the past 12 months, but that the size of the home was small enough for the residents’ families and supporters be to be able to informally raise concerns that were usually dealt with immediately. As required at the last inspection, the recently appointed staff had not received the training in relation to policies and procedures for protecting residents from harm. This subject is also covered for those staff that are getting training in a National Vocational Qualification (NVQ). Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 24 and 30 The home is equipped, furnished and maintained to a high standard and offers homely and spacious facilities for residents to enjoy. EVIDENCE: The finishing touches to the redecoration of the lounge were being made at the time of the inspection and residents’ comfort has been increased by this. More sensory and personal equipment has been purchased for the residents in their bedrooms and comfort levels have remained high. As has been noted at previous inspections the standards of cleanliness and hygiene at the home were high. For the full assessment of the key standards see the inspection report dated 14 June 2005. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The home is well staffed with experienced, skilled and knowledgeable people who are supported to work effectively by management and the staff peer group. Because staff supervision is not carried out in a structured way with individuals, consistency and safety may be affected. EVIDENCE: Examination of the rota indicated a very high level of staffing with a 1-to-1 arrangement at all times and the manager’s hours being in addition. The staff group is a stable one with only one change in the past 12 months. Examination of their staff file indicated that recruitment had been carried out properly and all checks required to ensure protection of the residents had been made. Staff are very committed to the home and reported that teamwork is their main focus and that this is very effective and positive. They have a broad range of skills knowledge and experience to build on, and levels of training have been high with a target for all to achieve the National Vocational Qualification at level 3. Only 2 staff have not achieved the level 2 so the home is above the standard required by law. With the staff levels as high as they are, and with the variety of staff available, flexibility of arrangements is offered to the residents so that they have been able to continue to develop social and personal skills. For, example 1 resident has enjoyed 2 holidays this summer for the first time, accompanied by 2 staff,
Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 16 and they reported that he had become much more relaxed and responsive as a result of this experience. Whilst the focus of staff development has been on continued training, the manager has not made much progress with reintroducing a system of formal supervision meetings with individual staff; work monitoring is carried out only in informal ways. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home is well managed and the manager receives informal feedback about the running of the home and involves family members in the home. Safety of the home had been improved through specific aspects of staff training, but a number of activities still need to be carried out to make sure of complete safety. EVIDENCE: The manager has applied to register with the CSCI but that process is not yet complete. Because of the small size of the home, feedback from family members is regular and informally given and previous discussions have indicated a good level of satisfaction with the way care is being provided. Supporters of the residents attend the care review meetings and are able to influence the care standards of the home. The home’s line manager visits the home on a monthly basis and written reports of these visits, as required by law, are available at the home. The company is registered as an ISO 9002 organisation, which is a nationally recognised quality standard, but the
Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 18 manager had not been developed an annual plan for the home, which should cover all aspects of its running and will allow a for a better evaluation of the home’s activities. Examination of records indicated that good standards of health and safety practice has been carried out at the home, particularly in relation to staff training and fire safety. However a number of important activities had not been carried out and some key documents were not available for inspection, compromising the complete safety of the residents: A regular fire drill with staff and residents had not been carried out. The certificate of electrical wiring compliance was not available. The Environmental Health Officer has not visited the home for some time. A risk assessment had not been carried out for all aspects of the health and safety of the building. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 19 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 3 X X X 3 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 4 X X X X X 4 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hillside House Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000019915.V270287.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 YA23 Regulation 13(6), 18(1) Requirement All staff must receive training in relation to their responsibilities in recognising and reporting the abuse of vulnerable adults. (Previous timescale of 30/09/05 not met). The registered person must reestablish the system of 1-to-1 supervsion meetings for all staff. (Previous timescale of 30/09/05 not met). An Annual Development Plan for the home must be developed. The registered person must arrange regular fire safety drills at the home. (Previous timescale of 30/09/05 not met). A 5-year certificate of electrical wiring safety must be forwarded to the CSCI for inspection. The registered person must consult with the fire and Environmental Health Officers as to the need for inspections of the premises. A risk assessment of the home’s environment must be carried out and measures taken to manage any hazards identified.
DS0000019915.V270287.R01.S.doc Timescale for action 30/03/06 2. YA36 18(2) 30/03/06 3 4. YA39 YA42 24(1-3) 23(4) 31/01/06 31/01/06 5. 6. YA42 YA42 23(2) 23(4, 5) 31/01/06 31/01/06 7. YA42 13(4) 31/03/06 Hillside House Version 5.0 Page 21 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 YA6 YA35 Good Practice Recommendations The registered person should ensure that strategic reviews of care are held at least six monthly. All staff should receive an annual appraisal of their work that identifies training needs and work performance and capabilities. Hillside House DS0000019915.V270287.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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