Inspection on 28/12/05 for Hillside House

This inspection was carried out on 28th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillside House 17/12/07

Hillside House 26/09/06

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 Sam Fox Unannounced Inspection 28th December 2005 &10th January 2006 09:30 Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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.V276615.R01.S.doc Version 5.1 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.V276615.R01.S.doc Version 5.1 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 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.V276615.R01.S.doc Version 5.1 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 17th September 2005 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. There are 17 permanent residents and this level will remain to reduce the amount of people who have to share a room. There is no lift in the home and residents must therefore be independently mobile. Hillside House is situated in a busy suburban 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 DS0000020335.V276615.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two visits. The first focused on the premises and long awaited plans to refurbish the home. The second visit took place over five hours. Predominantly this centred on record keeping and discussion with staff. Three residents were case tracked and discussed in depth with the manager. In addition to this particular attention was given to staff recruitment, training and supervision. Evidence was gained through discussion with staff, examination of records and observation. Not all standards were inspected during this visit and this report should be read in con junction with others so a fuller picture of the home can be gained. What the service does well: What has improved since the last inspection? There have been a number of positive delopements since the last inspection. More staff have received protection of vulnerable adult training so they now have a greater awareness about issues involving abuse. Improvements have been made to the care planning systems and risk assessments have been further developed. This enables the home to more clearly evidence the support they give to residents with particularly complex needs. The home has introduced a monitored dosage system for the administration of medication and this has made the system safer. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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 DS0000020335.V276615.R01.S.doc Version 5.1 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.V276615.R01.S.doc Version 5.1 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): 5 Terms and conditions need to be updated so residents are more informed of their rights. EVIDENCE: The majority of these standards were not assessed. There is a stable and settled group at Hillside House and the home rarely have any new admissions. All residents are issued with a statement of terms and conditions and these were seen at the time of the visit. They state the house rules and fees payable, although some of this information was inaccurate as they were completed in 2003. They should be updated in April when the new financial year begins. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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): 6,9,10 Care plans are well written and enable staff to provide a consistent and individualised service. Residents are supported to take risks, which means they lead active and interesting lifestyles. EVIDENCE: Three residents files were examined in detail. The staff team have reviewed the format of the care planning systems and this has represented a real improvement to the depth and detail of information. Each file contains personal information; individual support needs, care plans and risk assessments. The majority of the information seen was well written and provided evidence that the home provides a holistic service which takes into account social, emotional and physical needs. This meets with a requirement made at the last inspection. The manager acknowledged that there was some work to be done to standardise the quality and depth of care plans but that he was to make this a focus of the forthcoming months. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 10 Since the last inspection some of the risk assessments available have been improved – this is particularly true in relation to the relationship between two residents, which are potentially volatile. It was noted, however, that there is still some work to do to expand on these and to expand them to individual needs. A requirements made at the last inspection in this respect has been met, however, this will continue to be a focus of forthcoming visits. It was apparent that residents are encouraged to take risks as apart of independent lifestyles. Some are able to access the community on their own, within certain guidelines; some are encouraged to have paid employment whilst others lead relatively quiet lifestyles. The home manages the diverse needs of residents well and ensures that those who are able, are encouraged to take calculated risks in order to maintain their independence. Hillside House operates a “key working” system whereby each resident has a named staff who plays a more central role in co-ordinating the service they receive. This provides a means through which staff can remain consistent. This is particularly important for those residents who have complex needs. All staff displayed a good understanding of the key working systems and of their roles within it. It is apparent that this is working well within the home. It was noted, however, that some record keeping, particularly around one to one time spent with residents, was poor. It is recommended that this be improved, as they do not always reflect the actual good progress which is achieved. Aspects and Milestones have a confidentiality policy which is discussed as part of the initial induction process. This was confirmed through records and discussion with staff, all of whom displayed a good understanding of their responsibilities in this respect. All records of a personal nature are kept in locked cabinets. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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 the following standard(s): 11,12, 13,14,15,16 Staff have the skills and resources to enable residents to lead active lifestyles, be part of the local community and to maintain links outside of the home that are important to them. EVIDENCE: Residents continue to be supported to have active lifestyles. Each has a weekly plan, which is tailored to their individual preferences and developmental needs. These range from paid employment to regular attendance to college courses and activity resource centres. The home should continue to be commended for the support they provide in this respect. In addition to this residents pursue hobbies and activities of personal interests during their leisure time. All staff spoken with displayed a good awareness of individual preferences in this respect. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 12 Hillside House is ideally located in the heart of Bristol and is close to many local facilities and places of interest. Residents were observed going out on their own or being supported to by staff. It was apparent that the home sets great store in ensuring that residents remain valued members of the community and that they were aware of issues that may lead to discrimination. Discussion with staff and records indicated that residents are supported to maintain friendships and links with their family. Some residents went to stay with relatives at Christmas. Staff were aware of issues in relation to supporting residents to have relationships and they endeavour to provide sensitive support. 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. 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. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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 the following standard(s): 18,19,20 There are good systems in place to ensure that residents receive personal support in a sensitive and dignified manner in a way that they prefer. Staff have the skills to ensure their health needs are met but some records need improving. The medication system has changed and is safer. EVIDENCE: Three residents files were looked at in depth. Each contained individual support plans, which cover all aspects of personal care needs. The majority of those seen were written to an excellent standard and gave good detail of individual preferences. They ranged from skin care, to bathing and to assistance with personal hygiene. They also included information as to gender preferences. Records and discussion with staff provided evidence that residents are supported to have regular health check ups and to visit the opticians and dentists. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 14 One resident, whose records were looked at in detail, has significant health issues, some of which are more recent. The home has some difficulties in supporting them to attend health appointments. There was insufficient recorded evidence to indicate how the home is supporting them to lead a healthier lifestyle. It was apparent through discussion that the support staff give is greater than records would suggest. The home needs to develop a care plan in relation to this. Significant improvements have been made to the medication system since the last inspection. The home now operates a monitored dosage system, which is supplied at regular intervals by the local pharmacist. Using this can reduce the risk of errors and enables staff to more clearly monitor that residents are receiving the correct medication. All records held in relation to the administration of medication were found to be accurate and well maintained. The home has also responded well to the new legislation requiring them to dispose of medication. Tablets given on an as and when basis were spot-checked and records were found to be accurate. It was noted that some tablets were transferred into a newer bottle. This would not be viewed as safe practice and should cease. The manager has developed a local policy for the new medication system and this works in conjunction with the general policy issued by Aspects and Milestones. This was clearly written. It was noted that residents benefit from annual reviews of their medication by their GP. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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 the following standard(s): 23 Staff are well trained so residents can expect to be protected from abuse. Financial arrangements should be more fully recorded so that it is clear that they are equitable. EVIDENCE: Considerable progress has been made in ensuring that staff have received their protection of vulnerable adults training, there are only three outstanding and dates were seen for when they have been booked to go on the course. The manager has recently received an updated vulnerable adults policy published by Bristol City Council, which includes the contact number of the Adult Protection Co-ordinators who should also be contacted if there are suspicions of abuse. The manager has left this in a prominent position for easy access. There has been a series of instances between two residents, whose relationship is volatile, which has resulted in potential assault. The home has acted appropriately and promptly to resolve this. They have reviewed risk assessments and care plans and implemented an individualised policy. This is good practice. Opportunity was taken to discuss the financial arrangements of the three residents whose records were looked at in detail. Support given for this varies. All benefits, including disability living allowances, are paid into residents’ bank accounts. Fees are then taken out via direct debit. All residents are entitled to a set weekly personal allowance. Records held in relation to this were found to be accurate with bank statements tallying with running records. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 16 Some residents are able to get their own money, others require support with this and to budget their money. The manager was advised to ensure that financial arrangements are fully recorded within the care plans. This should also include agreed arrangements for paying for use of the home’s mini bus. This would further enable the home to demonstrate the equitability of arrangements. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 17 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): 24,25,26,27,28,30 Action needs to be taken to refurbish the premises so that residents can benefit from a more homely and comfortable environment. EVIDENCE: Hillside House is a listed premise and requires high maintenance. Aspects and Milestones have submitted plans to refurbish the premises and convert some of it to supported living. After two years of waiting for a decision they have been refused planning permission. This has been a major disappointment for staff. 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. In addition to the above the bathrooms and toilets are institutional in appearance and not homely. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 18 Aspects and Milestones have now put forward new plans to split the house into two, provide additional bedrooms so residents don’t have to share and to refurbish the premises. A requirement is made that these works commence by April. 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. It should also be noted that staff have made strenuous efforts to make the premises homely and comfortable. All areas of the home were found to be cleaned to a good standard and there are infection control procedures in place. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 19 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): 31,33,34,35,36 Staff have the resources and skills to meet residents’ complex needs. They are well supervised and can therefore carry out their duties with confidence. There is a robust recruitment procedure in place that protects vulnerable adults. EVIDENCE: All staff spoken with displayed a clear awareness of their roles and responsibilities. There were copies of their job descriptions within their personal files that clearly stated what was expected of them. They all said they felt they worked well as a team and supported one another. Staffing rotas indicated that there are sufficient numbers on duty to meet the needs of those residents currently accommodated. Some staff expressed concern about the possibility that the number of “nursing” hours may be reduced. Aspect and Milestones would need to apply to the CSCI formally about this and demonstrate, through re-assessments, that this level of staffing was no longer needed. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 20 There have been high levels of sickness in the home over the last month – this was discussed at length with the manager who has found this frustrating. He has taken the appropriate action to try and improve this situation and to try and find out the reasons why. This has inevitably led to a higher use of agency staff and it was apparent that this has been unsettling for residents – indeed the number of “incidents” occurring within the home appears to increase when agency staff are on duty. It is hoped that this situation will improve soon. All personal files are now held on the premises. Opportunity was taken to view two of these. They were well maintained and included completed application forms, two references and criminal records checks. There was also evidence that pin numbers had been checked for the clinically trained staff. This is good practice and the home continues to evidence that they have a robust recruitment procedure in place that protects vulnerable adults. All those staff spoken with were pleased with the opportunities they have for training. All have received statutory training of first aid, fire, manual handling and food hygiene. They had also continued to attend external courses including relating to dementia care and mental health needs. Opportunity was also taken to see individual training profiles which further evidenced that the manager has been encouraging staff to get trained, particularly within the last year. This is a positive development. In addition to the above opportunity was taken to speak with a housekeeper. She has also been afforded many opportunities to train and said she liked the fact she felt equal to all the other staff – she said that the manager values all jobs within the home. She did say she would like to do Makaton training and this was passed on to the manager. Two clinical trained nurses were also spoken with. They said they also had opportunities to ensure they keep up to date and maintained their nursing portfolio. All those staff spoken with were either pursuing their National Vocational qualifications or had achieved equivalent training. This is good practice. Staff also discussed the induction they received when they first began at the home. They said this was carried out both in- house and with formal sessions at the Trust headquarters. They said that this gave them the confidence to carry out their jobs. Staff conformed that they received formal supervision at regular intervals and they said they found it a useful time to talk about their concerns. This was confirmed through records. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 21 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 Residents’ benefit from a well run home EVIDENCE: All staff consulted with spoke positively about the manager and said that he was firm but fair so they all knew where they stood. He has been working at the home for a number of years and has demonstrated his ability to change his work practices during this time. He also displayed a good knowledge of his responsibilities as a registered manager and has worked positively to meet all requirements. Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 1 28 2 29 x 30 3 STAFFING Standard No Score 31 3 32 x 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x x x x x x Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 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. Standard YA5 YA19 YA20 YA23 YA24 Regulation 5(c) 15 13(2) 12(2) 23(2) Requirement Timescale for action 01/04/06 Ensure all terms and conditions are updated Develop a care plan in relation to 01/02/06 one resident with identified significant health needs. Ensure all tablets are kept in 10/01/06 their original packaging Ensure financial arrangements 28/02/06 are recorded within care plans. Begin refurbishment of premises 01/04/06 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 YA6 Good Practice Recommendations Key workers to improve their recording Hillside House DS0000020335.V276615.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos 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 DS0000020335.V276615.R01.S.doc Version 5.1 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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