Inspection on 14/10/08 for Hillside Residential Home

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Poor 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillside Residential Home 03/10/07

Hillside Residential Home 09/11/06

Hillside Residential Home 13/03/06

Hillside Residential Home 21/11/05

Hillside Residential Home 21/03/05

Hillside Residential Home 03/08/04

Hillside Residential Home 21/01/04

Hillside Residential Home 23/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hillside Residential Home Alcester Road Hollywood Birmingham West Midlands B47 5NS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Hillside Residential Home Alcester Road Hollywood Birmingham West Midlands B47 5NS 01214302126 01214306306 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Christopher Michael Higgins care home 20 Number of places (if applicable): Under 65 Over 65 0 20 learning disability old age, not falling within any other category Additional conditions: 10 0 The maximum number of service users to be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only - Code PC To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (E) 5 Old age, not falling within any other category - Code OP 20 Physical Disability (E) 20 Learning Disability - Code LD 3 Three people over the age of 50 may be accommodated with learning disabilities. Date of last inspection Brief description of the care home Hillside is a detached, purpose-built property situated in a secluded, semi-rural position on the outskirts of Birmingham. The property stands in its own grounds surrounded by lawns and set well back from the main road at the end of a driveway. There are carparking facilities at the front of the premises. Hillside is registered as a care home providing residential i.e. personal, care for a maximum of 17 older people above the Care Homes for Older People Page 4 of 32 Brief description of the care home age of 65 years who may also have a physical disability. The home may also accommodate five named people with a dementia illness. The home is a single storey building. All of the service users are accommodated on the ground floor in 15 single bedrooms and 1 double bedroom. The double bedroom has been used as a single bedroom. All of the single bedrooms, except one, have an en suite facility. The upper floor of the home is a self-contained apartment, Hillside View, which is registered to provide accommodation for 3 people over the age of 50 with learning difficulties. The schedule of fees is not included in the Service User Guide, so the home should be contacted for any information relating to fees. The fees do not cover the cost of additional services including chiropody, dental and ophthalmic treatment, hairdressing, newspapers, taxis and telephone. A copy of this inspection report is available to view at the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent a day at the home talking to the people who use the service and the staff, and looking at the records which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the care provided by the home for three people living there. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. Care Homes for Older People Page 6 of 32 We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides written information to help people to decide if they wish to live at Hillside. People can visit the home before they make a decision. The home carries out assessments before people begin living at the home. These assessments are written in sufficient detail for staff to know what care needs to be provided. Evidence: The home provides people with a Service User Guide and Statement of Purpose, both of which describe in some detail the facilities available at Hillside and Hillside View. We saw that these documents had been recently updated, and were written in an easy to read and informative format. The manager told us that the Service User Guides can be made available in other formats to suit the needs of prospective residents. Hillside also provides a brochure for people who are considering whether they might wish to move there. The brochure gives some information which is not completely up Care Homes for Older People Page 10 of 32 Evidence: to date. For example, it states that the home has a sauna, although this is no longer in use. Seven people who live at the home completed our survey forms, and one commented my family checked it out and found it very good. Another said it came highly recommended by the daughter of a previous resident. We spoke to the daughter of someone living at the home, and she told us that she had visited Hillside before her mother moved there, and found the staff very welcoming. We looked at the records of someone who had recently moved into Hillside. We saw that a thorough assessment of their needs had been carried out before they entered the home. This assessment included details of the care which the staff would need to provide and information about the persons likes and dislikes. This information means that the home can be sure that it can meet peoples needs before they move in, and gives staff the information they need to provide the care that is required. We also looked at the records for someone who has moved into Hillside View. The two people living at Hillside View both moved from other homes within the ownership of Care Through the Millennium, and members of staff who know them have transferred with them. This means that the people who were living at Hillside View on the day of the inspection have the reassurance of having familiar staff to care for them. At the previous inspection, we required the home to make sure that information in the pre-admission assessments was specific and detailed. This requirement has been met. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone who lives at the home has a comprehensive plan of care which is based on assessments of individual needs. Staff provide care which promotes peoples privacy and dignity. Medication is not managed safely, and this puts people at risk of not receiving the medication which has been prescribed for them. Evidence: We looked at records for two people living at Hillside, and one person living at Hillside View. We saw that the home had carried out detailed assessments for all the activities of daily life, and that these had generally been reviewed and updated regularly, although we saw some instances where care plans did not reflect the risk assessment. For example, one person had had two falls within one month, and yet their care plan had not been reviewed to address the additional risk of them falling again. The manager clearly understands the principles of person-centred care, and has tried to incorporate these principles into the care plans. We saw that one persons records contained a very informative section which included information about their likes and Care Homes for Older People Page 12 of 32 Evidence: dislikes, and the ways in which they wish their care to be provided. We saw from the records that the family of one person had expressed concern that the person was losing weight. There was no record of the person ever having been weighed since they moved into the home, as they are not able to bear their own weight. The manager explained that the home does not have chair scales or any other means of weighing people who are unable to stand. If the home provides care for people who are unable to use floor scales, they must provide access to facilities to enable them to be weighed. At the previous inspection, we recommended that the home should provide suitable scales so that people with mobility problems can be weighed. This recommendation has therefore not been carried out. In the AQAA, the manager told us We have introduced nutritional charts for service users and implemented their use at the home to record all refusals of food and weight loss and weight gain. The evidence does not support this, as, if people are not weighed, it is not possible to determine any weight loss or weight gain. We saw from the records that one person was not able to get out of bed unaided. The care plan gave information about how staff should assist the person to get out of bed. We spoke to two members of staff, who both explained clearly how they would assist the person with their mobility. We received seven completed surveys from people who use the service and six of them told us that they always receive medical support when they need it. We saw in the records that someone who was confined to bed had trapped their foot between the mattress and the bed rails a few days ago. The home had not carried out a risk assessment for the use of bed rails, nor gained the consent of the person or their representative. Bed rails are potentially dangerous, and they should only be used after a full risk assessment has been carried out. As bed rails are a form of restraint, consent for their use needs to be obtained. We saw that the person still had the bed rails on their bed on the day of the inspection. We made an immediate requirement that the home must carry out a full risk assessment and gain consent, and until this was done, the home was required to cease using the bed rails, and put in place other means of ensuring the persons safety. The manager co-operated with us fully, and we saw that the bed rails were removed and the bed moved to keep the person safe. The manager subsequently sent us copies of the risk assessment which she had carried out. This issue was raised at the last inspection, and we recommended then that there should be a review of the risk assessments for the use of bed rails. This recommendation has not been implemented. We talked to staff who work at Hillside View, and they showed good understanding of Care Homes for Older People Page 13 of 32 Evidence: the specific needs of the people who live there. They were able to describe in detail the ways in which they work to support the people living at Hillside View. The pharmacist inspector visited Hillside Residential Home on the 19th December 2008 to fully assess the way the home was managing medicine on behalf of the people who used the service. In summary, the medicines management systems within the home were poor and as a result evidence was photocopied and removed from the home under code B practices set out in the Police and Criminal Evidence (PACE) Act 1984. We found that the home was failing to record the receipt of all medication received into the home. We found that medication that had been carried over from previous months had not been accounted for in the records and therefore as a consequence the home did not know whether this medication was being used appropriately. We found a number of problems with the medicine administration records (MAR). We found evidence of where members of staff had signed the MAR charts but had not administered the medication. We found that some tablets that were for the treatment of calcium and vitamin D deficiency and used to prevent osteoporosis had not been administered as prescribed. We found that 56 tablets had been received by the home and the records showed that 51 of these had been administered. We expected therefore to find 5 tablets in the container, but we actually found 16 tablets. We also found that some sleeping tablets had not been administered as prescribed. We found that 56 had been received by the home and the records showed that 25 tablets had been administered. We expected therefore to find 31 tablets in the package they had been dispensed in, but we actually found 35 tablets. We also found that 21 antibiotic capsules had been administered on 22 occasions. We also found numerous quantities of tablets missing and the home could not account for their whereabouts. The MAR chart for one person who was using the service showed that they were receiving two doses of the same diuretic solution. The home had not recorded the receipt of this medication so they were not able to tell whether this person was receiving more medication than was required or whether the issue was down to a recording problem. We also found that where variable doses had been prescribed the records did not always show what quantity had been given. Where medication had not been administered and a generic abbreviation had been used the lack of defining some of these abbreviations meant that the reason for the non-administration was not evident. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about how and when medicines prescribed on a when required basis should be administered. We found no evidence that clarification had been sought with the prescriber about medicines that had been prescribed with a variable dose. We found an asthma inhaler in the medication cabinet that had not been recorded on the MAR chart. A member of Care Homes for Older People Page 14 of 32 Evidence: staff thought it had been stopped. The deputy manager contacted the house manager who dealt with all the medication issues, and the house manager told the deputy manager that it had been changed from a regular dose administration to a when required dose administration. On examining the care notes we could not find any account of this change or the circumstances for the change. We were told that all of the staff responsible for administering medication had been trained by their supplying community pharmacist. We asked whether any of these staff had been assessed to determine whether they were competent to handle and administer medication safely. The deputy manager said that she did observe the staff and had found them to be competent. We asked whether we could see the written assessment used to complete the competency monitoring of the staff. The deputy manager said that the completion of any such paperwork was not a practice that the home used and agreed therefore that she had little evidence to support that her staff were competent to handle and administer medication safely. In light of some of the issues identified during the inspection the assessment of the senior care staffs competency to handle and administer medication safely must be carried out as a matter of urgency. We found that the Controlled Drugs held within the home were not being stored in a cabinet that would comply with the Misuse of Drugs (Safe Custody) Regulations. We also found that the current location of the cabinet being used to store the Controlled Drugs was not in a very secure location. As a consequence of both the location and the type of cabinet being used, access to the Controlled Drugs to those not authorised to have access could easily be achieved. We also found that the practice of the home was to keep medicated creams and ointments in the bedrooms of the people they had been prescribed for, thus allowing access to all living and entering the home. We found that the home was failing to ensure that the medicines kept in the medicine fridge were being stored at the correct temperature. The cook, who was responsible for measuring the temperature, admitted that the temperature of the fridge had not been measured for six days. The home was only measuring the ambient temperature, even though the thermometer being used was able to measure both the maximum and minimum temperatures. We found from observing the maximum and minimum temperatures that the fridge was not being maintained within the correct temperature range. As a consequence the home was advised to discard the insulin and seek new supplies. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of opportunities for people who use the service to socialise and enjoy leisure interests. Meals are varied and nutritious, and people are able to choose from a range of options. Evidence: During the inspection we spoke to three relatives of people living at the home, and they all told us that they are made welcome whenever they visit. One relative told us that she views Hillside as almost like an extension of home. She told us that her mother enjoys the fitness class which the home organises. She also said that her mother has been out to the local pub for carvery lunches on several occasions. One relative told us about the Golden Wedding celebration which the home had organised for her parents. She said they laid on a beautiful meal, and the staff had decorated the sun room with balloons and table decorations so that they could have dinner for two together. The people who live at Hillside View sometimes join in activities at Hillside, such as the fitness classes, Bingo sessions and parties. On the day of the inspection, we saw that Care Homes for Older People Page 16 of 32 Evidence: one of the people who lives at Hillside View was going out to do their personal shopping with a member of staff and also visiting old friends at their previous home. We saw posters advertising the homes Halloween party, and one relative told us my mother really looks forward to the parties and other things they lay on here. In the AQAA, the manager told us We are aware of religious observance, whilst a small number of service users had attended church services with a member of the care team, we have also invited the church into the home to make worship accessible to all. One relative told us my mother doesnt want to go to church, but Im sure she could if she wanted - the staff are so helpful with everything. We saw that the kitchen was clean and tidy. The cook works from Monday to Friday, and care staff cook at the weekends. We discussed the menus and peoples special dietary needs with the cook, and she showed a good knowledge of nutrition. We saw that the home keeps a daily menu record for each resident to show what they have actually eaten. We saw people enjoying their lunch of roast chicken quarters, roast potatoes, mash, sprouts, cauliflower and swede, followed by sponge pudding and custard. Most days there is a choice of main meal, although this is not offered at weekends when care staff cook, but staff confirmed they will cook anything which is requested. One relative told us my mother eats well, the food looks fine. In our surveys, everyone told us that they enjoy the food provided by the home. The local Environmental Health Officer had required the home to put in place a food safety management programme, and we saw evidence that this had been implemented. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes complaints policy is readily available, and people know how to raise any concerns. Evidence: The homes complaints procedure is clearly displayed. In our surveys, people told us that they know who to talk to if they have any concerns. Two relatives told us that they would feel comfortable raising any concerns with the manager. We saw a comments book in the reception area, and visitors to the home told us that they are encouraged to write any issues in the book if they do not wish to raise them face to face. We looked at the homes records of complaints and saw that there had been two complaints within the last year. Both complaints had been resolved and we saw that the people making the complaints had signed to say that they were happy with the way they had been managed by the home. One of these complaints had been notified to the Commission for Social Care Inspection, and we were pleased to see that this had been resolved to the satisfaction of the complainant. We spoke to staff, who showed a good knowledge of the signs of possible abuse, and knew how to report any suspicions of abuse. The home carries out checks, including a Criminal Records Bureau (CRB) check, before new staff start work. This ensures that Care Homes for Older People Page 18 of 32 Evidence: only suitable staff are employed and helps to protect the people living at the home. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable environment for people to live in. It is kept clean and tidy, but the home does not manage infection control safely. Evidence: The home is a large detached building standing in its own extensive grounds. It has been adapted to meet the needs of the people who live there without losing its character. Up to seventeen people can be accommodated within the downstairs part of the building, which is known as Hillside, and up to three older people with learning disabilities can be accommodated upstairs in a self-contained apartment, known as Hillside View. Hillside has a large lounge, which has been newly decorated and furnished. On the day of the inspection, there were no curtains in the lounge, but the manager told us that these would soon be in place. The dining room is a very pleasant and light room, which again has been newly decorated. There is a small sun room with finches in a cage, and also a large, light conservatory with books and games. We saw that people tend to congregate near the office in the reception area, where there is a large sofa, and during the day of the inspection, we saw people who live at the home enjoying chats with staff and relatives there. Care Homes for Older People Page 20 of 32 Evidence: At the previous inspection, we recommended that storage space should be provided for wheelchairs and other equipment. We saw that wheelchairs and other equipment are now stored in a cupboard. This will help to keep communal areas free from obstructions. The garden is landscaped and there is a gazebo and patio furniture. The garden is accessible for wheelchair users. When we went into the garden at the back of the home, we saw a dustbin with a lid which did not fit the bin properly. We looked inside the bin, and saw that an unwrapped used incontinence pad had been discarded there. The pad would have been carried through part of the home, including the laundry. The manager told us that this is the usual practice at the home, and that the waste is then collected by a specialist disposal company. There is a risk of cross infection if waste is not disposed of safely. Whilst we were at the home, the manager arranged for a lockable secure bin to be provided for the safe disposal of clinical waste such as used pads, and also assured us that clinical waste will be placed in bags before being carried through the home and put into the bin. We saw that one bathroom contained a whirlpool bath. The jets for the whirlpool were visibly dirty and encrusted, and there was a wet bar of soap in a jug next to the bath. Whirlpool baths require a special cleaning regime to minimise the risk of cross infection due to water becoming trapped in the tubes supplying the jets. The manager told us that the home does not have a prescribed cleaning programme for the whirlpool bath, but that this bath was due to be replaced with a new walk-in bath within the next few weeks. The home was otherwise clean and tidy on the day of the inspection, and in our surveys, people who use the service expressed their satisfaction with cleanliness and tidiness within the home. One relative said its as comfortable as they can possibly make it. Hillside View is a self-contained apartment on the first floor, which has been newly redecorated throughout. The lounge and dining area are furnished with leather sofas and modern wooden furniture. The three bedrooms are all en-suite and are spacious and comfortably furnished. Although the decor was chosen by the home, the manager of Hillside View assured us that the people who live there could choose if they wished their bedrooms to be redecorated to their own taste. One person living at Hillside View showed us their bedroom and told us how pleased they are with their curtains. We saw that their artwork was displayed in the bedroom and that personal ornaments gave it a homely feel. Care Homes for Older People Page 21 of 32 Evidence: Access to Hillside View is via an external lift which opens into the lounge area, and is secured by a key pad to prevent unauthorised use, and via a staircase which is not usually used by the people who live there because of their mobility. There is a fire evacuation procedure which includes the use of a specialist sledge to enable people to be evacuated safely via the stairs. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedures are robust and help to protect the people who use the service. Staff receive training to enable them to carry out their work. There are enough staff on duty to meet the needs of the people who live at the home. Evidence: We saw that staff were kind and caring in their manner towards the people who live at the home and their relatives. The daughter of one person living at the home said that she felt that her mother had settled in easily because the girls have a laugh and a joke with her. We received seven completed surveys from people who use the service, and everyone said that staff listen to them and act on what they say. One person said all carers are very caring. One person had written in the homes comments book nothing is too much trouble and it always feels like home. We looked at staffing rotas and they showed that there are enough staff on duty to meet the needs of the people who live at the home. Two relatives told us that there are always enough staff, and the people who completed our surveys told us that staff were always or usually available. We looked at records which showed that the home makes sure that checks are carried out on new members of staff to ensure that they are suitable to work in a care home. Care Homes for Older People Page 23 of 32 Evidence: These include Criminal Records Bureau (CRB) checks and two written references, one of which is from a previous employer. Training records showed that staff receive regular training which gives them the skills and knowledge they need to provide care to the people who live at the home. Hillside View has its own manager, who is responsible for the day to day running of the service. She is accountable to the registered manager of Hillside. On the day of the inspection, Hillside View was staffed mainly by staff from the companys other care homes. The manager told us that they hope to recruit new staff soon, but that it had been considered to be important that the people living at Hillside View already knew the staff who would be caring for them. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a way which meets the needs of the people who use the service. Health and safety procedures do not always protect the people who live at the home from the risk of harm or injury. Evidence: The manager has completed the Registered Managers Award since the last inspection. She has been the manager at the home for over four years. She told us in the AQAA that she has provided leadership to the team and operates an open door policy with clean lines of accountability within the home. We saw that, on the day of the inspection, the manager was very much part of the life of the home, and people living at the home responded positively to her. In a survey, one person said she (the manager) always has time to sit and listen to what you have to say. The home holds regular meetings for the people who live there and their families. We saw notes of the meetings, and a newsletter from July 2008. The manager told us that Care Homes for Older People Page 25 of 32 Evidence: she plans that the newsletter should be published at least quarterly. The manager sent us the AQAA when we asked her to. It contained detailed information about the home and it was clear to see that the manager is aware of how the service can be improved. The manager has responsibility for the health and safety of people living at the home. The fact that the use of bed rails had not been assessed (as mentioned in the section on Health and Personal Care) and the shortfalls in infection control mentioned in the section on Environment, show that this area of responsibility is not being managed well. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13(2) A system must be devised to 30/11/2007 ensure that the Medication Administration Record (MAR) chart is completed by the member of staff that administers the medication at the time when the medication is administered. This will help to ensure that the service users receive the correct medication at the right time and that they are protected by the homes medication practices and procedures. The timescale for compliance with this requirement has not been met. This has now been referred to the Enforcement Team. A suitable lockable, 22/10/2007 dedicated refrigerator for storing medication that requires cold storage must be provided. The medication must be stored within the correct temperature range of between 2 and 8 degrees C and a daily temperature record maintained. This will help to ensure safe storage and administration. (Previous timescale 31/12/06 not met). The timescale for compliance with this requirement has not Page 27 of 32 2 9 13(2) Care Homes for Older People been met. This has now been referred to the Enforcement Team. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 8 13 You must ensure that the use 15/01/2009 of bed rails is governed by a comprehensive risk assessment, and that written consent for their use is gained. This is to protect people from the risk of injury, and to ensure that they have given consent to the restraint provided by the bed rails. This requirement has a 48 hour timescale, due to the risk to people using the service. However, our computer system does not allow this to be shown, so the correct timescale is 16/10/2008. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 You must ensure that people 22/02/2009 who are at risk of not having their nutritional needs met, and are therefore at risk of weight loss, have access to facilities to enable accurate monitoring of weight Care Homes for Older People Page 29 of 32 This is so that you can be sure that the nutritional needs of the people who use the service are met. 2 8 13 You must carry out risk assessments for any identified risk, and use the outcome of the risk assessments to inform care planning. This is to ensure that people living at the home are not at risk of harm or injury. 3 9 13 (2) All Controlled Drugs must be stored in accordance with the Misuse of Drugs (Safe Custody) Regulations. This is to ensure that Controlled Drugs are kept securely. 4 9 13 (2) Staff who administer 22/02/2009 medication must be competent and their practice must ensure that people receive their medication safely and correctly. This is to ensure that people receive their medication safely and correctly. 5 9 13 (2) Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required and variable dose medication. 22/02/2009 22/02/2009 22/02/2009 Care Homes for Older People Page 30 of 32 This is to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. 6 9 13 (2) The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate. This is so that you can demonstrate that all medication is administered as prescribed 7 26 13 You must ensure that the home has procedures in place to prevent the spread of infection. This is so that people who live at the home are not at risk of illness caused by preventable infection. 22/02/2009 22/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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