Inspection on 03/10/07 for Hillside Residential Home

This inspection was carried out on 3rd October 2007.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillside Residential Home 14/10/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillside Residential Home Alcester Road Hollywood Birmingham West Midlands B47 5NS Lead Inspector Nic Andrews Unannounced Inspection 3, 15 and 22 October 2007 03:30 X10015.doc Version 1.40 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 Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Residential Home Address Alcester Road Hollywood Birmingham West Midlands B47 5NS 0121 430 2126 0121 430 6306 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) Mr Christopher Michael Higgins Angela Christine Griffiths Care Home 17 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (17) Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may also accommodate 5 named people with a dementia illness. 9th November 2006 Date of last inspection Brief Description of the Service: 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 car-parking facilities at the front of the premises. The property is registered as a care home providing residential i.e. personal, care for a maximum of 17 older people above the 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 first floor accommodation that had been previously occupied by the registered provider for his own personal use had been vacated. A passenger lift was in the process of being installed so that this part of the premises could eventually form part of the registered premises. This will require an application to be made to the Commission for Social Care Inspection (CSCI) for a variation in conditions of registration. At the time of the inspection there were fourteen service users in residence, one service user in hospital and two vacancies. The home’s main aim is to provide a warm, homely environment for the service users and to provide individual care. The fees ranged from £475.00 per week for a single room, £575.00 per week for a large single room, £700.00 per week for single occupancy of a double room and £750.00 each per week for double occupancy of a double room. The fees did not cover the cost of additional services including chiropody, dental and ophthalmic treatment, hairdressing, newspapers, taxis and telephone. The fee information included in this report applied at the time of the inspection. More up to date information can be obtained from the care home. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of three days. The home was inspected against the key National Minimum Standards and time was spent with the registered manager assessing the home’s response to the requirements and recommendations that were made as a result of the previous key inspection. Various records including staff files and service user care plans and a number of different policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were held with six service users, the visitor of one service user and four members of staff. The care of two service users was case tracked. Survey forms were also issued to the relatives of all the service users. Some of the comments contained in the responses that were received are reflected in this report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to make improvements in several areas including assessments, care planning, record keeping, risk assessments and a more robust approach towards complaints and the protection of service users. Improvements in these areas will help to ensure that the service users’ individual care needs are met, their quality of life is enhanced, their safety is maintained and their rights are protected. Improvements to the physical environment will help to ensure that the service users benefit from living in surroundings that are safe. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 6 Staff training will help to ensure that the staff have the necessary skills to enable them to perform their duties to the required standard. The systems for monitoring and promoting the quality of the service need to be developed. This will help to safeguard and promote the service users’ care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be assured that their needs will be fully met when they move into the home because assessments do not include enough detailed information. EVIDENCE: A copy of the statement of purpose was displayed in the main corridor near to the registered manager’s office. It contained relevant information about the home and details of the service provided. The contents of the service users’ guide were satisfactory and service users were provided with a copy of the guide at the point of admission. At the last inspection copies of the service users’ terms and conditions of residence (contracts) had not been kept in the home and, therefore, they had not been available for inspection. Although Standard 2 was not fully inspected on this occasion, the home’s response to the requirement and recommendation that were made as a result of the previous inspection was assessed. The requirement was that a copy of the service users’ contracts must be kept in their individual files. The recommendation was that the incorrect reference in the contract to the Registered Homes Act 1984 should be deleted and replaced Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 9 by a reference to the Care Standards Act 2000. It was pleasing to note that both the requirement and recommendation had been implemented. This also meant that copies of the contracts were readily available for the service users if they wished to refer to them. The assessment forms in respect of a number of service users were inspected. In some cases the assessment forms had not been fully completed. For example, the assessment form in respect of one service user did not include any information in regard to diet and dietary needs, food preferences (likes and dislikes), pressure areas, oral care, activities/social interests and social contacts. Other parts of the assessment form had been completed but the information provided was extremely limited. For example, in respect of foot care the assessment form stated ‘arranged by Hillside’; in respect of bathing, hair washing and grooming the assessment form stated ‘assistance of carer’. Similarly, the information contained in the assessment form of another service user was extremely limited and contained very little relevant detail. For example, in respect of dressing and washing the assessment form simply stated ‘needs help’ without specifying the tasks that the service user was able to undertake without assistance or precisely what help was needed or how it should be given. In respect of ‘grooming’ the assessment form stated ‘assistance’ and in respect of social activities the assessment form contained no information at all. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Basic health and personal care needs are being met but the care plans do not contain sufficient guidance to enable the staff to provide a personalised service to the people living at the home. EVIDENCE: An individual care plan had been prepared in respect of all the service users living at the home. However, some of the care plans had not been fully completed. For example, the care plan for one service user did not contain any information regarding social interests or religious needs. Information that had been obtained as part of the assessment of another service user included the comment, ‘Enjoys being taken for a ride in wheelchair’. However, there was no reference to this in the service user’s care plan. During the discussion with the same service user he said that he enjoyed watching cricket and golf and that he would like to be taken to the shops occasionally. However, there was no mention of either of these activities in the care plan. Another service user said that he would ‘like the staff to sit and chat a bit more’. In the same service user’s care plan it stated, ‘He does like to sit and talk to staff and other residents’. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 11 However, the ‘Action Plan’ column stated, ‘Try to get him to be more motivated’. Under the heading ‘Personal Safety and Risk’ the care plan of another service user stated, ‘Try to promote independence as much as possible’. The care plan did not state how this should be achieved. The information recorded in the care plans did not set out in detail the action to be taken by the staff to ensure that all aspects of the service users’ needs were met. Three requirements were made in regard to Standard 7 as a result of previous inspections. The first requirement was that a risk assessment in regard to nutrition must be carried out and recorded in respect of all service users and, where necessary, risk assessments on pressure sores, and included in the service users’ individual care plans. This requirement had been implemented. The second requirement was that clear, specific and detailed guidance must be included in the service users’ care plans to ensure the appropriate delivery of care. The requirement had not been implemented. The third requirement was that the service users’ care plans must be reviewed at least once a month by the staff. This requirement had been implemented. A member of staff was observed giving appropriate assistance to one service user during lunch. The appearance of one service user, particularly in regard to her nails and her hair, was brought to the attention of the registered manager and discussed. All of the service users apart from two who had been recently admitted to the home were registered with a local GP. None of the service users had pressure sores. None of the service users required the help or support of a district nurse or community psychiatric nurse. A risk assessment had been carried out on all of the service users in respect of their mobility. The continence adviser visited the home when requested to offer guidance and support to the staff on the management of the service users’ continence. An optician from Healthcall Optical Services had visited the home on 26 July 2007 to check the service users’ eyesight. The registered manager was actively seeking the help of a dental practice that would provide an NHS dental service. One service user was not being weighed because the home did not have suitable scales. Bed rails were being used in respect of two service users. It was confirmed that a risk assessment had been carried out regarding the use of the bedrails. However, bumpers were not being used to protect the service users from possible injury. The relative of one service user felt that the staff were sometimes ‘slow in getting a nurse or doctor to look at a problem’. Another relative said that there had been ‘several minor accidents when her mother had injured herself and she had not been told’. The arrangements for the storage of most of the medication were secure and access to the medication was restricted to senior staff. All of the staff involved in the administration of medication had received accredited training. The local pharmacist carried out a review of medication every three months. Two requirements and two recommendations were made in regard to medication as a result of the previous inspection. The first requirement about the administration of covert medication was no longer applicable and has, Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 12 therefore, been deleted. The second requirement was that a suitable dedicated refrigerator for storing medication that requires cold storage must be provided. Since the last inspection a refrigerator had been provided and it contained eye drops, eye ointment and antibiotics. However, the refrigerator was not lockable and a daily record of the temperature was not being maintained. Therefore, the requirement had not been fully implemented. The first recommendation was that when medication is written on to the MAR charts by hand it should be checked and signed for as being correct by two members of staff. The recommendation had not been fully implemented and still stands. The second recommendation was that a metal cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 should be provided for the storage and safekeeping of controlled drugs. The recommendation had not been implemented and still stands. It was also noted that that there was a recent gap in the Medication Administration Record (MAR) chart for the administration of eye drops in respect of one service user. The staff with whom discussions were held understood the importance of respecting the service users’ privacy and dignity. However, both staff and service users acknowledged that the staff did not always knock the service users’ bedroom doors before entering. Two service users had their own telephones and the home had a mobile phone to enable the service users to make and receive calls in private. The staff referred to the service users by their preferred form of address. The home’s one double bedroom had a curtain rail so that a curtain could be used to enhance the service users’ privacy when it was occupied. The staff induction programme included instruction on treating service users with respect. The service users said that they were treated with respect by the staff. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are able to maintain contact with their relatives and friends and to exercise choice in regard to aspects of their care. However, the social and leisure activities both inside and outside the home are insufficient to meet people’s individual preferences and the quality of the food is not to everyone’s liking. EVIDENCE: The home provided different activities in which the service users could participate. These included Bingo every Friday, fitness and fun every Tuesday, hairdressing every Wednesday, nail painting, videos, music and television. A summer fete had been held in July and a Halloween party and pantomime had been arranged for the end of October. One service user was taken to the shops each week and a religious service was held in the home once a month for any service user that wished to attend. However, there had been very few opportunities for the service users to engage in social and leisure activities outside the home during the past year. There had been no small group outings. There was also little evidence to show that particular consideration had been given to the social needs of service users with dementia and other cognitive impairments. More armchairs had been placed in the conservatory in response to a recommendation that had been made as a result of the previous Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 14 inspection but the height of the television had not been lowered to a more appropriate level. One service user said that there were ‘not enough activities’. Another service user said, ‘They say they have activities but I’m not impressed’. One service user said that he liked watching cricket and golf and that he would ‘like to go out to the shops occasionally to buy biscuits’. Another service user made a similar comment and said that he would ‘like to be taken out occasionally’. He also said that he would ‘like the staff to sit and chat a bit more’. The registered manager said that all of the service users received visits from their relatives. There were no unreasonable or unnecessary restrictions in regard to visiting. The service users and the visitor of one service user with whom discussions were held stated that visitors were made welcome. They also confirmed that they were able to hold discussions in private. The registered manager said that none of the service users required help or support from an advocate. The service users said that they were able to exercise choice in regard to the clothes they wore, where they ate their meals and the time they got up and went to bed. The service users’ guide stated that prospective service users were entitled to bring personal possessions with them. It also contained details of the local advocacy service, social services and information regarding the service users’ right of access to the records held about them by the home. A recommendation was made in regard to Standard 15 as a result of the previous inspection that a suitable heated food trolley should be provided in order to encourage service users to exercise greater independence and choice at mealtimes. It was confirmed that a new heated food trolley had been provided but there had been no noticeable increase in the level of service users’ independence as a result. However, the recommendation was regarded as having been implemented. The menus indicated that the food provided was wholesome but with very little variation. The service users’ comments about the food were mixed. One service user said that she enjoyed the food and another described it as ‘fine’. Other service users were not so positive in their remarks and described it as ‘okay’ and ‘satisfactory’. One service user felt that ‘the standard of food could be improved’ and another service user said that the food was ‘not as good as it used to be’. The relative of one service user felt that the standard of catering was not as good as it was and that the solution was to ‘use better quality food for more varied meals’. The food observed being served during the inspection was of a satisfactory standard. An alternative meal was provided if the service users did not like the main, midday meal on offer. The service users were consulted about the food and there was choice of food for breakfast and at teatime. However, the care plans did not always specify the service users’ dietary preferences. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home know how to complain but not everyone feels confident about doing so. Policies and procedures do not fully ensure an appropriate response to incidents of suspected abuse. EVIDENCE: A recommendation was made as a result of the previous inspection that all of the out of date copies of the home’s complaints procedure, including those on the service users’ files, should be replaced with an up to date copy and a copy of the complaints procedure should be displayed in the home. The recommendation was fully implemented on the day of the inspection. The complaints record contained details of three complaints made by three service users who had complained on the same day about the conduct of another service user. The complaints had been responded to appropriately. However, the complaints record did not include the details of all of the complaints that had been made against the home during the past year. Two service users said that the staff were approachable and that they felt confident about making a complaint, if necessary. One service user felt confident about making a complaint but added, ‘Staff don’t always listen to me’. Another service user said that she did not feel able to approach the staff. The survey form completed by the relative of one service user stated that she had not been provided with a copy of the home’s complaints procedure. A requirement and recommendation were made in regard to Standard 18 as a result of the previous inspection. The requirement was that all of the home’s Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 16 policies and procedures, including the policy and procedure on the protection of service users, must be reviewed, amended where necessary, signed and dated by the registered manager. It was noted that all of the policies had been signed and dated and the registered manager confirmed that all of the policies had been reviewed. The recommendation was that action should be taken to ensure that the home’s policy on ‘Adult Protection and Prevention of Abuse’ contains the correct address and telephone number of the Adult Protection Coordinator. The recommendation had not been implemented and still stands. The wording of the home’s ‘Abuse Policy’ needed to be amended and appropriate advice was subsequently given to the registered manager about the necessary changes. The registered manager said that no suspected or alleged incidents of abuse had been reported to her or otherwise come to her attention since the last inspection. The registered manager had had no reason to refer any member of staff for consideration for possible inclusion on the POVA register. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in comfortable and homely surroundings. However, the maintenance and cleanliness of the home does not fully ensure their comfort and safety. EVIDENCE: The home was purpose built and all of the accommodation was provided on the ground floor. The visual outlook from most of the bedrooms gave a feeling of space and the gardens were well maintained. The premises were safe and accessible and all of the bedrooms except one had an en suite facility. Alterations were being made to the first floor accommodation that had previously been occupied by the provider. This had inevitably created some disruption and noise for the service users. A passenger lift was also being installed. The registered manager said that it was the provider’s intention to make an application for registration to the Commission to enable service users to be accommodated in this part of the building. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 18 Items that needed to be repaired or replaced were referred to the provider for attention. An emergency maintenance request form was used. However, the recommendation that was made as a result of the previous inspection that a programme of routine maintenance and renewal of the fabric and decoration of the premises should be introduced and implemented with records kept had not been implemented. It was noted that a door was missing from the wardrobes in bedrooms 10 and 17 and that the wardrobe doors in bedrooms 11 and 12 were warped and that the toilet seat in the bathroom was broken. The Environmental Health Officer from Bromsgrove District Council had visited the home on 19 February 2007. Five issues had been identified for attention including the introduction of ‘Safer Food Better Business’. The ‘Safer Food Better Business’ initiative had not been implemented. The registered manager said that the other four matters raised by the Environmental Health Officer had all been addressed. Standard 22 was not fully inspected on this occasion. However, the home’s response to the recommendation that was made as a result of previous inspections was assessed. The recommendation was that adequate storage space for storing wheelchairs and other equipment should be provided. The recommendation had not been implemented. The laundry was appropriately sited and contained a washing machine and a tumble dryer. The washing machine had a sluice facility. The laundry had a wash hand basin and paper towel and liquid soap dispensers. The floor finishes were impermeable and these and the wall finishes were readily cleanable. The service users said that they were satisfied with the laundering of their clothes. However, one service user said that his pyjamas recently went missing but were quickly found again. Another service user also said that sometimes her underwear went missing. The service users said that their bedrooms were cleaned regularly and one service user said that her room was ‘kept spotless’. However, odour control in some of the service users’ bedrooms was a problem. The survey form completed by the relative of one service user stated that the standard of cleanliness did not always appear satisfactory. Another relative felt that the standards in regard to the cleanliness of the rooms were not as good as they were. The respondent felt that this was because ‘the home was without a cleaner for weeks and care staff had to clean as well as care’. The registered manager felt that the standard of cleanliness and odour control could be overcome by an increase in the number of domestic hours provided per week. The kitchen was inspected and it was noted that there was grease around the deep fat fryer, on the oven top and above the back of the oven. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are safeguarded by use of appropriate checks on staff and the provision of training. However, staff do not always meet the individual needs of people living in the home. EVIDENCE: In addition to the registered manager the home employed an assistant manager, a senior team leader, three senior care assistants and four care assistants all of whom worked 35 hours per week. The home also employed five night care assistants, a cook who worked 30 hours per week and a domestic assistant who worked 16 hours per week. Two waking members of staff were on duty at night. The registered manager stated that during holiday periods and sick leave staff were willing to work additional hours to cover the shifts. However, this meant that during these periods, the staff had less time to spend on individual activities with the service users. The registered manager was hoping to develop a small group of bank staff who would be available to help cover holidays and sick leave when relief staff were needed. The registered manager was often needed to cover caring duties and this detracted from her primary role of managing the home. There was a problem of odour control within the home and the number of domestic hours provided was not considered sufficient to overcome this difficulty. It was noted that nine members of staff were related to at least one other member of staff working in the home. The employment of staff who are related to each other is not considered best practice and should be avoided wherever possible. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 20 Four of the service users with whom discussions were held confirmed that the staff were kind to them, treated them with respect and that they were happy with the care they received. However, one service user said, ‘The staff are very helpful but you get the exception occasionally’. Another service user said, ‘The staff are a bit mixed. The attitude of some can be quite sharp at times’. The home employed fourteen members of staff who were involved in caring duties. Four of these staff had completed NVQ level 3 training and seven of the staff had completed NVQ level 2 training. Therefore, the minimum ratio of 50 trained members of care staff with NVQ level 2 or equivalent as set down by the National Minimum Standards was exceeded. It was also pleasing to note that three members of staff had enrolled on the NVQ level 4 training and were also undertaking the NVQ Assessors training. Three other members of staff were undertaking NVQ level 2 training. The files of three newly appointed members of staff were inspected. These contained relevant information including an application form, job description, a contract, proof of identity, induction training forms and supervision forms. There was evidence to show that a CRB disclosure check had been carried out in respect of two care staff. A Povafirst check had been carried out in respect of a third member of staff who was employed as a domestic assistant and a CRB disclosure application had been made but not yet obtained. A requirement was made as a result of the previous inspection that two relevant, written references must be obtained before appointing any member of staff and any gaps in employment records must be explored. The requirement had been implemented. The registered manager was aware that no member of staff must be employed at the home without all of the specified recruitment checks being undertaken prior to their appointment and determined as satisfactory. The home had an in-house, staff induction training programme and also an induction programme that met the Skills for Care standards. All of the staff had at least three paid days training per year and an individual training and development assessment and profile. However, the individual training profiles that listed the training that had been undertaken were not up to date. The registered manager said that she was aware that this was an area that she needed to address. The recommendation that was made as a result of previous inspections in regard to this matter had not been fully implemented and still stands. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being managed in a way that meets the basic needs of the people living there but does not always promote the best outcomes for these people. EVIDENCE: The registered manager had appropriate experience and displayed an understanding of her role and responsibilities. She had completed the NVQ level 4 training in health and social care (adults) in July 2006. She had also completed the NVQ assessor’s training in September 2007 and had undertaken training in the supervision of students. However, the requirement that was made as a result of previous inspections that she must continue to pursue the training necessary to achieve the Registered Managers’ Award had not been fully implemented and still stands. The registered manager said that she hoped to complete the training by March 2008. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 22 The assistant manager and the senior team leader had completed the NVQ level 3 training and were undertaking the NVQ level 4 training. A requirement was made in regard to Standard 33 as a result of previous inspections that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The registered manager had introduced forms to enable her to carry out monthly audits of various aspects of the service. However, these had not yet been fully completed. There was limited evidence to show that the outcomes of the audits had resulted in any changes to the service. A recommendation of a previous inspection was that the results of service user surveys should be published and made available to current and prospective users, their representatives and other interested parties, including the CSCI. The recommendation had not been fully met. Questionnaires had been issued to the relatives of service users in June 2007. There had been nine responses but the results had not yet been analysed or published. Questionnaires had not been issued to visiting professionals recently. However, it was pleasing to note that meetings with the service users had been held on 02/01/07, 24/03/07 and 31/05/07. No one employed by or connected with the running of the home acted as an agent or as an appointee on behalf of any of the service users. However, the home held money in safekeeping on behalf of three service users. A requirement was made as a result of the previous inspection that a secure, lockable facility must be provided for the safe keeping of any money or valuables held by the home on behalf of the service users. The requirement had been implemented. The service users’ money and individual accounts were kept in separate envelopes in a lockable safe. The accounts and corresponding amounts were checked and these were correct. The home did not hold any personal possessions or valuables on behalf of any of the service users. The registered manager reported that £20.00 that had been collected for a gift for the baby of a member of staff had been taken from the office on 20 September 2007. The registered manager was advised to report the matter to the Police. Three requirements were made in regard to Standard 38 as a result of previous inspections of the home. The first requirement was that intumescent strips and cold smoke seals must be fitted to all fire resisting doors. The requirement had not been implemented and still stands. The fire safety records were checked and these were satisfactory. The second requirement was that risk assessments must be carried out and recorded for all safe working practice topics covered in Standards 38.2 and 38.3 including the safe storage and disposal of hazardous substances. The requirement had been implemented. The third requirement was that arrangements must be made for all the staff to undertake training in all of the core areas. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 23 Some staff training had been carried out since the previous inspection. However, it was noted that three recently appointed members of staff had not undertaken any training in moving and handling or in any of the other core areas. It was also noted that none of the staff had undertaken risk assessment training and none of the senior staff had undertaken any training in person centred care. Copies of the monthly reports prepared following visits made to the home in accordance with Regulation 26 were made available for inspection except for September and October2007. PAT tests were carried out on 11 January 2007. Water temperature checks were being carried out but not on a weekly basis as stated by the home. The home’s hoists had been serviced on 15 February 2007. The record of accidents was checked. It was noted that the record of four recent accidents that resulted in cuts and marks was incomplete and did not include the treatment that was given. Another accident form had not been signed. The home was unable to make available the current servicing certificate for the boilers and central heating system. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14(1)(2) Requirement Timescale for action 30/11/07 2 OP7 15(1)(2) 3 OP9 13(2) A system must be devised that will ensure that specific and detailed information is recorded in the assessment forms in order to reflect more accurately the needs of the service users. This will help to ensure that all of the service users’ needs are met. Clear, specific and detailed 22/10/07 guidance must be included in the service users’ care plans to ensure the appropriate delivery of care. The care plans must include the action to be taken to ensure that all aspects of the service users’ needs are met. (Previous timescales 31/05/06 and 31/12/06 not met). A suitable lockable, dedicated 22/10/07 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). DS0000018507.V352188.R01.S.doc Version 5.2 Hillside Residential Home Page 26 4 OP9 13(2) 5 OP16 17(2) 6 OP31 9(2) 7 OP33 24(1)(2) 8 OP38 23 (4A) A system must be devised to 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 home’s medication practices and procedures. A procedure must be introduced that will ensure that a record is kept in the home of all complaints made by service users, their representatives or their relatives or by persons working at the home about the operation of the home and the action taken by the registered person in respect of any such complaints. This is to ensure that people living in the home receive an appropriate response to any complaint that is made. The registered manager must continue to pursue the training necessary to achieve the Registered Managers’ Award. This will ensure that the registered manager has the necessary qualifications to manage the home. (Previous timescale 31/12/07 not met). A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. This will help to ensure that a high quality service is provided. (Previous timescales 30/06/06 and 31/01/07 not met). The requirements of the Regulatory Reform (Fire Safety) Order 2005 must be met in order to safeguard service users from DS0000018507.V352188.R01.S.doc 30/11/07 30/11/07 31/03/08 22/10/07 22/10/07 Hillside Residential Home Version 5.2 Page 27 9 OP38 18(1) 10 OP38 26(5) the risk of fire. (Previous timescale 12/04/06 and 31/12/06 not met). Arrangements must be made for all newly appointed staff to undertake training in all of the core areas. This will ensure that the service users are cared for by staff who are trained and competent to do their jobs. (Previous timescale 28/02/07 not met). A system must be devised that will ensure that the person carrying out the monthly visits on behalf of the registered provider prepares a written report on the conduct of the home and supplies a copy to the registered manager. This will help to ensure that any issues that need to be addressed are brought to the attention of the manager. 22/10/07 30/11/07 Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 28 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 OP1 OP8 Good Practice Recommendations The statement of purpose should include the correct address of the registered provider. Suitable scales should be provided to enable the staff to monitor the weight of all the service users including those with mobility problems. This will help to ensure that the service users’ healthcare needs are met. The risk assessments in respect of the service users who require the use of bed rails should be reviewed. This is to ensure that the safety of the service users who use the bed rails is not compromised. When medication is written on to the MAR charts by hand it should be checked signed for as being correct by two members of staff. This will help to ensure that the service users receive the correct medication. A metal cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 should be provided for the storage and safekeeping of controlled drugs. This will help to ensure that the service users’ medication is stored securely. More opportunities should be provided to enable the service users, including those with dementia, to engage in a wider range of individual and small group social and leisure activities both inside and outside the home. This will help to ensure that the service users’ individual social and recreational needs are met. The height of the television in the conservatory should be lowered to a more appropriate level. This will enable the service users to watch the television with greater ease and comfort. The advice of a qualified dietician should be sought in order to improve the standard and variety of the food provided in accordance with the service users’ preferences and needs. This will help to ensure that the service users receive an appealing and balanced diet. The home should bring the guidance ‘Safer Food Better Business’ into operation. This will help to ensure that food DS0000018507.V352188.R01.S.doc Version 5.2 Page 29 3 OP8 4 OP9 5 OP9 6 OP12 7 OP12 8 OP15 9 OP15 Hillside Residential Home 10 OP18 11 OP19 12 OP19 13 OP22 14 OP26 15 OP26 16 OP27 17 OP30 18 OP33 hygiene and catering standards are maintained at a consistently high level. Action should be taken to ensure that the home’s policy on ‘Adult Protection and Prevention of Abuse’ contains the correct address and telephone number of the Adult Protection Coordinator and that the home’s ‘Abuse Policy’ is amended in accordance with the guidance given. This will help to ensure a more robust response to any suspected or alleged incidents of abuse and provide greater protection for the service users. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be introduced and implemented with records kept. This will help to ensure that the service users live in a safe and well maintained environment. The missing/warped wardrobe doors in bedrooms 10, 11, 12 and 17 and the broken toilet seat in the bathroom should be replaced. This will help to ensure the service users’ comfort and safety. Adequate storage space for storing wheelchairs and other equipment should be provided. This will help to ensure that the home is tidy and that there are no obstructions or unnecessary risks to the service users. The laundry procedures and practices should be reviewed and any necessary changes introduced in order to ensure that the service users’ clothes do not get lost. The service users should be compensated for any lost items. This will help to ensure the service users’ dignity and comfort. The top of the deep fat fryer in the kitchen, the top of the oven and the area behind and above the oven should be thoroughly cleaned and maintained in a clean condition. This will help to ensure the health and safety of the service users. The number of care staff hours and domestic staff hours per week should be increased in order to provide the staff with sufficient time to meet all the service users’ needs and to maintain a satisfactory standard of odour control. This will help to ensure the care, safety and comfort of all the service users. The individual staff training and development assessments and profiles i.e. ‘Individual Record of Staff Training’, should be developed in accordance with the guidance given in the report dated March 2006 and kept up to date. This will help to ensure that the staff receive appropriate and up to date training to enable them to do their work effectively. The results of service user surveys should be published and made available to current and prospective users, their DS0000018507.V352188.R01.S.doc Version 5.2 Page 30 Hillside Residential Home 19 OP33 20 OP38 21 OP38 22 23 OP38 OP38 24 OP38 representatives and other interested parties, including the CSCI. This will help to assure the quality of the service. The views of stakeholders in the community e.g. GPs, chiropodists, district nurse, should be sought on how the home is achieving goals for service users. This will help to assure the quality of the service. All of the staff should undertake training in risk assessment. This will help to ensure that the service users receive a risk-managed service that maintains their safety and independence. The three senior staff should undertake training in person centred care. This will help to ensure that all the service users, including those with dementia, receive a personalised service that will meet all of their individual needs. Water temperature checks should be carried out weekly and recorded. This will help to ensure the safety of the service users. The accident records should be completed in full and include the details of the treatment given and signed. This will help to ensure that the service users receive care that is appropriate to their needs. The current servicing certificate for the boilers and central heating system should be kept in the home and made available for inspection at all times. This will help to ensure the health and safety of all the service users. Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillside Residential Home DS0000018507.V352188.R01.S.doc Version 5.2 Page 32 - 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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