Inspection on 02/11/05 for Hilltop

This inspection was carried out on 2nd November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilltop 25/02/09

Hilltop 07/03/07

Hilltop 28/02/06

Hilltop 07/03/05

Hilltop 11/05/04

Hilltop 16/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hilltop Ridge Walk Ruardean Hill Drybrook Glos GL17 9AY Lead Inspector Barbara Davies Unannounced 2 November 2005 15:00 nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hilltop Address Ridge Walk Ruardean Hill Drybrook Glos GL17 9AY 01594 542026 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orchard Trust Mrs Donna Rickards Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07/03/05 Brief Description of the Service: Hilltop is a purpose built facility situated approximately 2 miles from Cinderford town centre in the Forest of Dean. The home currently provides permanent residential placements for two residents and respite care for up to four service users, all of who have a learning disability, and may also have a physical disability. On the ground floor there are five single bedrooms, kitchen, laundry, dining room and two lounges. There are also two bathrooms and an additional toilet. On the first floor there is a further single bedroom with en-suite facilities and an office. The gardens and ground floor are fully accessible to people who use wheelchairs. Bathrooms have been adapted to meet the needs of service users who have physical disabilities.The home has a saloon car and access to a mini bus.The home is part of the Orchard Trust. The respite facility is funded by Social Services on a block-funding basis. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the home was unannounced and commenced at 15:00hrs. on 2nd November 2005. It took place over hours five during the afternoon and early evening. The service manager, unit manager and deputy manager were spoken to during the inspection concerning requirements from previous inspection reports. Several care staff were spoken to informally during the course of their duties and the Inspector spent short periods of time with three of the service users. One service user showed the inspector her bedroom. The manager accompanied the inspector on a tour of the communal areas of the building and of the bedrooms used to provide respite care. Files relating to two service users were inspected and other records kept in the home were examined. The statement of purpose and the service user guide were also seen. What the service does well: What has improved since the last inspection? The home has introduced further safeguards when recruiting staff. Evidence that gaps in employment history have been explored with the candidate are now on file and a full employment history is sought from applicants. The home has taken action to address all the requirements imposed following the unannounced inspection of the home in March 2005. The Service User Guide Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 6 has been amended to indicate any extra costs that service users pay and a Statement of Terms and conditions has been put in place for all respite service users. A service user plan has been completed for each person receiving care at the home and these describe how the home is going to attend to the care needs of the individual concerned. The information recorded in risk assessments has been extended to clearly indicate hazards and how they are reduced. Requirements made about information held on particular service users have been addressed and service user plans now contain all the detail required. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 5 Information that has been published about the home, needs to provide more detail and be available to service users in a more accessible format. Written contracts between the home need to show that the service user (or their representative) understand the service they are to receive from the home. EVIDENCE: Copies of documents describing how the home operates is available to service users and visitors in the entrance hall of the home. These were examined during the inspection. The date on the statement of purpose indicated that the information had last been updated in July 2003. The manager of the home said that it had been updated more recently to take into account changes that had occurred in the staff team and that it was an oversight that the date had not been altered. This was found to be the case. It was noted that the statement of purpose does not currently include a summary of the complaints procedure or details of the admissions criteria. The guide for service users contained comprehensive information about the services offered at the home. It’s current format is one that cannot easily be understood by service users. The size of the print is small and there are no pictures. The service manager and manager reported that computer software‘ Communicate in Print’ has just been purchased and this will allow the home to publish the service user guide using pictures, symbols and words. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 9 Files for two service users were seen during the inspection. These contained copies of the assessments that had been completed by health and social services prior to the service users being admitted to the home. In addition there was evidence that either the manager or the deputy manager completes a comprehensive needs assessment to determine whether the placement will be appropriate. The manager said that the home liaises with the Community Learning Disability Team and also involves the service user and their carers in designing a package of care. There were plans on file that showed how the home is going to meet the specific care needs of service users. The home has addressed a requirement made following the last inspection of the home in March 2005 and written contracts have now been introduced for respite service users. The two files examined during the inspection contained copies of the contracts. The contents of the contract did not cover all of the matters specified within the standard, such as room to be occupied and the signature of the service user (or their representative) to whom the contract applies. It was noted that the style and language of the contract was complex and consequently service users would not be able to access it independently. This was discussed with the unit manager who indicated that it was a matter that the home had identified as requiring attention. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 and 10 Service users are consulted and involved in planning their own care. Service users would be better informed about the contents of service user plans if these were published in a user- friendly format as well as the existing one. Risks to service users are identified and appropriate actions taken to manage these. More secure arrangements need to be identified for storing service user records. EVIDENCE: Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 11 Service user plans have been developed for all the people living in the home and these show how the home is working, on a day-to-day basis, with each person living there. Plans describe the actions to be taken by staff to attend to the personal care needs of service users, how they are to support them to develop skills and to participate in leisure activities. The manager said, that the staff consult with service users about their plan. Their preferences are sought by using objects around the home to obtain client preferences. Where appropriate service users are asked to sign their care plans to show that they agree with the contents. Consultation is also said to take place with parents/carers and the Community Learning Disability Team about the matters to be included in the plans. Care plans are dated and signed by key workers. There was evidence in two of the files examined that the contents of plans are reviewed by the home every month. A more formal review of the service users care takes place annually. The service user, family, social worker and day care service are involved in this process. Service users are supported to participate in a wide range of individual and group activities. The two files seen during the inspection, contained copies of risk assessments that had been completed in relation to each service user. These indicated the hazards that had been identified and the action to be taken by staff to reduce the risk. The manager said, that staff are well-informed about the precautions that need to be taken to ensure the safety of service users whilst undertaking these activities. Most of the information and records relating to service users and to the operation of the home are kept securely in the manager’s office on the first floor of the main building. Some of the daily records maintained in relation to service users, including those about medication administered are kept in filing cabinets in the dining room. This arrangement is not ideal as service users and visitors have access to this area. There is the potential for information recorded to mislaid, removed or read by others if not locked away immediately after use. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 The home supports service users to develop skills and to lead an active social life. EVIDENCE: Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 13 The home supports respite service users to maintain their day time activities during their stays. This includes attending day centres, an AOC and work placements. The Orchard Trust has it’s own education centre which is supported by Gloscat. The centre offers a range of recreational, educational, occupational and therapeutic opportunities. These include access to a sensory room, training in computer skills, work with animals and trips out. The two permanent service users are supported to access this facility and it is also used by some of the respite service users. Activity programmes showed that service users attend community groups that have been established specifically for adults with learning disabilities. Activities in which service users participate include: include visits to cafes, pubs, leisure centres, walks, bowling, skittles and shops. Opportunities are also created for service users to engage in activities in the home. Television and video facilities are provided and a range of board games is available. One service user was actively engaged in completing a jigsaw puzzle during the inspection and several of the staff were seen to spend short periods of time helping him in this activity. Two of the service users spoken to, said that every Tuesday evening they go to a social evening at ‘the triangle club’ in Lydney. They said that they really enjoy the activities that take place there and said that they had enjoyed the Halloween party that had been organised the previous week. Staff had helped those who wanted to dress up in fancy dress for the occasion. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The home is sensitive and responsive to the needs of service users and involves them in deciding how they would like to be cared for. The home ensures that the health needs of service users are met. EVIDENCE: Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 15 The home has a range of aids and adaptations to assist service users with their personal care. Records showed that these have been serviced regularly. Service user plans describe the arrangements for staff to provide support to service users. These are designed to take into account the stated preferences of individual service users. The manager said that the preferences of service users are sought during the admission process by discussions with the service user and their parents/carers. Consent forms agreeing to the home providing personal care were present on the files examined during the inspection. These have been signed by the service user or their representative and provide the opportunity for the service users to state whether they would prefer a male or female member of staff to attend to their personal care needs. The manager said that there is a daily routine in place for each service user but that the routines still allow for flexibility about the time that service users go to bed. The home has staff awake during the night and the manger said that this arrangement also allows service users to stay up later if they want to. Records held in the home for both permanent and respite service users contain details of their health needs and the actions to be taken by staff to meet them. There was evidence that permanent service users are registered to receive services from a G.P, dentist and optician and that the home supports them to attend medical examinations at appropriate intervals. Records are kept of any treatment and medication required and administered. Files for respite users contained information about their health needs and details of the any health professionals involved. The home supports respite service users to attend any health appointments during their stays. Records show that the home and the parents/ carers keep each other informed of any changes that occur. Records of training for staff show that training in first aid is given to staff during their induction period and that this is repeated every three years. The medicines cupboard is currently located in a communal are of the home. This potentially has implications for medication being administered appropriately and safely to service users. A pharmacist inspector from the CSCI has been asked to conduct an inspection of the home to determine whether the appropriate arrangements are in place and to offer advice to the home. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Safeguards are in place to protect service users from harm. EVIDENCE: The Trust has policies and procedures relating to adult protection, whistle blowing and managing personal money. The home has obtained a copy of Gloucestershire Social Services Department Adults at Risk procedures to supplement their own. Staff confirmed their induction and foundation covered adult protection and that there is an expectation that this will be repeated at regular intervals. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 28 and 30 EVIDENCE: Service users have access to facilities within both the building and the grounds. The décor and environment within the home is maintained to a high standard and provides a homely, clean, bright and spacious environment The large external grounds are well maintained. A patio area is equipped with garden furniture and this area is readily accessible to accessible to people using wheel chairs. Each service user has a single room. Rooms are tastefully decorated and have appropriate furniture and fittings. Communal toilets and bathrooms are within close proximity of the bedrooms. It was pleasing to see that bedrooms of the permanent service users contained personal items belonging to the service user concerned. The manager said that requests from permanent service users to have their bedrooms decorated in a particular way will be responded to. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 18 The communal facilities are suitably furnished. The number of communal rooms is sufficient to allow a number of activities to take place at the same time and to allow service users to pursue separate activities should they wish. The sitting room provides comfortable, domestic style facilities for service users. The dining room would also do so if it did not contain a filing cabinet, photocopier and a large medical cabinet secured to the wall The home was clean, hygienic and free from odours on the day of the inspection. The home has an infection control policy and procedure and staff are familiar with the precautions they need to take. The laundry contained a copy of the homes’ own laundry policy which had been signed by staff. The laundry has an impermeable floor and contains a supply of aprons, gloves, plastic laundry bags and plastic baskets. The laundry has a sink that can be used for sluicing. Arrangements are in place for clinical waste to be collected weekly. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Informal support of staff is good, there is a need for more regular, structured and recorded supervision to take place EVIDENCE: Records of individual supervision sessions for staff show that during the preceding twelve months period, the frequency at which staff received individual professional supervision varied. Some but not all staff had received supervision at the frequency specified in standards. A record is kept of all the sessions that have taken place. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home takes the necessary precautions to ensure that the environment is safe for service users. EVIDENCE: There was evidence that the relevant health and safety checks were maintained. The record of checks completed in relation to fire equipment showed that checks are completed at the required frequency. Other records kept in relation to fridge/freezer temperatures, legionella screening, servicing of adaptations and electrical equipment also show this to be the case. A pictorial notice had been placed by the cooker drawing service users attention to the dangers involved. This is good practice. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hilltop Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement The date on the statement of purpose must be amended to indicate when it was last reviewed and updated. The statement of purpose must include a description of the admissions criteria and the homes arrangements for dealing with complaints. (including details of informal/ formal complaints, process by which complaints can be made and to whom,timescales within which a response will be received and how complainant will be informed of the outcome) An audit of the contents of the statement of purpose should be conducted against schedule 1 of Care Homes Regulations 2001. Where the schedule requires the statement of purpose to idescribe the arrangements for.., the home must include a summary of the homes policy and not simply refer to the policy The service user guide must be published in a format that makes it more accessible to service users The statement of terms and Timescale for action 14/03/06 2. YA1 4 14/03/06 3. YA1 4 14/03/06 4. YA1 4 1/06/06 5. Hilltop YA5(2) 5 14/03/06 Page 23 D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 (c) 6. YA10 23 7. YA28 23 8. YA36 18(2) conditions for service users must be personalised to the service user concerned and address all the matters specified in this standard including the signature of the service user to show their agreement. All records relating to the operation of the home and to service users must be stored securely and not in communal areas of the home. The filing cabinet and photocopier must be sited away from communal areas of the home. Supervision must take place at least six times a year for all staff. An up to date written record should be kept of each session detailing the matters discussed. 28/02/06 28/02/06 30/06/06 9. 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 5 Good Practice Recommendations The contract/statement of terms and conditions should be in a format/ language appropriate to each service users needs. Hilltop D51_D03_S16468_Hilltop_V247177_031005_Stage2_U.doc Version 1.40 Page 24 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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