Inspection on 28/02/06 for Hilltop

This inspection was carried out on 28th February 2006.

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 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 2 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 02/11/05

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 Kath Houson Unannounced Inspection 28th February 2006 10:00 Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 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 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) The Orchard Trust Mrs Donna Ann Rickards Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Hilltop is a purpose built detached six-bedroom house situated in the Forest of Dean. The home is part of Orchard Trust and has other homes within the area. There are breath-taking views at the top of the hill that would be pleasing to clients. The home currently provides permanent residential care and respite care for adults with learning and physical disabilities. The home provides an additional day care service to clients’ from neighbouring areas. On the ground floor there are five single bedrooms, kitchen, laundry-room, communal dining area and two communal lounges. There are also two bathrooms one is currently being decorated and an additional toilet. On the first floor there is one single bedroom with en-suite facilities and the office. The gardens and the ground floor are fully accessible to wheelchair users. The bathrooms have been adapted to meet the needs of service users with physical disabilities. The home has its own vehicles such as the use of a saloon car and minibus. The respite service is funded by Social Service on a block-funding basis. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place one day in February 2006. The registered and deputy managers were available throughout the inspection and able to assist and provide all relevant documentation on request. Twenty-nine of the core and non-core standards were assessed and included an examination of documentation; three residents records were case tracked, a short and informal discussion was conducted with guests’ and staff team, a tour of the environment and a short succinct feedback was given to conclude the inspection visit. The inspector would like to extend her thanks to the service users, and staff team for their assistance throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Service users benefit from information presented in a user-friendly manner that results in informed choice being made about their place of residence. EVIDENCE: The home operates an adequate admissions process in which potential service users are given information that would assist in making an informed choice about their place of residence. The manager undertakes an assessment of care needs and will compile a care plan according to the needs of the service users. The manger said that they were revamping the service user guide (SUG) to include universal symbols and pictorial images which would make the document more accessible to all service users. The redesigning of the SUG is being put together with a committee that has the input from service users as part of the committee panel and is working concurrently with the Adult Opportunity Center (AOC). The Commission asks that a copy of the completed SUG is forwarded to them. Each service user had copies of the terms and conditions placed in their files which have now been personalised. The manager said that the format is being changed over to show that service users have signed the document and consented to their care. The home’s Statement of Purpose is comprehensive and informative and is placed in the entrance door of the home and is accessible to all. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Service users are included in drawing up care plans which provide a detailed record of the needs and wishes of residents. More secure arrangements need to be identified for storing service user information to protect their confidentiality. EVIDENCE: The manager said that the staff team work with the service users within the community and there is a discussion with service users about their requests. An example such as decision-making on planning activities and shopping, was seen which showed that service users tell staff about what they would like to do. One service user said, “ I learn new things cooking, cleaning, go out with other clients.” This account from a service user would suggest that needs are taken into account and are practically carried out on a daily basis. Evidence taken from the care plan would reflect that recording of client’s suggestions and wishes are implemented and supported. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 9 The manager said that the service users were involved in planning their own care and exercise their rights to choice. The home’s care plans are individualised and personalised to reflect the use of service users choice. One service user said, “I choose when to get up 6 or 7; I like to sleep in more”. Accounts in client’s daily records illustrate how choice is made with staff support and discussion. The staff team according to the manager are making pictorial flash cards in order to communicate with non-verbal clients which would further assist clients in making and implementing choice. Care plans contained client consent signed forms. This additionally demonstrated that clients have been consulted in discussion about the care they receive. This will be monitored at the next inspection. Service users benefit from support given to take risks as part of living an independent lifestyle. Risk assessments were individualised and reflected in care plans that show activities that would promote independent lifestyle. Although this standard was not fully assessed, there are confidentiality and security issues highlighted from the last inspection that was raised during the current inspection. The issue of client file and the storing of client information was noted, that clients files are held in the communal area. Suggestions were put forward to the manager to discuss with her support team in order to reach a solution that would be beneficial for service users. During discussions with staff it was mentioned that it was inconvenient to have the client files in the office where most of the homes confidential information was also kept. The reasons highlighted and shared with the manager and the staff members are as follows: • • • Services users and visitors have access to the communal area. The potential risk for information to be mislaid is high and include files being removed, or read by others if not locked away immediately after use. Makes the home less homely for service users and raises confidentiality and security issues. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 The staff team support service users to participate in activities in-house and external to the home. EVIDENCE: Client activities and educational opportunities are reflected in client care plans and indicate service users tastes. The home has access to a day centre which offers a range of recreational, educational, occupational and therapeutic activities. The home also has the opportunity to organise in-house activities. In-house activities include arts and crafts, jigsaw puzzles video games, karaoke and snooker. The home additionally has its own vehicle for service users transportation. The staff team encourage service users to become part of the local community within the Forest of Dean. Services users are able to contact their families. The manger said that service users have their friends over for tea. One service user said “ I have contact with my family.” The manager also said that service users have the use of both mobile phones and the use of the home’s home, mobile phones are brought in for extra privacy. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 11 The daily routines of the service users promote independence and freedom and according to the manager service users have no set routine and that the clients are able to have a lie-in if they choose. One service users said that “I would like to sleep in more, I’m happy here.” During the current inspection the inspector had observed lunch being prepared and many of the service users were in the dining area, some had arrived back from being at the day centre. No set menus are provided at the home. The routine is that each client will have a cooked meal after day care. Clients have the choice of alternative menus and the choice for different dietary requirements are taken on board. The current inspection took place on a shopping day in which the basics are topped up and the home is busiest in that was a fair amount of activity was taking place. The manager had said that the delivery of fresh fruit and vegetable happens in the week. The manager said that the service users are offered a healthy diet and have meals according to the health conditions such as diabetic controlled diets. The inspector observed a meal being cooked for service users waiting in the dining area. The inspector felt that some aspects of the meal preparation could have been improved and this has been raised subsequently with the home. The Manager has stated that they feel these observations are unfounded and that the home is proud of the quality of the meals presented. Standard 17, as described on the previous page, is a core standard and will be assessed at future inspections. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home ensures that the health needs of service users are met. EVIDENCE: The home has a key worker system in which members of staff key work named service users. This is beneficial, as this allows for increased awareness of care. Key workers have the opportunity to discuss the service user care plan and document those changes. Client preference for care is documented and consented and found in client’s file. A daily routine was seen for clients whose files were case tracked and daily needs being reassessed were additionally documented. Some of the client files are for those in respite and those for permanent residency. Both respite and permanent clients appear to enjoy the activities the home provides. A review of the medication policy is being undertaken to include the monitoring of medication. All members of staff are qualified to give medication and follow an agreed procedure. A few suggestions were put forward to the manager based on the previous inspection and followed-up with a telephone conversation with the pharmaceutical inspector that was shared with the manager during the current inspection. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users have the opportunity to participate in regularly meetings that take place in the home. EVIDENCE: Service users have regular meetings, as evidenced in documents seen during the current Inspection. Service users are able to share their views and know that their views matter. The staff team additionally have regularly meetings to discuss any issues arising in response to service users requests. The Staff have in house training with the Head of Care particularly in abuse training to make staff more aware of abuse issues and the protection of vulnerable adults. Training matrixes was seen in the office and show the staff training programme. A senior staff member said that they were aware of whistle blowing procedure and was familiar with the procedure, saying they would “instantly reprimand staff there and then.” Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29 and 30 Service users live in a homely and comfortable establishment. EVIDENCE: Service users live in a homely safe environment that reflects their lifestyle. The bedrooms are comfortably decorated. A service user showed their bedroom to the inspector, after permission was granted from the service user, and assisted with some of the current inspection. Some of the bedrooms are permanently used for social services respite use and suitably decorated for allocated stays. Some plans are being made to have some additional tracking for hoists for people with physical disability. The downstairs bathroom is currently being tiled and decorated and will provide additional facilities for personal care. Fixtures and fittings are satisfactory and in good order. Communal space is satisfactory and comfortably decorated. All outdoors activities are supervised, as the home is located at the top of a hill with breath-taking views. Clients are risk assessed on a regular basis and not left unsupervised in the patio garden area. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 15 The dinning room is adequate and has a large photocopier and two large medicine cupboards on two different sides of the walls. A small freestanding cupboard holds the clients files. The manager said that the photocopier is for the service users arts and crafts. However no service users artwork was to be seen. The manager additionally said that staff also uses the photocopier for non-data sensitive work. It was good to see photos of service users in their home. A small pocket document holder placed on the wall had the client medication file during the current inspection. The suitability of this was discussed with the manager and the document was subsequently locked in the medicine cupboard. The home is clean and has a tidy laundry room that is additionally free from offensive smells. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,34 and 36 Service users benefit from clarity of staff roles and responsibilities. EVIDENCE: Service users are aware of whom to go to in time of crisis and are key worked with staff members. The staff team are suitably qualified to carry out their task as part of providing care to service users. Additionally staff have specialist knowledge and training in diabetes and epilepsy to meet needs of service users. The night staff are additionally included in training. Service users are protected by the homes recruitment policy; all applications are vetted at the central office. All staff are now allocated a supervisor within the home. The supervision programme was seen and is arranged in 6-8 weekly sessions and staff have the added option to request supervision sooner. The manager said that she is also supervised every two months by the Head of Care of The Orchard Trust. A member of staff commented that they sleep on a mattress on the floor when sleeping-in. However, the manager has stated that there is a Z-bed for use in the sleep-in room. There appears to be an inconsistency here and it is recommended that the manager reviews the sleep-in arrangements to ensure they meet the needs of staff. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39 Service users benefit from a home that is well managed and meets its aims and objectives. EVIDENCE: The home has a communication book in which any issues are documented allowing for the staff team to share information. The manager of the home has good support from the deputy and wider management team. The home has a number of cards of compliments from relatives who are satisfied with the service placed by the entrance door. The home appears to be adequately managed and the staff team are aware of their role. The opinions of service users are noted during service users meetings and are acted on swiftly, according to the manager. For instance, when service users discussed activities this was taken onboard. During this inspection it was noted that no notifications under Regulation 37 have been received by the Commission since 2004. Whilst the Commission found no evidence that incidents had occurred that should have been reported, it is unusual for no notifications to be made over this period of time. The Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 18 Commission recommends that the process for making notifications is reviewed to ensure that the process is being correctly followed. Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X X X Hilltop DS0000016468.V285856.R02.S.doc Version 5.1 Page 20 Yes 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 YA10 Regulation 23 Requirement 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 the communal areas of the home Timescale for action 28/02/06 2 YA28 23 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA36 YA42 Good Practice Recommendations Review sleep-in arrangements with staff. Review process for notifying Commission of any incidents as required under Regulation 37. 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