CARE HOME ADULTS 18-65
Hilltop Peewit Hill, West End Road Bursledon Hampshire SO31 8BP Lead Inspector
Annie Billings Unannounced Inspection 30th January 2006 11:00 Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hilltop Address Peewit Hill, West End Road Bursledon Hampshire SO31 8BP 023 8040 5944 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) Mrs Jane Strange Mrs Jane Strange Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th July 2005 Brief Description of the Service: Hilltop is a family run home, registered to accommodate four adults with a learning disability. The home is situated on the outskirts of Southampton, with local shops nearby, and offers single, ground floor rooms, a communal lounge / dining room, large kitchen, conservatory and gardens. Bathroom and WC facilities are also on the ground floor. The registered provider and their family live on the premises, in first floor accommodation. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours and was the second inspection of the year April 2005 to March 2006. Many of the core standards were inspected during the previous visit on the 8th July 2005; therefore referral to both reports will give a full overview of the service. A tour of the ground floor premises took place, records were sampled and comments were received from two residents. Questionnaires were completed with assistance from day services staff, to ensure residents feel enabled to be open and honest. None of the residents were available during the inspection. Additional information was supplied within a pre-inspection questionnaire, and discussions were held with one staff member and the registered provider/manager. What the service does well: What has improved since the last inspection?
Since the last inspection new flooring has been laid in the WC, a new door lock has been fitted, and one bedroom has been redecorated. Radiator covers have been fitted in several areas, based on the outcome of risk assessments, to ensure the protection of residents and cushions have been fitted to plastic chairs, to ensure the residents comfort. The manager said that the lounge and hallway were planned for redecoration in the month or two. Comments made by residents confirm their satisfaction with the service. Comments received included, “Well cared for”, “Staff treat me well” and “I like all the staff, I can talk to them about my problems”. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 6 As suggested at the last inspection, the manager confirmed they had consulted with the pharmacist to ensure that medication procedures in the home are in line with best practice. No issues were identified. Two issues were identified at the last inspection. Good progress has been made in ensuring that recruitment files contain all the necessary preemployment checks, although one application form was not available on file; and a staff rota is now in place to clearly identify who is working in the home. Monthly residents meetings have been organised, to demonstrate residents’ involvement in the running of the home. A maintenance book, and health and safety audit system have been developed, to demonstrate that any issues identified are dealt with promptly, and the premises remain safe. A service plan has been developed, to ensure the service continues to improve and moves forward. 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 DS0000012179.V279290.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: Hilltop DS0000012179.V279290.R01.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, 16 Residents are able to engage in a range of activities in the home and the community, enabling independence and choice. EVIDENCE: Three care plans sampled demonstrate that residents take part in appropriate activities. One attends day services five days a week, while another attends college during the week. Minutes of residents’ meetings, and discussions with the provider, further demonstrate that residents make their own choices in accessing community facilities and activities, such as local fetes, pubs, cinema and other leisure facilities. One resident has recently undertaken a balloon ride. Care plans identify the abilities of residents and the support needed to undertake their responsibilities in undertaking household chores. A staff member confirmed that they always knock on bedroom doors before entering, and that mail is delivered unopened. Detail within care plans show that residents can choose to be alone, although encouragement is given to socialise, where a risk of isolation has been identified.
Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 11 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): 19 There are appropriate systems in place to support residents’ health care needs, although there is a lack of consistency in recording. EVIDENCE: Following a recommendation at the last inspection, the home has consulted with the local pharmacy to ensure that medication practices in the home remain in line with best practice. No issues have been identified. The residents’ health care needs are well documented in the care plans sampled. Health care and specialist visits are recorded in the residents’ files seen, although these have not been updated since 2004. Recent visits to GP’s and dentists have been recorded in daily diaries, and there is some evidence that specialist referrals have been made when appropriate. Sampling of diaries identified that staff recording is at times inappropriate. The manager agreed to address this, and provide training as required. Discussion with the manager identified that one resident had been referred to a physiotherapist towards the end of last year, but there was no record of this or any follow up since. The manager said that well woman check ups had been offered to all residents, but had been refused. This had not been recorded, and the manager has agreed to record all contacts with health professionals.
Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Procedures are in place to protect residents from abuse. EVIDENCE: Discussion with the provider/manager and one member of staff confirmed their awareness of abuse issues and the reporting procedures, although no formal training has been undertaken. This has been recommended, and the manager agreed to access an appropriate course for all staff and volunteers. A copy of Hampshire Adult Protection Policy has been obtained. Discussion with the manager confirmed that residents have control over their finances, with support where necessary. Personal allowances held by the home were checked and balanced against the records maintained. The manager said they intend to further empower the residents to hold their own allowances, once risk assessments have been undertaken. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected. EVIDENCE: Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 14 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): 32, 35 Residents are supported by a competent and trained staff team, although records are not fully completed. EVIDENCE: The three residents are currently supported by two part time staff, two volunteers and the manager, all of whom have been checked by the Criminal Records Bureau. One member of staff is a registered nurse, and is currently undertaking a degree course in management. Another has achieved a National Vocational Qualification (NVQ) Level II, and the manager is partway through an NVQ4 course, although is looking to transfer to an alternative assessor. One volunteer has extensive experience of working in social care, while the other has little contact with the residents, other than maintenance within the home. The manager has initiated induction and foundation training packs to Sector Skills Council specifications, but on examination there were found to be incomplete. The manager has agreed to ensure these are signed off, and was reminded of the timescales these should be completed within. Certificates were available on file to confirm recent training in challenging behaviour and first aid, and the manager has an awareness of the need to
Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 15 access update training in food hygiene later this year. Medication training and competency assessments are undertaken for anyone undertaking the administration of medication. Following a training needs assessment, the manager agreed to access further training courses to ensure that staff have the appropriate skills to meet people’s needs. This will include supervision and risk assessment training for those undertaking these tasks, epilepsy, infection control, protection of vulnerable adults. Fire safety training is currently undertaken internally, and does not include practical skills. The manager has agreed to consult with the fire safety officer, and implement their recommendations on staff training needs. Comments made by residents confirm their satisfaction with the service. Comments received included, “Well cared for”, “Staff treat me well” and “I like all the staff, I can talk to them about my problems”. Comments made by residents confirm their satisfaction with the service. Comments received included, “Well cared for”, “Staff treat me well” and “I like all the staff, I can talk to them about my problems”. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 16 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, 39 Residents benefit from a well run home that is service user led. EVIDENCE: Hilltop is a small, well-run home that meets people’s needs within a family setting. The service has been managed by the registered provider for several years, and recently expanded their registration to accommodate four younger adults. Discussion with the manager confirmed that NVQ4 training had commenced, although they were accessing an alternative assessor and format. Training records confirm that they have recently undertaken training in challenging behaviour and first aid, to update their skills. Residents’ meetings are held monthly, and from minutes sampled the residents are offered choice and self-determination. The manager was discouraged from including resident’s personal details within the minutes. All three residents attend monthly advocacy meetings, to ensure they are fully supported. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 17 A service plan has been developed for 2006, to ensure the home continues to improve. There is no formal quality assurance system in place, although the intention to develop this area was discussed and agreed, to ensure that residents, relatives and health professionals views are sought, and used to inform the development of the service. Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 X X 3 X 2 X X X X Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hilltop DS0000012179.V279290.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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