CARE HOME ADULTS 18-65
Hilltop Peewit Hill West End Road Bursledon SO31 8BP Lead Inspector
Annie Billings Unannounced 8.07.05 12:45 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 H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Hilltop Address Peewit Hill West End Road Bursledon SO31 8BP 023 8040 5944 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) Mrs Jane Strange Mrs Jane Strange CRH 4 Category(ies) of LD(E) Learning Disability over 65 registration, with number LD Learning Disability of places Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 31.01.05 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 alson on the ground floor. The registered provider and their family live on the premises, in first floor accommodation. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over hours, and was the first inspection of the year April 2005 to March 2006. A tour of the ground floor premises took place, records were examined and interaction between staff and residents observed. Three residents were spoken with, and discussions held with one member of staff and the registered manager. Further information was available within a pre-inspection questionnaire and comment cards received from three residents, completed with the assistance of support workers at day services. What the service does well: What has improved since the last inspection?
Three bedrooms have been redecorated since the last inspection, with new bedding and blinds fitted throughout the home. A new TV has recently been purchased for the communal lounge, and a lock has been placed on the electrics cupboard, as requested at the last inspection. Fire safety system checks are now undertaken on a regular basis, the central heating system and boiler have been serviced, and a duty roster of persons working in the home has been developed, as requested at the last inspection, although this requires further work to be done. A deputy manager has recently been appointed; who is introducing improved recording systems in the home. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 6 The registered manager has consulted with infection control nurses, to ensure that laundry procedures in the home are in line with good practice. 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 H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 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 H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 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) 2 The home has clear systems to identify service users’ needs. EVIDENCE: No new service users have been admitted since the last inspection. Three files examined identified that full assessments had taken place prior to residents moving into the home. Specialist referrals had been made where a specialist need had been identified. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 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 standard(s) 6, 7, 9 Service users are clearly involved in developing support plans that reflect their needs and objectives, and are supported to make decisions about their lives. EVIDENCE: Three service user plans were sampled, that contained detailed information on how support would be given to residents, to enable them to meet the aims and objectives of the care plan. In respect of one service user over 65, the manager has agreed to provide more detail, to ensure that staff receive detailed guidance on how to support their needs. One resident advised, “I do what I want, when I want”. All residents are supported in decision-making, and meet with an advocate on a fortnightly basis. There are no restrictions on the individual rights of the residents, who were seen to move freely around the home. The manager stated that the needs of one older resident were beginning to impact on the younger residents. Having identified this, a referral has been made to the care manager, to support and access a more suitable placement. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 10 Evidence was seen to confirm that care plans are being reviewed regularly, and where a risk had been identified, risk assessments were in place, with appropriate measures taken to minimise risk, although these had been misplaced in one file seen. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 11 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) 15, 17 Contact with families and friends are well supported, and the nutritional needs of residents are well managed. EVIDENCE: Families and friends of residents are welcomed into the home, as observed on the day, with one resident bring a friend from day services to visit the family horse. Family contacts are well documented in the files examined. Meals are chosen by the residents, based on their preference, with records of their likes and dislikes recorded within their records. Two different meals were served during the inspection, with another resident observed being supported to make their own meal. Residents were seen to eat together or in their own room as they wish. A healthy diet is encouraged, as residents have a tendency to be overweight. This is being monitored on a six monthly basis by the GP, and records of food provided are maintained.
Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 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 standard(s) 18, 20 Personal care needs are well supported, and systems for managing medication are good, although records for administration were not up to date. EVIDENCE: From files examined, the three younger residents are able to manage much of their own personal care needs, with encouragement and supervision, as documented within care plans. One older resident with more physical support needs could be more detailed. This was discussed with the manager, who agreed to provide more detailed information, to ensure that staff receive guidance on how to support these needs. Medication was stored appropriately within a lockable cupboard, although the lock broke during the inspection. The manager gave assurances this would be repaired immediately. Medication is partially administered from blister packs, with others direct from bottles. Medication records examined had not been fully completed for that morning, and the manager agreed to ensure that records would be signed immediately on administration. As and when required medication is only administered following written confirmation from the GP. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 13 Training in the safe handling of medication has been accessed, and all staff will be undertaking training, although current administration is the sole responsibility of the manager. The manager is intending to share this responsibility with other staff, and it was recommended that the manager consult with the pharmacist, to ensure that the home’s procedures remain in line with good practice. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 14 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) 22 A satisfactory complaints procedure is available, which residents feel able to use. EVIDENCE: No complaints have been received since the last inspection. Each resident has a copy of the home’s service user guide, within which is the complaints procedure. One resident was able to advise they were aware of the procedure to follow, if they were unhappy about anything. This was also confirmed by three comment cards received, which state that residents were aware of whom to talk to, and they felt they would be listened to. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 15 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, 27, 30 The home provides a safe, clean and comfortable environment, however the identified deficiencies may compromise privacy and safety of residents. EVIDENCE: Since the last inspection three bedrooms have been redecorated, new bedding supplied and new blinds have been fitted throughout the home. Two residents confirmed they are quite happy with their rooms, which appeared homely and comfortable, although it was noted that three rooms only offer a plastic chair. This was discussed with the manager, who agreed to purchase cushion pads to make them more comfortable. Two bedrooms offer direct access outside, although these fire doors are alarmed for the protection of residents. A number of uncovered radiators and hot water pipes were seen in several rooms. The manager advised that the whole premises were being risk assessed, and has agreed to include these areas as part of the assessment, to ensure that residents are not at risk of burns. Communal areas are clean, well decorated, homely and comfortable. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 16 The WC door, adjacent to the kitchen, was not lockable. The manager agreed to have a lock fitted, to ensure the dignity and privacy of residents. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 17 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) 33, 34 The procedures for the recruitment of staff are not robust and do not offer satisfactory protection to people living in the home. EVIDENCE: Since the last inspection, a staff rota has been developed as requested. This does not fully identify persons working in the home, or that the agreed staffing levels are being maintained. This was discussed with the manager, and it was established that staffing levels were being maintained, but not being recorded accurately. The requirement will be repeated. Staff records were examined, and evidenced that some progress had been made in meeting a requirement of the last two inspections. Two staff records were complete, however there was no record of pre-employment checks in respect of one member of staff. A further file of a new member of staff was seen. Pre-employment checks have not been received, and there was no evidence that health issues identified within the application form had been followed up. The employment history given by the applicant was incomplete, and there was no evidence to support this had been checked. The requirement will be repeated for the third time.
Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 18 Comments received from residents confirmed that staff treat them well, with one commenting that the manager and staff are very kind. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 19 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 health and safety of residents is protected by the procedures within the home. EVIDENCE: Since the last inspection, regular testing and visual inspections of fire safety equipment have been recorded. Evidence of regular fire drills was seen, and one resident was able to advise of the procedure to follow, in the event of a fire. Current maintenance certificates were examined, including the gas boiler and central heating, following a service in February 2005, as highlighted at the last inspection. As requested at the last inspection, a lock has been placed on the electrics cupboard, as it is situated within one resident’s bedroom. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 20 Evidence of recent staff training was available within the files examined, including the induction training undertaken by a new member of staff. A bottle of bleach was found under the kitchen sink. This was pointed out to a member of staff, who removed the bottle immediately and placed it in a locked cupboard, along with other products that could be a potential hazard to residents. The home does not have a separate laundry facility, and the washing machine is located in the kitchen area. Following the last inspection the manager has been in contact with the infection control nurse, to discuss how best to meet infection control measures. As soiled laundry is a rare occurrence, it was agreed that laundry can usually be done outside of meal times, and in the event of soiled laundry, this can be taken around the outside of the home and the washing machine accessed via the back door. The manager has agreed to write a policy and procedure to this effect. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 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 x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 2 x x 3 Standard No 11 12 13 14 15 16 17 x x x x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 2 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hilltop Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 22 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 33 Regulation Schedule 4 [7] Requirement A duty roster must be maintained to identify the persons working at the home, and a record kept of changes to this roster Timescale of 28.2.05 not met. Pre-employment checks must be undertaken prior to employment and records maintained as specified in Schedule 4 of the Care Homes Regulations Previous 2 timescales not met Timescale for action 31.8.05 2. 34 Schedule 4 31.8.05 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 20 Good Practice Recommendations The registered manager should consult with the pharmacist, to ensure that medication procedures in the home are in line with best practice. Hilltop H54 S12179 Hilltop V234392 04.07.05.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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