CARE HOME ADULTS 18-65
Hilltop House Ashton Road Hartwell Northampton Northamptonshire NN7 2EY Lead Inspector
Kim Cowley Unannounced Inspection 1st December 2005 11:00 Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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 House DS0000063092.V263565.R01.S.doc Version 5.0 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 House DS0000063092.V263565.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hilltop House Address Ashton Road Hartwell Northampton Northamptonshire NN7 2EY 01604 864466 01604 864466 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) Oakleaf Care (Hartwell) Ltd Mr Ian Mosley Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Physical disability (3) of places Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. No person in the category PD shall be admitted to the home unless they are also in the category MD. No person in the category PD shall be admitted to the home when there are already three people in that category accomodated. That persons in the category PD are accommodated in Bedrooms 1, 2 and 5 (as identified in documentation received by CSCI on 25 October 2004) only. That only males are accommodated in the home. Date of last inspection 5th April 2005 Brief Description of the Service: Hilltop House is a new service for males with acquired brain injury and associated disorders. It opened on 3.01.05 and is situated in a converted manor house on the outskirts of the village of Hartwell in rural Northamptonshire. It provides personal care and nursing ten younger adults and includes three places for residents who have physical disabilities in addition to acquired brain injury. Accommodation is on two floors and all rooms are single and have ensuites. There is a dining room, a large lounge, a small smoking room, and a conservatory on the ground floor. The home is set in extensive grounds and features include a summerhouse, lawns and paddocks, and a secure garden area. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on a weekday. When undertaking inspections the Commission for Social Care Inspection (CSCI) focuses on the outcomes for residents living in a home. In order to do this, the inspector ‘case tracked’ three residents. This means the inspector checked their care records and met with two of them. In addition the inspector talked to the Manager, one of the care managers, the occupational therapist, and one of the carers. Further care and other records were examined. One recommendation was made. The home was commended in four areas. What the service does well:
Hilltop House offers a specialized service for younger adults with acquired brain injuries. The home, a converted former manor house, is decorated and furnished to a high standard and provides an environment that is both spacious and homely. Residents comments about the accommodation included, ‘My room is the biggest and best I’ve every had’, and ‘I can’t believe I’m living in such a fantastic place.’ The home is situated in extensive grounds including a secure garden, which is accessed via the conservatory. The premises are commended. Residents are encouraged to live active and useful lives. Each resident has a full activity programme of twenty sessions per week, combining life skills with leisure activities. The Manager said that activities are run on a one to one or small group basis as this suits the resident group. One resident said ‘There’s so much to do here that I never get bored.’ The activity programme is commended. Qualified nurses, care workers, and ancillary staff are employed. The home is run on a social rather than a behavioural model, and staff are expected to share the home’s ethos of giving residents as much choice as possible. Staffing levels are high and exceed the recommended minimum set out by the Residential Forum. Residents’ comments included ‘The staff are friendly and you can have a laugh with them’, and ‘The staff know what they’re doing and give me good advice.’ The staff team are commended. The Manager and Responsible Individual are qualified nurses with substantial experience of caring for people with acquired brain injuries. They work fulltime in the home and liaise with residents and staff on a daily basis. The Manager said ‘Both Clark (the RI) and myself spend a lot of time talking to residents and finding out what they want from this service. We encourage them to make suggestions about how to improve the home. It was the residents who instigated getting the dog, building rockeries in the garden, and
Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 6 having more trips out. If they have a good idea for something to improve the home we try and follow it through.’ This approach is commended. 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 House DS0000063092.V263565.R01.S.doc Version 5.0 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 House DS0000063092.V263565.R01.S.doc Version 5.0 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): EVIDENCE: These Standards were inspected at the last inspection on 5.04.05. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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): EVIDENCE: These Standards were inspected at the last inspection on 5.04.05. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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): 11, 12, 13, 14 Residents have access to a full programme of educational and recreational activities. EVIDENCE: Residents are encouraged to live active and useful lives. Each resident has a full activity programme of twenty sessions per week, combining life skills with leisure activities. Since the last inspection residents have been gardening, volunteering in the local community, and doing basic skills, and crafts in the home. There have been two holidays abroad and three in Norfolk. There are frequent trips out in the home’s minibus so residents can shop, or go to the cinema or bowling. Walks in the countryside are also popular with residents. The Manager said that activities are run on a one to one or small group basis as this suits the resident group. One of the care managers said ‘Our goal is to get as many residents as possible out and about each day.’ Residents said they were happy with this approach and their comments included ‘I like it here because I get to go out’, ‘There’s so much to do here that I never get bored’, and ‘I get to go out here – that’s the best thing about this place.’ The activity programme is commended.
Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 11 Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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): EVIDENCE: These Standards were inspected at the last inspection on 5.04.05. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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, 23 There is a user-friendly complaints procedure for residents and their representatives to follow. Good systems are in place to protect residents from abuse and staff are knowledgeable about these. EVIDENCE: There is a standard complaints procedure in the service user guide and this is made available to residents and their representatives. If necessary, the home’s speech and language therapist can translate the procedure into symbols for residents who are unable to read the written word. Residents are encouraged to tell a member of staff if there is anything they are not happy about. Each resident has a named nurse and a carer they can approach. Alternatively they can talk to any other member of staff including the Manager and the Responsible Individual (RI). All residents can use the home’s phones free for 45 minutes per week, and this is another way they can raise concerns as either the Manager or the RI are always on call. Residents’ comments included: ‘If I wasn’t happy about anything I’d just tell a member of staff.’ ‘If I didn’t like the food I’d go and tell the cook. ‘I’d tell the staff if I saw someone being shouted at.’ ‘Ian and Clark (the Manager and the RI) are all right – I can talk to them. They have time for me and I’d tell them if there was anything wrong.’ Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 14 Staff are knowledgeable about adult protection and the home has all the required policies and procedures in place. In-house training on this subject is also provided to all staff, including ancillary staff. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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 the following standard(s): 24, 30 The premises are of a high standard and well decorated and furnished. All areas inspected were clean and tidy. EVIDENCE: The home, a converted former manor house, is situated on the outskirts of the village of Roade in a rural setting. It is decorated and furnished to a high standard and provides an environment that is both spacious and homely. Residents comments about the accommodation included, ‘My room is the biggest and best I’ve every had’, and ‘I can’t believe I’m living in such a fantastic place.’ The home is situated in extensive grounds including a secure garden, which is accessed via the conservatory. The premises are commended. Since the last inspection a number of improvements have been carried out to the home including the creation of a new training kitchen for residents, a pebble oasis in the garden, and a self-contained flat that enables one resident to live more independently. Ongoing decoration and other improvements to the building have also been carried out. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 16 A cleaner is employed five days a week and the carpets are professionally cleaned every two months. Residents are encouraged to help with the cleaning, assisted by staff, as this is part of their daily living skills programme. All areas of the home inspected were clean and tidy. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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 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, 34, 35 The staff team are mostly qualified and experienced. Good recruitment procedures are in place. Staff receive a range of training opportunities. EVIDENCE: The home employs qualified nurses, care workers, and ancillary staff. Staff turnover is low. The Manager said 60 of the staff had previous experience working with residents with acquired brain injury. The home is run on a social rather than a behavioural model, and staff are expected to share the home’s ethos of giving residents as much choice as possible. Staffing levels are high and exceed the recommended minimum set out by the Residential Forum. Residents’ comments included ‘The staff are friendly and you can have a laugh with them’, and ‘The staff know what they’re doing and give me good advice.’ The staff team are commended. The Manager said staff tend to be recruited by word of mouth. Staff must have CRB and POVA checks and two written references before they start work. The home has its own training group headed by the RI and including members of staff with particular experience in staff training. Most training provided inhouse with external accreditation. Courses include first aid, health and safety, COSHH, POVA, and food hygiene. New staff undertake a comprehensive induction that helps to identify their future training needs.
Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 18 Nursing staff are supervised by the Manager and the RI, and carers are supervised by the nursing staff. Opportunities are available for external supervision if a member of staff requests it. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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 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, 43 The Manager and the Responsible Individual, who are experienced health care professionals, run the home in the best interests of the residents. Residents’ views are actively sought and responded to. Good policies and procedures are in place to promote and protect the health and safety of staff and residents. EVIDENCE: The Manager is a qualified learning disability nurse with a current pin number He has 12 years nursing experience. For the past five years he has specialized in the care of young adults with acquired brain injury. Both he and the Responsible Individual (who is a qualified mental health nurse) work full-time in the home and liaise with residents and staff on a daily basis. The Manager said ‘Both Clark (the RI) and myself spend a lot of time talking to residents and finding out what they want from this service. We encourage them to make suggestions about how to improve the home. It was the residents who instigated getting the dog, building rockeries in the garden, and
Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 20 having more trips out. If they have a good idea for something to improve the home we try and follow it through.’ This is commended. The home has an annual quality assurance questionnaire for residents. This is user-friendly and covers areas such as the premises, food, and care. Residents either fill it in on their own of with assistance from staff or their relatives or representatives. The residents’ group is now established. It meets monthly, facilitated by two designated members of staff. Attendance averages 50 of the resident group. Minutes are kept. The Manager said requests from different dishes at mealtimes, and for more trips out, have been made via the group. These have been actioned. A link is being set up with a Cambridge advocacy service, which employs staff who are experienced in working with people with acquired brain injuries. Staff at Hilltop have already identified two residents who they feel might benefit from this service. The RI oversees health and safety in the home. Records showed that good policies and procedures are in place, and ongoing improvements carried out. Contractors and the home’s handyman, who is a qualified electrician, carry out routine repairs and servicing. Both the Environmental Health Officer and the Fire Department have carried out satisfactory inspections of the home this year. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 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 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 4 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 4 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Hilltop House Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X 4 X X 3 X DS0000063092.V263565.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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. 1 Refer to Standard YA14 Good Practice Recommendations It is recommended that consideration be given to acquiring a full-size pool table. Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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. Extracts may not be used or reproduced without the express permission of CSCI Hilltop House DS0000063092.V263565.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
