Inspection on 05/04/05 for Hilltop House

This inspection was carried out on 5th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hilltop House 22/01/09

Hilltop House 10/10/06

Hilltop House 01/12/05

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

CARE HOME ADULTS 18-65 Hilltop House Ashton Road Hartwell Northamptonshire NN7 2EY Lead Inspector Kim Cowley Announced 5 April 2005 10:00 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 House Version 1.10 Page 3 SERVICE INFORMATION Name of service Hilltop House Address Ashton Road Hartwell Northamptonshire NN7 2EY 01604 864466 01604 864466 oakleafcare.hartwell@tiscali.co.uk Oakleaf Care (Hartwell) Ltd 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) Ian Moseley Care Home with Nursing 9 Category(ies) of Mental Disorder (9) registration, with number Physical Disability (3) of places Hilltop House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: *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 accommodated. *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 NA 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 vilage of Hartwell in rural Northamptonshire. It provide personal care and nursing for up to nine younger adults and includes three places for service users who have physical disbilities in addition to acquired brain injury and associated disoders. Accomodation 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 summer house, lawns and paddocks, and a secure garden area. Hilltop House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection which took place on a weekday at 10am. The inspector met all three of the residents who currently live in the home, and talked to one of them. The inspector also spoke to the Manager, the Responsible Individual, a senior nurse, and the cook. The premises were toured and one resident allowed the inspector to see his bedroom. Care, medication, and other records were inspected. He home was commended in nine areas. This is exceptional for any care home and a clear indication of the high quality service the home provides. What the service does well: The home’s has a good quality, detailed information pack. It includes a summary aimed at residents and their families/friends. There is also a full colour brochure with photographs of the home and its surroundings. The information provided makes it clear who the home is suitable for. Residents and their families are encouraged to visit the home prior to admission and to spend time there to see if they like it. All but one of the current residents visited the home twice prior to moving in, and their families also visited. Residents have a thorough assessment before moving in. Staff talk to residents, their family/friends (where relevant), and health and social care professionals when completing this. Care plans were inspected and found to contain many example of good practice, particularly regarding residents being offered choice. For example one resident was encouraged to drink more liquids after being taken to the soft drinks aisle in a supermarket and invited to choose a range of drinks to try. Two of the current residents have been able to sign their care plans to show they agree with them. The home provides varied activities. Each resident has their own individual programme. Current activities include gardening, swimming (residents have access to a private swimming pool), shopping, playing pool, and walking. Therapuetic activities include orientation, physiotherapy, and daily living skills. Residents’ meetings are held monthly. Residents have appetising and healthy food. The home employs a full-time cook who previously worked in a local restaurant. On the day of inspection lunch was braised steak, creamed potatoes and mixed vegetables, or prawn Hilltop House Version 1.10 Page 6 salad. Dessert was apple pie and custard, fruit yogurt or fresh fruit. Residents and staff eat together at mealtimes. The home has excellent support from health care professionals. A GP, DN, consultant, physiotherapist, speech and language therapist, and a social worker provide private care to residents. Medication is well managed with support from the home’s contract pharmacist. The home is well-staffed. At there are four to five members of staff on duty during the day and two to three waking members of staff on duty at night (for three residents). The staff are well-qualified and experienced. All those interviewed were knowledgeable about the care of people with acquired brain injury, and committed to encouraging residents to make choices and gain independence. One member of staff said ‘Our current residents have previously been in hospital settings. Now they are living in the community we need to help them to build up their confidence so they can make choices and determine their own lifestyles.’ The inspector talked to one resident. He said he was happy at the home and was satisfied with everything about it. Three relatives/friends filled in survey forms to say they were also satisfied with Hilltop House. 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. Hilltop House Version 1.10 Page 7 The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hilltop House Version 1.10 Page 8 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 House Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 - 5 The home’s information pack (which include the Statement of Purpose/Service Users’ Guide) is of good quality and is tailored to meet the needs of residents, families/friends, and health and social care professionals. Prospective residents are thoroughly assessed following consultation with all involved in their care. The information pack is clear about what type of resident the home caters for, and staff will elaborate on this if necessary. Potential residents and their families/friends/professional carers are actively encouraged to visit the home. All residents are given a copy of the home’s Terms and Conditions prior to admission. EVIDENCE: The Owning Body has produced an information pack for residents, families/friends, and health and social care professionals. This includes a colour brochure with photographs of the premises and surroundings. The Statement of Purpose/Service Users’ Guide is available in full, or in a more user-friendly summary form, depending on who is requesting it. A website for the home is currently being developed. Hilltop House Version 1.10 Page 10 All current residents had a copy of the brochure and the user-friendly version of the Statement of Purpose/ Service Users’ Guide prior to admission. The Owner said ‘We tailor the information sent out to suit who is going to read it. If a resident needs the information in a different format, for example in Makaton, or in a language other than English, then we can supply this.’ All residents are assessed prior to admission. Staff use the home’s purposedesigned assessment pack and visit residents in their homes or in hospital. Before carrying out the assessment staff explain to residents who they are and what Hilltop House provides. The assessment form is then completed following consultations with the resident, their friends/families, and any health and social care professionals involved. Information about the home makes it clear that it is suitable for residents requiring long-term care who have normally been through a period of rehabilitation prior to admission. The home does not accommodate residents with Huntingdon’s Chorea or Korsakoff’s Syndrome. All residents are encouraged to visit the home prior to admission. Of the three residents currently accommodated, one spent two full days at the home prior to moving in. Another spent two days at the home and his family visited twice. The third did not visit prior to admission, although his family visited twice. All residents have a 12 weeks trial period following admission to ensure the home is suitable for them. The home’s Terms and Conditions are included in the introductory information. All residents and/or their funders have individual written contracts. Hilltop House Version 1.10 Page 11 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 - 10 Care plans are of a good standard, are individual to each resident, and regularly reviewed. Residents are able to take responsible risks following consultation with all those involved in their care. Resident records are kept securely in accordance with the Data Protection Act 1998. EVIDENCE: Care plans are initially based on the results of the assessment carried out when a resident first moves into the home (see ‘Choice of Home’). Each resident is allocated a named nurse and a named care worker. These staff oversee their care and are responsible for drawing up care plans and risk assessments. The Manager said this approach enables staff to employ the best practice from both health and social care to assist residents. Care plans are discussed with the resident. Two of the current residents have signed their care plans to show they agree with them. The third has had his Hilltop House Version 1.10 Page 12 signed by a relative, as it is not clear at present if he has the capacity to sign it himself. The home has a policy that care plans must be reviewed at least every 12 weeks. However the Manager said that if significant change occurs then the review will be brought forward. Records showed that this is the case. One resident, who had been in the home for eight weeks, had already had his care plans reviewed twice. Care plans were inspected and showed that all the current residents have made some progress since being in the home. They contained many example of good practice, particularly regarding residents being offered choice. For example: • One resident who was reluctant to drink liquids was taken to the soft drinks aisle in a supermarket and encouraged to choose a range of drinks that he would like to try. As a result he discovered some favourites and no longer has a problem with dehydration. One resident who had difficulty walking, but enjoys this activity, was given physiotherapy (the home has its own physiotherapist) and has increased the distance he can walk to the extent that he can now go for walks in the countryside. One resident has increased his independence skills since being in the home and has started to take responsibility for his own cleaning and laundry • • Daily records include a minimum of three entries every 24 hours. They are completed by nurses or care workers (nurses countersign those records made by care workers). Staff also use a Communication Book to alert each other to any incidents or changes to resident care. Daily records can be crossreferenced with care plans via a number system in the margins. Residents at Hilltop House are particularly vulnerable to risk due to the nature of their condition. In response to this staff have put in place detailed risk assessments. These were drawn up following consultation with residents, the health and social care personnel that support them, and, where relevant, their families/friends. Those inspected showed a range of potential risks being explored and decisions made about the level of risk in each area. Risk assessments are reviewed at least every six months and following any relevant incident. Residents’ case files are kept in the locked nursing office. The home has an ‘Access to files’ policy for residents, and guidelines for staff to follow should a resident wish to view their files. Archive documents are kept in the homes offices, which are separate for resident accommodation. Hilltop House Version 1.10 Page 13 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) 11 - 17 Residents are offered a broad range of leisure and educational activities. Each resident has a varied programme of activities that is individual to them. Facilities for visitors are good. The ‘Visitor’s Policy’ needs to be slightly amended. See Recommendtion 1. Staff are building links with local residents and enabling residents to access community facilities. EVIDENCE: Two staff have been given responsibility for co-ordinating activities in the home. Each resident has an individual programme of activities which is recorded. At present one of more activiites is scheduled for each resident every morning and afternoon on weekdays. Weekends are more relaxed with structured activities kept to a minimum. Hilltop House Version 1.10 Page 14 Current activities include gardening, swimming (residents have access to a private swimming pool), shopping, pool, and walking. Therapuetic activities include orientation, physiotherapy, and daily living skills. Staff are looking into opportunities for residents to attend local colleges and day centres. Newspapers are delivered to the home every day and residents are encouraged to discuss the reports in them. One resident has taken a particular interest in gardening and is looking after the home’s tomato plants. Staff and residents are building links with the local community. Regular visits have been made to the local pub and shops. Some of the staff employed in the home live in the local village. Staff have visited local leisure and activity centres and taken photos and collected leaflets. These have been put in a scrapbook for residents to look at. Resident meetings have already been introduced. Two members of staff have been given responsibility for facilitating these. They take place on a monthly basis with minutes taken. Initial meetings have been attended by two of the three residents and have focussed on menus and activities. The home has visitors lounge or visitors see residents in their rooms. The ‘Visitors Policy’ currently states ‘All visitors should, where possible, be prearranged and agreed with senior staff with a minimum of 48hrs notice given.’ This should be amended to explain why this (ie because residents may be out on pre-booked activities and/or the visitors room might already be booked). The home employs a full-time cook who works from 9am to 3pm from Tuesday to Friday, and on Sunday. On other days care staff serve food the cook has previously prepared. The cook, who previously worked in a local restaurant, has a good knowledge of suppliers in the area. Provisions are purchased from local shops and outlets, for example eggs come from a local farm. All staff who work in the kitchen have their Basic Food Hygiene certificate. Breakfast is served from 8.30 to 9.30. A cooked breakfast is served twice a week. Lunch, the main meal of the day, is served from 12.30 to 13.30. Tea is from 17.15 to 18.15, and supper is served on request. Tea is either cooked or cold. On the day of inspection lunch was served and consisted of braised steak, creamed potatoes, and mixed vegetables or prawn salad. Dessert was apple pie and custard, fruit yogurt, or fresh fruit. Menus are planned six weeks in advance, although the cook said these are flexible. There is a ‘wish list’ in the dining room where residents can record the dishes they would like to try that are not already on the menu. The majority of food served is home cooked. At present there are no vegetarians of residents on special diets. Hilltop House Version 1.10 Page 15 Residents and staff eat together at mealtimes. The Manager said this arrangement promotes social interaction and has the additional benefit of staff acting as role models for residents who wish to improve their social skills. Residents are weighed weekly and their food intake is monitored to ensure their diet is effective. Hilltop House Version 1.10 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 Personal care needs are identified in care plans and sensitively met by staff. Residents receive holistic care from a range of health and social care professionals employed by the home. Medication is safely stored and administered following the relevant guidelines. EVIDENCE: One resident needs help with his personal care. The other two are independent by need prompting. All resident have their own ensuite facilities. Residents are encouraged to do their own laundry. The home has one industrial and one domestic washing machine, the latter being for residents to operate themselves. All residents have laundry baskets in their rooms and they are expected to use these with support from staff where necessary. The home has its own GP service. Their GP, who has experience of caring for people with acquired brain injury, visits when required or residents can go to his surgery, which is a 20 minutes drive away. A District Nurse is attached to the GP’s surgery and provides care and advice where necessary All residents have an annual health check carried out by their GP. Hilltop House Version 1.10 Page 17 The home also has its own consultant, physiotherapist, a speech and language therapist, and a social worker. All these professionals have experience of working with people with acquired brain injury and the consultant is a specialist in this field. Dental services are accessed via a local hospital where staff have experience of working with younger adults with disabilities. Hearing services are accessed via the home’s GP. Staff are currently arranging for an optician to come to the home. The GP service has its own dispensary and medication is supplied from there. The home’s medication room is well organised and secure. Only nurses administer medication. The Manager said that if any new medication procedures are introduced the pharmacist or the relevant drug company provide staff training. The home’s contract pharmacist is responsible for inspecting the home’s arrangements for medication storage and administration. Those medication records inspected were clear and accurate with no missing signatures. The Manager said he checks medication records weekly to ensure they are filled in correctly and correspond to the medication in storage. At present no residents are self-medicating. An oxygen cylinder is kept. Appropriate signage has been obtained. This is documented in the home’s Fire Risk Assessment and the home’s Fire Officer has been informed. Appropriate signage has been obtained for the locked room where the oxygen in stored. Hilltop House Version 1.10 Page 18 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) EVIDENCE: These Standards will be inspected at the next inspection. Hilltop House Version 1.10 Page 19 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) EVIDENCE: These Standards will be inspected at the next inspection. Hilltop House Version 1.10 Page 20 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 The staff team are experienced, knowledgeable about the resident group, and committed to improving the quality of life of the people they care for. EVIDENCE: At present the home employs six qualified nurses with up to date PIN numbers, 10 care workers, and two ancillary staff. All staff are first aid trained. Approximately 30 of the care workers have NVQ Level 2 or above in care. There are four to five members of staff on duty during the day, and two to three waking members of staff on duty at night. The home’s current staffing hours exceed the recommended minimum set out by the Residential Forum. The Responsible Individual, the Manager, and a senior nurse were all interviewed in depth. All have many years experience in the care of residents with acquired brain injury. In discussion they demonstrated a clear understanding of their roles at the home, an impressive knowledge of the needs of the resident group, and a commitment to residents’ welfare and to improving their quality of life. All staff interviewed spoke of their dedication to encouraging residents to make choices and gain independence. The senior nurse said ‘Our current residents Hilltop House Version 1.10 Page 21 have previously been in hospital settings. Now they are living in the community we need to help them to build up their confidence so they can make choices and determine their own lifestyles. My ideal is to allow residents to develop their own personalities and to express themselves. I like this home because we are able to take a long-term view. Staff understand that residents may not “get better” as such, rather we take a realistic view of their prospects and help them to be self-caring and lead active lives.’ Hilltop House Version 1.10 Page 22 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) EVIDENCE: These Standards will be inspected at the next inspection. Hilltop House Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. 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 4 4 4 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 4 3 4 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score x x 4 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x Hilltop House Version 1.10 Page 24 NA 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 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 15 Good Practice Recommendations It is recommended that the homes Visitors Policy is improved (see main body of report). Hilltop House Version 1.10 Page 25 Commission for Social Care Inspection 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. 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