Inspection on 23/01/07 for Hillview

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillview 27/08/08

Hillview 15/10/07

Hillview 30/07/06

Hillview 15/11/05

Hillview 19/05/05

Hillview 07/12/04

Hillview 07/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Hillview 17 Collett Road Ware Hertfordshire SG12 7LY Lead Inspector Claire Farrier Unannounced Inspection 23rd January 2007 11:10 X10015.doc Version 1.40 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 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 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 Older People. 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. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillview Address 17 Collett Road Ware Hertfordshire SG12 7LY 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) 01920 469428 01920 469428 FP angelacsi@aol.com www.bmcare.co.uk Colley Care Limited (Trading as B & M Care) Angela Page Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: Hillview is owned and operated by B&M Investments Limited, and is registered to provide personal care and accommodation for up to 36 older people. Hillview is situated in a residential area of Ware, close to the town centre, with easy access to bus and rail services. It is a large house, which has been converted and equipped for use as a residential care home for older people. The accommodation is arranged over three floors and is, with one exception, in single rooms. Seven of the bedrooms have en-suite facilities. There is a passenger lift to all floors and the home is adapted for wheelchair use. There are gardens to the front and rear of the home, with car parking provided at the rear. A wooden decking area has been created at the front of the home, to provide an additional communal sitting area. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges range from £425 to £525 per week. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of this inspection year. Two unannounced random inspections took place on 4th September 2006 and 1st November 2006 to monitor the actions taken after the last key inspection. The findings of these inspections were taken into consideration in writing this report. This unannounced inspection took place over one day. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. The majority of time was spent talking to residents and staff, and discussions were held with the home’s manager. Some time was also spent in the office looking at records, care plans and staff files, and the inspector made a tour of the premises. 12 residents and one GP completed CSCI surveys about the quality of care provided in the home. What the service does well: What has improved since the last inspection? At the random inspection in September 2006 three requirements were assessed as met, and three as partially met. Evidence was seen that the care plans had been reviewed and updated where necessary. In November 2006 nine requirements were assessed as met, and one as been partially met. The serious concerns that had affected the health and safety of the residents have been addressed. Immediate action was taken to ensure that there was no risk from fire in the home due to doors being held open. The hot water temperatures are now monitored regularly. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 6 The temperatures of the medication storage cupboard and of the medication room where the medication trolley is stored are recorded every day and a procedure for medication for respite clients is now in place. The number of residents has increased since the last inspection, and the referrals from Social Services have increased. The home sent questionnaires to all residents and their families in December 2006 to ask their views on the quality of care provided by the home. The company provided some professional support for the manager, and she has more confidence in taking the necessary actions to monitor the environment and the services provided in the home What they could do better: Although the manager and the company have worked hard to make improvements in the home, some of the requirements made in the last inspection report have not been completely met. The hot water temperatures are now monitored regularly, but not accurately, and the bath water in one bath was observed to be over 50°C. Medication storage temperatures are not fully monitored, and some errors were seen in the way medication is stored, administered and recorded. The staff files contain satisfactory evidence of the fitness of the person to work in the home, but one did not have a current visa to allow the person to work in this country. It was reported that the proprietors make regular monitoring visits, but their reports are not in the home and have not been sent to CSCI as required. The induction training package does not meet the Skills for Care standards. Two aspects that affect the quality of life and care services in the home have deteriorated since the last inspection. There was no evidence of a programme of activities in the home or of engagement with the local community. It was reported that an activities organiser is being recruited, but at the time of this inspection the provision of activities was poor. Staff numbers in the home have been reduced and may not be sufficient to ensure that all the residents’ needs are met. There was no risk assessment for a resident who uses a hot water bottle. Medication is not administered in a way that respects the residents’ privacy and dignity. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not relevant for this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the residents was seen to be in place. The home has sufficient information on residents’ needs and access to appropriate services to enable the needs to be met. EVIDENCE: The care records of three residents were inspected and there was evidence of a pre-admission assessment of needs being carried out in each case. The manager or deputy manager carries out an assessment in the resident’s home, or in hospital if they are there. They gain as much information as possible, including any health and nursing needs. The assessment includes a comprehensive checklist covering all their personal care and health care needs, and a questionnaire for the resident or their relative to provide fuller details. The checklist is reviewed when the person is admitted to the home, and the care plan is written using the information in the assessment. Evidence was seen that admission has been refused when the home cannot meet a person’s Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 10 assessed needs, for example when a diagnosis of dementia may be discovered during the assessment. At the random inspection in November 2006 it was reported that two residents have moved to a nursing home as their needs changed; they had both made their own decision to move. There were 29 residents in the home at the time of this inspection, and four residents were in hospital. The number of residents has increased since the last inspection, and the referrals from Social Services have increased. The Statement of Purpose and Service Users Guide have been revised since the last inspection. They provide clearly written information on the home and the staff. The Service Users Guide includes some information about Ware, and details of some local community facilities and services. It is available in large print if required. Almost all the residents who completed surveys for this inspection confirmed that they received enough information about this home before they moved in so they could decide if it was the right place for them. One said that a needs assessment was carried out prior to an offer of a place being given. All the residents spoken to are happy in the home, and feel confident that the staff can meet their needs. One person had respite stays in two other homes before moving into Hillview, and she considers that Hillview is definitely better and cosier than the others. The staff have the experience and training to meet the assessed needs of the residents, and the care plans provide them with appropriate information. Any special needs are detailed in the care plans, for example diabetes and visual impairment. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ needs are clearly recorded in their care plans. These provide the staff with the information they need in order to provide a good quality of personal care and health care. The residents said that staff treat them with respect. The policies and practice in the home generally promote privacy and dignity for the residents, but medication is not administered in a way that protects privacy. The home has adequate procedures for administering and recording medication safely. However there are some lapses in administering medication as prescribed, and in storing it appropriately. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 12 EVIDENCE: Detailed case tracking was carried out through the files of three residents. During the random inspection in September 2006 evidence was seen that the care plans had been reviewed and updated where necessary. The care plans contain clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. They include a family history and background, and significant life events. These give a picture of the whole person, and provide the staff with useful information on their past as well as their current needs. There is a separate night care plan for each resident, and the night staff record two hourly checks on each person. There is a moving and handling assessment for each resident, and appropriate risk assessments, including assessments for the risk of falls. The risk assessment for falls for one person stated that she needs one person to assist her when walking. This resident confirmed that she is aware of her care plan and the risk assessment, and there are always staff available to assist her when she wants to move between rooms. However there was no risk assessment for one resident for the use of a hot water bottle. A waiver has been signed by the resident’s relative, as this person likes to have a hot water bottle. This is not sufficient as a measure to minimise any risk of injury that may occur. The residents spoken to said that they receive a good quality of care in the home, and the staff treat them well. The staff were observed to have a good relationship with the residents and to treat them with a friendly respect. They have time to talk to them and to provide the care they need without rushing. One GP returned a questionnaire for this inspection, and stated, “(The home) looks after patients/clients well and calls in the doctor appropriately.” However while administering medication a senior care worker shouted across the dining room to ask a resident of they would like their heart burn medication (Gaviscon) today. Another resident was given her eye drops while at the table in the dining room. These approaches do not respect the residents’ dignity and privacy. Almost all the residents who returned surveys for this inspection responded that the residents always or usually receive the care and support they need. However one relative stated that a resident had not had a bath for 2½ weeks, and when it was asked for it did not happen. One resident stated “Sometimes I feel I have been forgotten.” Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 13 The storage of medication was checked during the random inspections in September and November 2006. The temperatures of the medication storage cupboard and of the medication room where the medication trolley is stored are now recorded every day, and are satisfactory. An extractor fan has been fitted to the medication storage cupboard, with a switch that operates when the temperature rises. In November some bottles of lactulose were seen that should be stored below 20°C, and the pharmacist has now been requested to supply only lactulose with a maximum storage temperature of 25°C in order to avoid the risk of deterioration from too high a heat. A procedure for medication for respite clients is now in place. The home has not admitted anyone for respite since the last inspection. On this occasion the lunchtime medication round was observed. The senior staff who administer the medication have been trained in the home’s procedures. The procedures that were observed were generally satisfactory. However the MAR (medication administration record) charts were signed before the medications were administered. The signature should be a record that the member of staff has observed that the medications have been taken, and should therefore be signed after administration. There was one gap seen on a MAR chart when the medication administered from a blister pack had not been signed for, and no explanation for the omission was recorded. Several residents have been prescribed amoxicillin due to chest infections. The details on the bottles state, “Take this medicine at regular intervals.” However this information has not been transferred to the MAR charts, and this antibiotic is given to the residents at breakfast, lunch and tea. This is at intervals of at most 4 hours, with a 12 hour gap overnight. Antibiotics should be given every 8 hours in order to be fully effective. The MAR chart for an inhaler for one resident stated that it should be given twice a day, but the MAR chart has been signed as administered three times a day. The refrigerator in the medication cupboard contained several medications that need not be refrigerated. In one case the package was marked “Do not refrigerate. One person who looks after their own medication stated that they were without a medication for three days because it had not been re-ordered. In the controlled drugs (CD) cupboard there were two supplies of diazepam for one resident, one in a blister pack and one in a bottle. The CD register was completed properly, and the amount recorded tallied with the stocks, but the supplies that are not needed should be returned to the pharmacist. Diazepam is not required to be stored and recorded as a controlled drug. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Families and friends are welcomed into the home, and family members are consulted about the resident’s care. Wholesome and varied meals are provided within the home, offering a well-balanced and nutritious diet for the residents. There was no evidence of any activities within the home. EVIDENCE: Since the last inspection there is no longer an activities organiser in post, and there was no evidence of a programme of activities in the home or of engagement with the local community. It was reported that people come to the home occasionally to provide activities such as flower arranging and making Easter cards, but no evidence was seen of this. During the morning the staff led a session of armchair exercises with the residents in the main lounge, with a lot of interaction and encouragement. It was evident that the staff have the time to interact with the residents and they spend time with them, in small groups and individually. However there are no proactive measures in place to enable the residents to engage in activities of their choice in the home and the community. The residents’ surveys that were completed for this inspection stated that there are always or usually activities arranged by the home that they can take part in. The action plan following the home’s own quality Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 15 assurance survey of residents and relatives highlighted the need for an improvement in activities, and the manager is actively recruiting an activities organiser. Two visitors were spoken to during the random inspection in November 2006, relatives of a resident who was celebrating her 91st birthday on that day. They said that friends and relatives are welcomed in the home. The residents can choose whether they wish to look after their own financial affairs, but in practice their families handle their affairs for them. Information on advocacy services is available in the home. All the residents spoken to said that the food is very good. There is a four week rolling menu that provides a nutritious diet for the residents. The cook was spoken to in November 2006. She was making arrangements for Christmas. She said that she monitors what the residents are eating, and she knows their likes and dislikes. Lunch was observed on this occasion. The food looked appetising, and there was a sociable atmosphere. The lunch was served plated to the residents, and extra gravy was offered to those who wished. Individual drinks were poured from one table and taken to the residents. Consideration could be given to providing jugs of drink and gravy, and possibly dishes of vegetables, on the tables so that the residents who are able to do so can serve themselves. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive complaints procedure in place, and residents and their relatives are confident that any complaints will be properly investigated. All staff have appropriate training on prevention of abuse, and robust polices and procedures are in place to ensure that the residents are protected. EVIDENCE: The home has an adequatete complaints procedure. The complaints folder was seen, and there is an appropriate format for recording complaints. One complaint was received by the home since the last inspection, concerning the doors to the lounges being closed as a result of the last inspection. This was notified to CSCI. It was recorded properly, and a full response was sent to the complainant. The residents who completed surveys for this inspection stated that they know who to speak to if they are unhappy, and they know how to make a complaint. Some said that a relative would speak for them. One relative said that resident did not want her to complain. Training in the prevention of abuse has been arranged for all the staff in the home during the week following this inspection. The staff spoken to are aware of the home’s procedures and of the whistle blowing policy. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home and gardens are well maintained and provide a comfortable and attractive environment for the residents. Individual and communal facilities are generally appropriate for the residents’ needs. Water temperatures must be monitored effectively in order to ensure that there is no risk of scalding to the residents. EVIDENCE: Hillview is a large house, which has been converted for use as a residential care home for older people. It is situated close the centre of the Ware. The decorations and furnishings in the home are domestic in style, and provide a homely and comfortable environment. There are gardens to the front and rear of the home, and a wooden decking area has been created at the front of the home, to provide an additional communal sitting area. The home appeared to be clean in all areas, and hoists are no longer stored in corridors. The home has satisfactory procedures for handling and washing laundry in order to prevent the spread of infection. The residents’ surveys for this inspection Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 18 showed that the residents are generally satisfied with cleanliness in the home. One person stated, “The home is always clean. Improvements to this elderly building are being made to the benefit of its freshness.” At the random inspection in September 2006 it was observed that the doors of bedrooms on all three floors, the kitchen, laundry, two lounges, dining room and the office were held open by a variety of means, including wedges, doorstops and items of furniture. One corridor fire door was held open with a wedge, and one fire door had a damaged mechanism due to artificial means being used to hold it open. A metal plate was screwed to the floor in one room holding the door permanently open. One resident was asleep in their room, but was unable to close the door for privacy. The doors of the lounges, dining room and kitchen were closed immediately, and an immediate requirement was left that the fire authority must be consulted concerning adequate precautions against the risk of fire. Immediate action was taken to ensure that there was no risk from fire in the home due to doors being held open. The doors to all rooms were closed during the inspection, and remained closed until alarm activated door closures and magnetic closures were fitted. The relative of one resident made a complaint to the home about the restrictions that this caused, and the company made a full response. A further random inspection took place in November 2006. On this occasion all bedroom doors were seen to be closed. Automatic door closers were fitted to the bedroom doors of residents who like to have their doors open. Residents who wish to rest in their rooms are now able to close their doors and maintain their privacy. The fire service made an inspection of the home in November 2006 at the request of the manager. The fire officer was generally satisfied with the measures taken to improve fire safety in the home, but made a requirement that some of the doors must be repaired to ensure fire safety. In November it was reported that there are plans to convert the bathroom on the top floor into a sluice room, and it was then used for storing commodes, with commode pots being soaked in the bath. Removing this bathroom from use would mean that there are only three bathrooms in the home. The minimum standard for the number of bathrooms is one for each eight residents. On this occasion it was observed that the bathroom is no longer used as a sluice. It was reported that there are plans to change on of the toilets into a sluice room, and to put an additional bathroom as an ensuite in the large double bedroom. There is an efficient system for reporting any maintenance or repairs that are needed, and the records show that action is taken without delay. The hot water temperatures are now monitored regularly. However the records show temperatures of 22°C to 30°C, which is very cool. It is possible that the temperatures are not measured correctly. During a tour of the premises some water temperatures were tested. The bath water in one bathroom measured over 50°C on the home’s thermometer. It was also very hot in the washbasin in that bathroom and in the neighbouring toilet. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff numbers in the home have been reduced and may not be sufficient to ensure that all the residents’ needs are met. Training in essential skills is available for the staff, and they are encouraged to take NVQ qualifications. The induction training does not meet the standards set by Skills for Care. The recruitment procedures make sure that, as far as possible, the residents are supported and protected in the home, but there are some gaps in the information that is required to be kept. EVIDENCE: At the random inspection in November 2006 the staff rota showed that staff no longer work extended hours. It was reported that staff hours have been reduced due to the low number of residents currently in the home, and that overtime has been cut. The rota for the current week showed four care staff on duty in the morning and three in the afternoon. There were two night staff. No member of staff was recorded as working over 48 hours. This reduction in long working hours has been maintained, but there are now fewer staff working in the home, although the number of residents has increased to 29. On the day of this inspection there were three carers on duty in the morning and two in the afternoon. The list of staff currently employed in the home that was supplied prior to the inspection listed a complement of only 7 care assistants, 6 senior care assistants, 1 bank care assistant and 1 night care assistant. However no temporary agency staff were employed in the home. There was no evidence Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 20 that the needs of the residents are not being met by this low number of staff. All the residents who returned surveys for this inspection responded that the staff are always or usually available when they are needed. Almost all the questionnaires stated that the residents always or usually receive the care and support they need. However one relative stated that a resident had not had a bath for 2½ weeks, and when it was asked for it did not happen. One resident stated “Sometimes I feel I have been forgotten.” The staff spoken to said that regular training is available for them, and they are encouraged to take NVQ qualifications. A training matrix is maintained on the computer, which shows that there is a programme for all the staff to complete the mandatory health and safety training, and when updates are due. Six staff have now completed NVQ qualifications. During the last key inspection it was reported that the senior staff do not have time to provide induction training for new members of staff. The manager had obtained the Skills for Care induction training standards in November 2006, but no measures have been taken to implement them. Three staff files were inspected. They all contained all the required information to show that the home operates a thorough recruitment procedure. This includes references, evidence of identity, and a satisfactory CRB (Criminal Record Bureau) disclosure. However for one person was working on student visa which had expired. There was no evidence that the visa had been renewed. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Appropriate records are maintained for the effective management of the home and monitoring of health and safety procedures, and procedures are in place to ensure that the personal money of the residents is looked after and recorded appropriately. The practices in some areas must be tightened up to ensure that there is no risk to the health and safety of the residents. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager was registered as manager of Hillview in February 2005. She has completed the Registered Managers Award qualification. The company provided some professional support for the manager, and she has more confidence in taking the necessary actions to monitor the environment and the services provided in the home, and several improvements have been seen since the last key inspection. For example she has put forward plans to improve the number of bathrooms and showers available for the residents. Questionnaires were sent to all residents and their families in December 2006 to ask their views on the quality of care provided by the home. The report of this survey includes an analysis of the responses and complimentary quotes from the responses. The action plan following this survey highlighted the need for an improvement in activities, and the manager is actively recruiting an activities organiser. (See Daily Life and Social Activities.) The number of residents has increased since the last inspection, and the referrals from Social Services have increased. Following the last key inspection, some reports of the proprietor’s monthly monitoring visits to the home were sent to CSCI as required. However the last report received was for October 2006, and there is no evidence in the home that any monitoring visit has taken place since then. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Following the last inspection immediate action was taken to ensure that there was no risk from fire in the home due to doors being held open. The doors to all rooms were closed immediately, and remained closed until alarm activated door closures and magnetic closures were fitted. The fire service made an inspection of the home in November 2006 at the request of the manager. Water temperatures are now recorded regularly, and they are monitored to ensure that they remain at a safe level. However the recording is not accurate, and some temperatures remain high (see Environment). Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 13(4) (c ) Requirement There was no risk assessment for one resident for the use of a hot water bottle. Appropriate and adequate risk assessments must be put in place for all residents for situations in which there is any risk of harm or injury to themselves or others. Medication was signed for before being administered, and there was an unexplained gap on a MAR chart. Medications were not administered or stored according to the prescription and the manufacturer’s and pharmacist’s instructions. All medication must be stored, administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. Timescale for action 31/03/07 2. OP9 13(2) 31/03/07 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 25 3. OP10 12(4)(a) Residents are not treated with respect to their dignity and privacy during the administration of medication. The registered person must ensure that the care staff understand the need to treat residents with respect at all times. There was no evidence of a programme of activities in the home or of engagement with the local community. The registered person must ensure that a programme of activities is implemented in consultation with the service users. The water temperature in the one bathroom was above the recommended level to prevent a risk of scalding. Measures must be put in place to safeguard the residents from the risks of scalding. In particular: 1. All hot water temperatures in bathrooms, toilets and bedrooms must be regulated to a safe temperature, close to 43ºC. 2. All hot water temperatures in bathrooms, toilets and bedrooms must be regularly and effectively monitored and recorded. Previous timescale of 01/08/06 met in part. 31/03/07 4. OP12 OP13 16(2)(m) &(n) 31/03/07 5. OP25 OP38 13(4) 31/03/07 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 26 6. OP27 18(i)(a) Staff numbers in the home have been reduced and may not be sufficient to ensure that all the residents’ needs are met. The registered person must ensure that sufficient staff are employed in the home at all times to meet the needs of the residents. One staff file did not contain satisfactory evidence of the fitness of the person to work in the home, in particular a current visa. All the required information on staff, as listed in Schedule 2 and Schedule 4(6) of the regulations, must be kept in the home, including evidence of their entitlement to work. The induction training does not meet the standards set by Skills for Care. The registered person must ensure that all new members of staff complete a comprehensive induction training programme that meets the Skills for Care requirements. Previous timescale of 31/01/07 not met. 31/03/07 7. OP29 19(5)(d) 31/03/07 8. OP30 18(1)(c) (i) 31/03/07 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 27 9. OP33 26 The reports of the proprietor’s 31/03/07 monthly monitoring visits have not been sent the home or to the Commission since October 2006. The proprietor must make monthly monitoring visits to the home that focus on the provision of care and include the views of residents and staff. The reports of the visit must reflect this focus and a copy of the report must be sent to CSCI. Previous timescale of 30/11/06 met in part. 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 OP15 Good Practice Recommendations It is recommended that consideration is given to providing jugs of drink and gravy, and possibly dishes of vegetables, on the tables so that the residents who are able to do so can serve themselves. Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Hillview DS0000019430.V330285.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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