Inspection on 27/08/08 for Hillview

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Poor service.

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 15/10/07

Hillview 23/01/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Hillview 17 Collett Road Ware Hertfordshire SG12 7LY Lead Inspector Sheila Knopp Unannounced Inspection 27th August 2008 08:05 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.V370541.R02.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.V370541.R02.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 hillview@bmcarehomes.co.uk www.bmcare.co.uk Colley Care Limited (Trading as B & M Care) Manager post vacant Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th October 2007 Brief Description of the Service: Hillview is owned and operated by B&M Investments Limited, which is a private company. The home 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. Copies can be obtained on request from the manager. The current charges (correct on 27/8/08) range from £420.14 for residents funded by Hertfordshire County Council and £525 for people who fund themselves Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We (The Commission for Social Care Inspection) carried out this key unannounced inspection between 08:05 am and 16:45 pm and it took one inspector 8 hours 40 minutes. The timing of the visit enabled us observe how residents spent their day. We talked to 11 (38 ) residents individually and in groups over their breakfast and lunch. To make sure we included the views of people living, working and visiting the home we made survey forms available to 10 residents, 6 care workers and 2 health care professionals who visit people in the home. We received replies from 4 residents and 2 care workers. Their views have been included in this report. We have also reviewed the information we have received about this home and what other people have told us since our last inspection. This includes the annual quality assurance assessment (AQAA) that was sent to us by the manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have also looked at information B&M Care have collected from residents as part of their own review. Hertfordshire County Council are currently carrying out a review of the care, people they are funding are receiving, and have suspended admissions to the home pending the outcome of their enquiries. We looked at the legal requirements we made following our last inspection and found that they have not all been met and we have had to take further action as a result of this visit. The home has had a new manager since our last inspection and this was our first opportunity to meet with Denise Mudie at Hillview. She was supported during this visit by Vickie Maskall who is an independent care consultant acting for the registered provider, B & M. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: We are concerned about B & M’s management approach to this service as our inspections continue to identify problems, which may place people at risk and are not being adequately addressed between our visits. This means we are considering further enforcement action. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 7 Hertfordshire Social Services have placed an embargo on admissions while they carry out reviews of people living in the home they are responsible for. The last meeting under the Safeguarding Adult procedure to look at the progress being made was on 23/7/08 and B & M have provided an action plan to support continued improvements in the home. To protect people using the service information received from other health care professionals, as part of peoples’ admission to the home, needs to be included in the plan of care and risk assessments put in place. This is so staff have clear instructions on any preventative action they need to take and care requirements are regularly reviewed. To protect people there must be clear lines of accountability between the care home staff and community nursing staff. This is to make sure staff in the home have clear guidance for any procedures they have accepted delegated responsibilities for and have been individually trained and assessed by the community nurses concerned as being competent to carry them out. To protect people staff must have access to the prescriber’s instructions for medicines and it is good practice to ensure any handwritten entries on the administration records are verified and signed by two people as being accurate. Accurate records of medicines given to residents must be kept to demonstrate they have been administered safely in line with the prescriber’s instructions. 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.V370541.R02.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.V370541.R02.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): Standards 1, 2, 3, 4 & 5 (standard 6 does not apply to this service)- People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have the information they need to help them make a choice about using the service and will receive a contract setting out the terms and conditions of their stay. People looking to use the service will be involved in an assessment of their needs to make sure the home is suitable. However people may not receive all the care they need if important information from other health care professionals is not included in their care plan following admission. EVIDENCE: To look at how people choose to make Hillview their home and assess whether the staff can meet their needs we reviewed the surveys we received. We spoke with 2 new residents and looked at their care records. Information from visitors to the home and the manager’s self assessment has also been reviewed. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 10 Visitors told us they were impressed with the information and support the manager provided. They said they were encouraged to visit the home to look around at a time convenient for them. This reassured them that there was an open and transparent atmosphere. We also heard the manager talking to someone enquiring about a place for their relative and again they were encouraged to drop in whenever they wanted. All the residents who completed surveys (4) confirmed they had received enough information about the home before they moved in and one person told us their daughter had looked around and someone from the home had visited them in hospital. The two new residents we spoke to were happy with the care and support they were receiving. They had been made to feel welcome and were gaining in independence. Care plans had been put in place detailing the actions required by staff to meet their individual needs. However we found in one case that important health care information in the assessment received before the person moved in had not been included in their care plan. Staff training on the management of specific conditions such as supporting people who have diabetes of Parkinson’s disease has not taken place so staff may not have the skills or confidence they need to support people with complex conditions. These areas are referred to in more detail in the next section of this report on health & personal care. We were able to confirm that people who are funding their own care or supported by the local authority receive a contract setting out the terms and conditions of their stay. Many of the residents we spoke with were from the local area. The recent review of resident’s views by the company said that ‘Residents from Ware liked the fact they had known the home was in Collett Road and they had been able to live somewhere they had known’. Hillview DS0000019430.V370541.R02.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): Standards 7, 8, 9 &10 - People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident that they are getting the help and support they need. However the needs of people with more complex problems may not be sufficiently understood by staff and reflected in their care plans to enable specific problems to be managed safely. People have access to doctors and community health services to support their health needs. However better monitoring of tasks the community nurses have asked the care home staff to do for them needs to be put in place to make sure people are protected because there are clear lines of accountability and staff have received the training they require. People cannot be confident that the staff who are responsible for giving them their medicines are all working to the procedures in place to ensure it is given safely. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 12 EVIDENCE: To look at the care and support people are receiving we observed the interaction during the day between the residents and care staff. We looked specifically at the care four people were receiving by meeting with them and reviewing their care records. We also looked at the areas we had identified for improvement from our last inspection. Everyone we met during our visit had been assisted to achieve a good standard of personal care and hygiene. Three out of 4 residents who completed surveys said they ‘always got the care and support and medical attention they needed. One person said this was ‘usually’ the case. The two visitors we spoke to were also happy with the standards of personal care and support their relative was receiving. Our discussions with people using the service and review of care records told us that staff made sure people had access to the services of dentists, chiropodist and opticians. People moving in from the local area may not all be able to keep their own General Practitioner because of the way two local surgeries allocate their work. A new care planning system, designed to reflect a more person centred approach, so people get the individual care and support they say they would like has been introduced. Individual residents and or their representatives and relatives had signed the records we saw. This shows us people are being involved in planning their care and giving their views. Senior care staff have been having training in care planning and recording. Our review of care plans showed us that people are having their weight regularly monitored and the action taken to respond to changes is being recorded. A new resident had put on weight since their admission from hospital. It was reported that there were no residents with pressure sores, which is a positive indicator of the standard of care people are receiving. Risk assessments had been recorded for people who may be at risk of developing them, due to their frailty, and pressure relieving equipment is obtained from the community nursing services. People may be put at risk because staff have not received the training we asked for in the specific conditions people in the home have i.e. people who have diabetes or Parkinson’s disease. Subsequent to the inspection confirmation has been provided that training for Parkinson’s disease has been organised and that some aspects of diabetes are covered in the medication training. We found that a resident assessed by a speech and language therapist as needing a soft diet did not have this recorded as part of their care plan and there was a record of this person choking. The kitchen staff confirmed a soft diet was not being provided. We asked for immediate action to be taken and the manager has since advised us of the action taken to reassess this person’s current condition and ensure they receive the care they need. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 13 Adequate risk assessments must be in place for all situations in which there is an identified risk. The care plan of a resident who has diabetes stated they needed a diabetic diet but did not give the detail staff needed to follow this through and clearly understand this persons needs. Leaflets from the diabetic service were available. We were concerned that staff are calibrating the daily dose on insulin pens for a resident without there being a clear record of how the community nursing staff have delegated these responsibilities and the training staff have had to assess their competence. Staff are also checking blood glucose levels in a monitoring device, after the resident has taken their own blood sample, but do not have clear guidance recorded in the care plan as to the range of readings they can expect for this individual and at what point they need to take further action. To look at whether people are receiving their prescribed medication when they need it we look at the systems for ordering, storing and administering medication. We found errors in the recording of stock levels and on the medication charts. The date put on the boxes of medicines not contained in monitored dose blister packs was the date the medicine had been received rather that the agreed procedure in the home which is to add the date of opening. This means staff are not easily able to carry out an accurate audit of the amount of medication people have been given, if they need to do so. The manager has an auditing system in place but our review showed that this was not frequent enough to pick up the problems we identified. Staff are not taking responsibility for reporting and investigating errors they identify when they come to do the following medicine round as there was no information on the back of the administration chart identifying whether no signature meant staff had not given the medicine or it had been given but staff had forgotten to sign for it. We also found that staff had signed to say they had given medication on three consecutive days that is only prescribed once a week. We were able to check that they had received the correct dose but again staff had not flagged this up as a recording error. We were concerned that staff are hand writing the insulin dose for a diabetic resident and did not have any up to date information available from the Community Nurses, General Practioner or Diabetic Nurse authorising this. This is dangerous because staff do not have any prescribing details to refer to and can make errors recording the information received by telephone on the administration chart. During the visit the manager contacted the community nursing staff and conformed the current dose was accurate but the faxed details sent through later by the nurse were also out of date. Since our last inspection we have also been notified of a drug error where staff failed to follow the correct procedures. The interaction between staff and residents during our visit was positive and respectful. Staff interaction with residents needing assistance was discrete and respected their privacy. A male resident confirmed that staff carried out his personal care needs in a sensitive manner. Although we observed staff acting Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 14 sensitively to promote the dignity of people in the home a group of residents did speak about how it made them feel when other residents didn’t lock toilet doors and the difficulties of male and female residents sharing the same facilities in the communal areas of the home. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 & 15 - People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home should experience an improving service in relation to the range and frequency of activities available and the quality of the meals being served as a result of recent company audits and reviews they have been involved in. People are supported to maintain contact with their family and friends and staff are taking steps to promote more activities outside the home but would benefit from having access to transport and taking a positive approach to managing risk. Where people need help to maintain control over their lives staff need to be available in sufficient numbers to support them and make sure more assertive residents do not dominate them. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 16 EVIDENCE: The new care plans we saw enable staff to record information from a person centred perspective and staff have been receiving training in this approach. People living in the home or people who are close to them are being encouraged to add life history details to the records so staff know more about their lives, preferences and aspirations. A programme of activities is displayed for people to see. We were able to see from the records of activities taking place that there is more focus on providing people with a range of things to do. People told us about their involvement in preparations for an end of summer fete. A trolley shop enables people to buy things for themselves. Arrangements are made for people to maintain their religious observance and a monthly ecumenical service is held in the home. People were bright and alert during our visit, occupying themselves watching the television, knitting and doing crosswords. In the afternoon one of the activity organisers spent time with people drawing and putting puzzles together. The independent consultant brought in by the company has been meeting with residents to review the activity programme. Two out of the 4 residents who completed our survey said there are ‘always’ activities they could take part in. The other 2 people said this was ‘usually’ or ‘sometimes’ the case. Two told us they would like to go out more and spoke about seeing the countryside or going to the shops. A member of staff said they felt more able to take people out when there were fewer residents. There may be an element of aversion to risk rather than promoting independence based on an assessment of risk. A member of staff spoke about residents being ‘allowed’ to do things and relatives have signed agreements giving staff permission to take residents out. A staff car is available to take individual people out but the manager may wish to explore the availability of suitable community transport to take small groups out for trips. The home currently employs 2 activity organisers covering 16 hours a week Monday to Friday. On three days of the week this only covers 2 hours of the day. On the morning of our visit we saw that residents were left unsupervised in the lounges. This meant there were no staff around to intervene when we heard a resident being verbally aggressive to another resident and encouraging other people to join in. In the afternoon staff did not mediate between residents at odds over whether the television should be on or not. Following our last visit we said the activities organisers would benefit from specific training in providing activities for residential care. This has not taken place and we hope the company keep this under consideration but the activity Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 17 staff do now meet with other activity organisers within the company to share ideas. Breakfast was leisurely and people were served in the dining room or their own room as they got up. The tables were attractively set with flower arrangements, tablecloths and linen napkins. People were able to pour their own tea and coffee. A variety of breakfast options were available. Staff have clear instructions on making sure people have plenty to drink and drinks were available to people in their rooms and lounge areas. A new menu has been introduced and we were able to confirm that fresh vegetables are now available as this is an area that has caused residents some concern in the past. Fresh fruit was available for people to pick up throughout the day. A group of residents were happy for us to join them for lunch. The meal was attractively served and people agreed it was tasty. Letting people serve their own vegetables and gravy at table would encourage people to retain independence. A new menu has just been introduced and requires some adjustment to make sure similar things are not served on consecutive days. As well as the hot main meal of the day people are now being offered a selection of items such as salads, baked potatoes or omelettes. A list is available to prompt staff to people’s individual likes, dislikes and dietary needs but this is displayed in the dining room and infringes people’s privacy particularly as a resident was reading it out to people passing by. Dietary supplements were available and being given to people who need extra support to maintain their nutritional needs. A recent audit by the independent care consultant into residents’ views on the home including meals and activities has just taken place and will continue to inform the changes being made. Her report identified that recording of activities needs to be improved, as there is a lot going on that is not recorded. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 18 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): Standards 16 & 18 - People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident they will be listened to any concerns they have will be taken seriously. People can be reassured that staff are receiving the training and supervision required to protect people and promote positive care practices. However we do not yet have the outcome of a review being carried out by Hertfordshire Social Services following concerns earlier in the year, which has led to a suspension of admissions by that authority. EVIDENCE: We have not received any complaints about this service between our inspections. The manager’s AQAA states they have received 1 complaint in the last 12 months. The complaints procedure is made available to people on admission and displayed in the home. We also saw a folder of cards and letters thanking staff for the service provided. Everyone who completed survey forms (100 ) said they knew how knew how to make a complaint and 3 out of 4 people said they ‘always’ knew who to speak to if they were not happy. One person said this was ‘usually the case’. The manager’s AQAA told us about improvements made to ensure the views of people living in the home and their families are listened to. These include holding residents and relative meetings. A notice advertising a ‘drop in’ surgery Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 19 where relatives can meet with the manager to discuss any issues was on display. Following an alert by hospital staff about the condition of people being admitted from Hillview earlier in the year there have been a series of meetings under the Hertfordshire Safeguarding Adult procedure. This has led to a review of people placed by social services. Representatives of B & M have attended meetings when requested and provided an action plan regarding the individual issues raised. The nature of these concerns are that the company may be breaching the duty of care that is implicit in the social services contract with the home because people may lack social stimulation & access to fluids. The home may not be able to balance resident wellbeing and fulfilment with safety. There were concerns about low staffing levels and some rough handling. At this inspection we have observed that steps are being taken to improve social stimulation. Routines have been put in place to make sure staff offer drinks at regular intervals and residents have access to drinks when they want them. The staffing levels we saw provided adequate support to maintain people’s personal care needs but people were left on their own at times during the day which caused some residents distress. We did not see any evidence of rough handling or poor moving and handling. See also comments in Daily Life and Social Activities for further details. Also see Health and Personal Care for details relating to risk assessments. Overall people felt the staff were kind and supportive but two people felt the night staff made then feel they were a ‘nuisance’ when they called them. A recent B & M survey identified that 84 of the 19 residents who responded said staff were either good or excellent. Staff have received training in protecting people from abuse and institutional care practices. They have access to a Whistle Blowing procedure and the General Social Care Council Code of Conduct, which set out the responsibilities of social care workers and their managers. The company have also put in place night monitoring visits to check on the home at different times. We saw the record of a random night visit, which had recently taken place. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a fresh, clean, comfortable, hygienic, well maintained home to live in. EVIDENCE: The home is fresh, bright and well maintained. There has been a lot of decoration and upgrading of bedroom and lounge furniture and fittings since our last inspection. New notice boards have been put up so information about events in the home can be displayed. The front of the home has been extended to include a narrow conservatory area off the main lounge, which leads on to an external decked seating area with views over Ware. The garden to the side of the house has also been made more accessible and a gazebo and new seating provided to make it a more attractive area to sit in. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 21 People are able to add personal possessions to their rooms to make them feel comfortable and at home. Bathing aids and adaptations are available for those who need assistance. The manager’s AQAA states that plans for improvement over the next 12 months include the creation of en-suite facilities where possible, a shower room and activity area. All areas of the home we visited were found to be fresh and clean. The manager’s AQAA states this has been achieved by changing the structure of the domestic team. Three out of 4 people who completed surveys confirmed that the home was ‘always’ clean another person said this was usually the case. We did note that the domestic staff took the opportunity to hoover the main lounge while people were eating their lunch in the adjacent dining room. This produced background noise and an odour, which was not in keeping with the relaxed atmosphere staff were trying to create and made it difficult for people to hear. The manager has access to current infection control guidance and the necessary equipment to promote good hand hygiene is available in the areas required. The laundry service provides people with smart well laundered clothing and the laundry assistant makes sure clothes are labelled and returned to the correct person. The laundry equipment and infection control systems enable staff to wash items at the correct temperature. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 22 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): Standards 27, 28, 20 & 30 – People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident staff will be provided in sufficient numbers to meet their personal care needs but an increase in resources would promote opportunities for greater fulfilment and make sure staff are available t support the more vulnerable people who cannot speak up for themselves. People can be confident that checks are carried out on staff before they start work to make sure they are suitable to work with vulnerable people. People need to be aware that there is a training programme in place to provide staff with the skills they need when they start work and as their career develops but more training, related to the needs of people with specific conditions, is required so staff have a greater understanding of the assessment, care planning and delivery of care required in these areas. EVIDENCE: Three out of the 4 people who completed surveys told us there were ‘always’ enough staff available. The people we spoke with confirmed staff responded in good time when they used the call bell. However as noted in the social care section of this report there are times when people are left unsupervised during the day and opportunities for social interaction and support may be limited by the availability of activity and care staff at specific times during the day. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 23 The rotas indicate that currently for 29 residents in addition to the manager, 5 care staff work during the morning from 8am – 2pm with 4 staff working from 2pm – 8am. Three staff work at night. This includes a senior carer on each shift. Agency staff are used to cover last minute shift changes due to sickness or unexpected absences if the home’s own bank staff are unable to cover. There is a separate rota for the housekeeping, catering, maintenance, laundry and activity staff. To check that the manager is recruiting staff safely we reviewed the personnel records of 4 staff. This showed us that two references and a criminal records bureau check are being obtained before people start work. The staff files had details of the specific training people had received since joining the home. There is evidence from the action plan provided by the company, staff interviews and training records that there has been an intense period of training since our last visit. New staff receive an induction that meets the Skills for Care requirements for social care workers. The number of staff with NVQ qualifications has increased since our last inspection. One of the staff we interviewed was currently studying for the award at NVQ level 3. The manager’s AQAA told us that 34 of care staff had achieved qualifications at NVQ 2 or above in care practices with other staff working towards the award. This will mean on completion the target of 50 workers with NVQ qualifications will be achieved. Following our last inspection we said that people needed more training in the specific conditions of old age such as diabetes, Parkinson’s disease and depression. The manager has reported difficulty in accessing suitable training and it is disappointing that the company have not assisted the new manager to achieve this within the dates we set. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 & 38- People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To ensure people receive good quality care, that meets their individual needs, people need to be confident that the registered provider (B & M Care) is responding to the things we ask them to do within the timescales we set and that the intensive training programme put in place for staff results in sustained improvements. People are able to give their views on how the service is being run as part of the homes quality assurance programme but we are concerned about the monitoring by senior managers and lack of progress made overtime to take this home forward and make sure all standards are consistently met. People can be confident that any money deposited with the manager will be stored securely and appropriate records kept. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 25 People can be confident that there are suitable health & safety procedures in place to keep them safe but the manager needs to familiarise herself with the home’s fire safety risk assessment so she is aware of what is required. EVIDENCE: We are concerned about B & M’s approach to the management and monitoring of this service as we have repeated requirements being brought forward from inspections because compliance dates have not been met. Over the last 3 key inspections, prior to this one, only 49 of the standards we inspected were met. The last registered manager left the home in March 2007 and there was a further change in January 2008 following the suspension of the manager. The current manager took up her post on 28/1/08, has applied for registration and is reported to be studying for the Registered Managers Award (RMA), which is the standard qualification for managers of care services. She was not managing the home at the time the initial Safeguarding referrals were made to social services or when previous requirements were made. Residents and staff were positive about the approach of the manager and felt she was someone they could go to if needed. We were concerned that the company were allowing the new manager to work in the kitchen at the weekend as well as covering her managerial role but the recent company action plan confirms this has stopped. The company have quality auditing & monitoring systems in place that include seeking the views of people using the service. However they need to look closely at the role of senior managers in monitoring this service in light of the continued non-compliance with regulations and repeated failure to meet standards on medication, care planning and risk management. Enforcment action will now be considered. People are able to deposit small amounts of money in the office for safekeeping. The records and money held are audited regularly by the manager and company. Our spot check showed that 2 signatures are recorded for money deposited and withdrawn. Receipts are kept to support any transactions and the records tallied with the amount of money available. There is a training plan in place to make sure staff receive the regular health & safety training they need to promote safe working practices. Staff have received updated moving and handling training and we did not identify any practice issues at this visit, which would cause concern. We have had previous concerns about the monitoring of hot water temperatures but did not find any problems on this occasion. The hot water we tested during out visit was within the required range to prevent accidental scalding. Windows on upper floors are fitted with restrictors to prevent accidents and radiators have cool to touch Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 26 surfaces. We spot checked the service records for safety equipment and systems against the information provided in the manager’s AQAA and found that the required checks had been carried out. One person who completed a survey said the lift was unreliable. The manager told us that a contract had been set up with a new company and this had improved things. Accident and incidents are recorded on monitoring forms and reviewed as part of the company’s auditing procedures. At the Safeguarding meeting which took place on 23/7/08, with the manager and area manager for Hillview, we discussed the number of notifications we had received since the last inspection in relation to people being sent to hospital when they were unwell. We asked the company as part of their own monitoring procedures to investigate if the home is managing risk appropriately. We have asked the manager to locate the company fire safety procedure and risk assessment required under fire safety legislation as a current copy could not be found and the manager did not know the frequency with which fire drills should be carried out. There were records of drills that had taken place as a result of the emergency alarm being activated and regular testing of fire safety equipment. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 27 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 3 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 3 Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 28 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 OP30 Regulation 18(1)(c) (i) Requirement Timescale for action 31/12/08 2. OP7 15(1) 3. OP7 OP18 13(4)(c) So people receive the care they need training must be made available for staff in specific conditions that may affect individual people in the home. Previous timescale of 29/2/08 not met but we are aware the manager is taking steps to achieve this. So people receive the care they 31/12/08 need the manager must ensure that all care plans provide adequate and appropriate details of each person’s needs, so that the staff have the information that they need to be able to meet their needs. Previous timescale of 29/2/08 not met. 31/12/08 To protect people 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. Previous timescale of 31/03/07 & 29/2/08 not met An immediate requirement was made following this inspection in relation to a DS0000019430.V370541.R02.S.doc Version 5.2 Hillview Page 29 4. OP9 13(2) 5. OP9 13(2) 6. OP8 12(1) specific risk related to choking and the manager has since provided us with a satisfactory response on the action taken. To protect people measures must be put in place to ensure that medication is audited effectively, and that any errors in medication are noted and rectified without delay. Previous timescale of 29/2/08 not met. To protect people suitable arrangements for the satisfactory completion of medicine administration records in respect of medicines administered to residents by workers at the home in accordance with individual prescription instructions must be put in place. To protect people and make sure that there are adequate lines of accountability any procedures delegated by community nursing staff to the care home staff need to be recorded for each resident and details of the training and competency assessment provided by the community nurses for individual staff need to be available. 31/10/08 31/10/08 31/12/08 Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 30 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 2 Refer to Standard OP9 OP8 Good Practice Recommendations Where staff are hand writing prescription details on medication charts it is good practice for 2 staff to verify and sign the entries to confirm it is an accurate record. To make sure staff know what to do if blood sugar levels change for the people they are monitoring on behalf of the community nurses there should be clear guidance, recorded as part of the care plan, on the range of readings to expect and the point at which medical or nursing staff should be contacted. Hillview DS0000019430.V370541.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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.V370541.R02.S.doc Version 5.2 Page 32 - 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. 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