Inspection on 30/07/06 for Hillview

This inspection was carried out on 30th July 2006.

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 23/01/07

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 Key Unannounced Inspection 30th July 2006 1:00 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.V299368.R03.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.V299368.R03.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 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.V299368.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 15th November 2005 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. None 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.V299368.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one Sunday afternoon, and including preparation time a total of nine hours was allocated to it. The focus of this 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. The staff and residents were very welcoming, and the manager came to the home especially for the inspection. 27 residents were in the home on the day, and there were nine vacant rooms. 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. What the service does well: What has improved since the last inspection? The requirements made in the last inspection report have been met. The procedures for the administration and recording of medication are generally good, but some recommendations were made on this occasion to improve the good practice further. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 6 What they could do better: Although the requirements in the last report have been met, the management of the home and the company are not sufficiently proactive in monitoring for themselves and rectifying any changes that are needed. Following a recommendation in the last inspection report, the temperature of the cupboard holding the controlled medication cabinet is monitored, but no action has been taken to rectify the high temperatures that are recorded, and the temperature of the room where the medication trolley is stored is not monitored. Medication must be stored according to the manufacturers instructions to ensure that it remains effective. The hot water in two bathrooms was very hot, but there was no evidence that water temperatures are monitored regularly. This leaves residents at risk of accidental scalding. The doors of 18 bedrooms, the office and the laundry were held open by a variety of artificial means, with no regard for the possible fire hazard that this may cause. There is no evidence that residents are able to raise concerns, and there is no procedure in place for recording and responding to concerns appropriately. A care plan is not in place for every resident. The main improvement needed is to establish a robust system for monitoring the quality of the care provided by the home. A system of quality assurance that is based on the views of the residents should form the foundation of the service, and lead to a cycle of planning, action and review for developing the services provided by the home. Many of the requirements made in this report would have been discovered and rectified if regular audits of all aspects of the service were carried out. The lack of a quality monitoring system has been highlighted in inspection reports for the last three years. The home cannot be assessed as proving a good quality of care until this is addressed. Enforcement action will be considered if this is not addressed within the timescale given. Training in essential skills is available for the staff, but there is no ethos of valuing and promoting training and qualifications in this home. Training in the protection of vulnerable adults is essential for all staff in order to ensure that the residents are protected from abuse. The staff records have improved, and now contain all the required information, but measures must be taken to ensure that no-one starts work in the home without satisfactory evidence of their fitness and their right to work. Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, but some staff work very long hours. All these concerns could affect the quality of care and the safety of the residents. Please contact the provider for advice of actions taken in response to this Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillview DS0000019430.V299368.R03.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.V299368.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the 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 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 care record for a resident who was staying in the home for a respite break contained a very detailed social worker assessment. The checklist is reviewed when the person is admitted to the home, and the care plan is written using the information in the assessment. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 10 The Statement of Purpose and service users’ guide were not seen on this occasion. The last inspection found that they provide appropriate information to enable people who are considering Hillview as a home for themselves, or for someone they care for, to make an informed decision. It was reported that no changes have been made since the last inspection. All the residents spoken to are happy in the home, and feel confident that the staff can meet their needs. One person said that admission to Hillview was arranged by the social worker, and they did not know they were coming there. This person would rather be at home, but they have no complaints about the home. The home has had nine vacant beds for the past six months. The manager reported that on several occasions Social Services have requested that she carry out an assessment, but they have then placed the person elsewhere. Hillview DS0000019430.V299368.R03.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 at least once during a 12 month period. 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 the 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. However not all residents have a written care plan, and those that do must be reviewed regularly to ensure that they provide up to date and accurate information. The home has generally good procedures for administering and recording medication safely, but the temperature of the rooms where it is stored must be monitored effectively to ensure that the medications are not affected by high temperatures. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 12 EVIDENCE: Detailed case tracking was carried out through the files of three residents. The care plans of the permanent residents 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. The home has a policy of “positive recording”, and evidence was seen of this in the daily records. Only information that is significant in relation to each care plan is recorded. The care plans seen include any risks related to the care needs, and the actions needed to manage those risks. For example, one resident has low blood pressure, and the care plan for their mobility needs states that the person should therefore stand up slowly, be supervised when transferring, and move slowly as they may faint. There is a moving and handling assessment for each resident, but some seen were not dated and there was no evidence of a review. The care plans are updated when required, for example an addition was made to one care plan to say that they now need help with personal care. However each care plan should be reviewed regularly as a whole. One care plan gave details of a resident’s spouse, but the resident said that the spouse died a year ago. If anyone read the care plan and spoke to the resident about the spouse, it could cause distress. The file for a resident who was staying in the home for a respite break contained a detailed assessment but no care plan. 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. The doors to many of the bedrooms were held open as it was a very hot day (see Environment). However this meant that the bedroom doors could not easily be closed. The door of one resident who was very ill was open, although it was later closed. Another resident was observed asleep on the bed in their room, with the bedroom door held open by moving the chest of drawers. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 13 Details of each person’s health needs are recorded in their care plan. Several residents have stayed with their own GP, and a total of five GP practices visit the home. No one currently has any pressure sore, or needs regular treatment from the district nurses. One resident was very poorly at the time of the inspection. The staff gave this person almost constant attention, and contacted the district nurse for advice during this Sunday afternoon. It was reported that each person’s weight is regularly recorded, but there was no evidence of this. Regular monitoring of weight is a useful indication of good health and nutrition, and must be completed. The manager and senior carers are currently undertaking training in administration of medication. The medication trolley is stored in an unlocked room, but it has now been secured to the wall. Most medications are supplied in individual blister packs, and recorded appropriately on MAR (medicines administration record) charts. Some prescriptions have been written on the MAR chart by hand. This is good practice, but the record should be checked and countersigned by a second member of staff to ensure that the details have been copied accurately. The medication for the respite client was supplied by the person’s family in a monitored dosage dossette box, with all the medications for each dosage in one compartment. There is no accurate record of what is in the dossette box, but each medication is signed as administered on the person’s MAR chart. The policy of the home is that respite clients should bring their medication in the original container. If this does not happen, a procedure should be put in place to ensure that an accurate record is maintained that does not require the staff to sign that they are administering a medication for which they have no evidence of identity. One resident administers their own medication. They sign the MAR chart when they receive it, and they have a secure locked drawer to store the medication in their room. Controlled medication is recorded and stored appropriately, in a separate room to where the medication trolley is stored. Following the last inspection a thermometer has been placed in the cupboard that contains the controlled medication cabinet. However the temperatures recorded are regularly over 25°C, which is the maximum temperature for the safe storage of medication. The temperature of the room where the medication trolley is stored is not monitored. Hillview DS0000019430.V299368.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are encouraged to take part in their choice of activities. They have good relationships with their families and with the local community. The menus offer a balanced and nutritious diet. EVIDENCE: This inspection took place on a Sunday, and the activities organiser was not in the home. The residents spoken to said that there are activities and entertainments that they can join in. The manager said that the entertainments in the home have included a full Salvation Army band and a bagpipe player in full regalia, both of which the residents thoroughly enjoyed. All the residents are registered with Dial-A-Ride, and they go out in small groups to Van Hague’s garden centre near Ware. Other outings depend on the cost of transport, and the home carries out fundraising activities to provide for this. It was reported that last summer there was an outing to Southend. One resident spoke of going out for a walk every day. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 15 During the afternoon 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. No visitors were seen during the inspection, but one resident said that family members visit regularly and bring everything they need. 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. Cold drinks were available and the staff regularly took cold drinks around to the residents and encouraged them to drink. Hillview DS0000019430.V299368.R03.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There is no evidence that residents are able to raise concerns, and there is no procedure in place for recording and responding to concerns appropriately. Training in the protection of vulnerable adults is essential for all staff in order to ensure that the residents are protected from abuse. EVIDENCE: The home has an appropriate complaints procedure. The procedure includes a format for recording complaints, but the manager was unaware of this. It was reported that there have been no complaints, and that “grumbles” would be recorded in a spiral bound notebook labelled Grumbles Book. The book was blank, but an example of what a grumble might be was “my bedroom is cold”. One resident said in conversation with the inspector that the bedrooms are very hot today, but in winter they are cold. In the inspector’s opinion this is a valid complaint with implications for the comfort and well-being of the residents, and should be recorded and acted on as such. There has been no recent training in the protection of vulnerable adults. Some of the staff attended appropriate training last year, but no training has been available this year, and many of the staff have not completed this training. This is essential for all staff in order to ensure that the residents are protected from abuse. Hillview DS0000019430.V299368.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home and gardens are well maintained and provide a comfortable and attractive environment for the residents and individual and communal facilities are generally appropriate for the residents’ needs. However the measures for protecting the residents from injury are inadequate, particularly with regard to water temperatures and fire safety. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 18 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 and well maintained. There is a rolling programme for redecoration and refurbishment. Many of the bedrooms have new furniture, and the furnishings in the front lounge were renewed. The outside of the home is due to be repainted. New washing machines have been installed in the laundry, and new tumble driers are on order. The home has satisfactory procedures for handling and washing laundry in order to prevent the spread of infection. This inspection took place on a hot summer day, and most of the residents were in the lounges. One person said that the bedrooms are too hot to sit in all day, and too cold during the winter. Portable tower type fans have been placed in the lounges, in bedroom corridors, and in several bedrooms, and a risk assessment is in place to ensure that they are positioned and used safely. This may assist in regulating the heat in the rooms during the summer, but measures must also be taken to ensure that the bedrooms are warm enough during the winter, and that the residents can control the temperature in their rooms. None of the bedrooms have en-suite facilities, but there is a bathroom and toilet on each floor, within reach of each bedroom. There is sufficient equipment, such as hoists and assisted baths, in the home to meet the needs of the residents. The hoists are stored in the corridors, and one is outside an empty bedroom and would impede access to the room if it were occupied. One bathroom on the top floor is used as a sluice room. There is a notice on the door stating that it is a sluice room, and the bath was filled with soaking commodes. The use of this bathroom for this purpose means that there is one less bathroom and toilet for the residents to use. The hot water in two bathrooms was very hot. It was reported that staff test the temperature of the bath water before assisting residents to bathe, but there was a thermometer in only one bathroom. There was no evidence that water temperatures are monitored regularly. (See Management and Administration.) Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 19 The doors of 18 bedrooms, the office and the laundry were held open by a variety of means, including a wedge, waste bin, footstool, and in several cases by moving the chest of drawers and wardrobe. One resident was asleep in her room, but was unable to close the door for privacy (see Health and Personal Care). Fire doors must not be held open by artificial means, and advice must be sought from the fire authority concerning adequate precautions against the risk of fire, when residents wish to have their bedroom doors open. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. 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 are sufficient to ensure that all the residents’ needs are met, but some work very long hours. Training in essential skills is available for the staff, but there is no ethos of valuing and promoting training and qualifications in this home. 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: The home has a good level of staffing for the current number of residents, with four care staff on duty throughout the day and three night staff. The shifts are 7am to 1pm, and 1pm to 7pm, and at night two staff work 7pm to 7am and one from 10pm to 6am. The rotas for two weeks were seen, and they show that bank staff, night staff and the chef fill any vacant shifts. On almost every day one or two people work a 12 hour shift during the day, from 7am to 7pm. One person worked four 12 hour shifts on the week of the inspection, and was rostered to work three 12 hour shifts the following week. The total hours for this person were 60 on the current week and 54 the following week. One night care assistant worked four 12 hour nights and two 8 hour shifts this week, with a total working week of 64 hours. One night care assistant worked a night shift 10pm to 6am followed by a day shift 1pm to 7pm and another nightshift the following night from7pm to 7am. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 21 These shift patterns do not comply with the Working Time Regulations for the maximum number of hours anyone should work, the length of shifts without a break and the time off between shifts. Two staff files were inspected. They both 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 there was no evidence of a work permit or the person’s immigration status. Training for the staff is arranged through Oaklands College. The manager and senior carers are currently undertaking training in administration of medication, and the college also provides training in all the mandatory health and safety training for the staff. Some proof of training attended was seen in the individual staff files, but there is no record of the training of all the staff, that shows the mandatory training completed and when updates are due. An induction and foundation training book is provided to every new member of staff, but those seen were not completed, and it was reported that the senior staff do not have time to train the staff. Two care assistants and the chef have completed NVQ level 2, and the deputy manager and one care assistant have completed NVQ level 3. Three care assistants are waiting to start NVQ level 2 or 3. Only 25 of the care staff currently have NVQ qualifications. Appropriate training and qualifications provide the staff with the skills to meet the needs of the residents and to ensure that they are in safe hands at all times. There is no ethos of valuing and promoting training and qualifications in this home. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Adequate records are maintained for the effective management of the home and monitoring of health and safety procedures, and appropriate 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. An effective quality assurance system is needed, to ensure that views of the residents and their families underpin all self-monitoring, review and development of the home. EVIDENCE: The manager was registered as manager of Hillview in February 2005. She has completed the Registered Managers Award qualification. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 23 There is no structured system for monitoring the quality of the care provided by the home. Questionnaires for residents, visitors and professionals are available in the entrance hall of the home, but there is no method for distributing them and analysing any results. A robust system of quality assurance that is based on the views of the residents should form the foundation of the service, and lead to a cycle of planning, action and review for developing the services provided by the home. Many of the requirements made in this report would have been discovered and rectified if regular audits of all aspects of the service were carried out. Senior personnel of B&M Care make monthly monitoring visits to the home. Their reports are of variable quality, and several had no mention of the views of the residents. No report has been sent the home or to the Commission since March 2006.The lack of a quality monitoring system has been highlighted in inspection reports for the last three years. The home cannot be assessed as proving a good quality of care until this is addressed. 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. At a recent EHO (Environmental Health Officer) inspection, the good standard of recording of food hygiene was noted. The report stated that the home maintains a good standard of food hygiene. An infestation of ants in the cellar store was dealt with immediately. Fire records are up to date, and all the staff take part in regular fire training and fire drills. Two health and safety concerns were noted during this inspection. 1. The hot water in the baths and washbasins in several bathrooms and toilets felt extremely hot when tested by hand. There was a thermometer in only one bathroom, opposite room 30 on the top floor. The water in the bath in this bathroom tested at over the maximum measurement of 50°C, as did the water in the washbasin in the next-door toilet. During the inspection it was reported that the plumber was contacted immediately and would visit the home to rectify the problem on the following day. 2. The doors of 18 bedrooms, the office and the laundry were held open by a variety of artificial means (see Environment). Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 24 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 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X 2 2 X X 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 2 Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 25 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 15(1) Requirement The file for a resident who was staying in the home for a respite break contained a detailed assessment but no care plan. A care plan must be in place for each resident, that provides details of their personal and health care needs, and the actions needed to meet those needs. Care plan details are updated, but there is evidence that the total care plan is not reviewed regularly. Moving and handling assessments are not reviewed regularly. All care plans must be reviewed regularly and updated to ensure that the information they contain is accurate. There is no evidence that each resident’s weight is monitored. Measures must be put in place to ensure that the weight of residents is recorded regularly, as an aid to monitoring their good health and nutrition. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 26 Timescale for action 31/08/06 2. OP7 15(2)(b) 31/08/06 3. OP8 12(1)(a) 31/08/06 4. OP9 13(2) The temperature of rooms used for storing medication, including the controlled drugs cupboard, was observed to be high. The temperature of all rooms used to store medication must be regulated to below 25ºC. The policy of the home is that respite clients should bring their medication in the original container, but medication was administered from a dossette box filled by the resident’s family. When medication is not supplied in the original container, a procedure must be put in place to ensure that an accurate record is maintained that does not require the staff to sign that they are administering a medication for which they have no evidence of identity. The doors to many of the bedrooms were held open, and residents were not able to have privacy in their rooms. The registered person must ensure that residents are able to enjoy privacy in their bedrooms, especially when they are ill or they wish to rest. There is no evidence that residents are able to raise concerns, and there is no procedure in place for recording and responding to concerns appropriately. The registered person must ensure that residents concerns and complaints are recorded and addressed effectively. 31/08/06 5. OP9 13(2) 31/08/06 6. OP10 12(4)(a) 31/08/06 7. OP16 17(2) Sch. 4.11 22(3) 31/08/06 Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 27 8. OP18 13(6) There has been no recent training in the protection of vulnerable adults. All staff in the home, including domestic staff, must have adequate and appropriate training in the recognition and prevention of abuse. The doors of 18 bedrooms, the office and the laundry were held open by a variety of artificial means. The registered person must consult the fire authority concerning adequate precautions against the risk of fire, in particular with regard to the use of door wedges on bedroom doors, and take action on any subsequent recommendations. One bathroom on the top floor is used as a sluice room. Sufficient numbers of bathrooms must be available for the residents, and this number should not be less than was available at 31 March 2002. Hoists are stored in the corridors, and may impede access for the residents. Adequate and appropriate storage must be provided for all equipment in the home. It was reported that the bedrooms are too hot during the summer and too cold during the winter. Measures must be put in place to ensure that the residents’ bedrooms are maintained at a comfortable temperature that they can control. 31/10/06 9. OP19 OP38 23(4)(c) (iii) 13/08/06 10. OP21 23(2)(j) 31/10/06 11. OP22 23(2)(l) 31/10/06 12. OP25 23(2)(p) 31/10/06 Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 28 13. OP25 OP38 13(4) The water temperature in the baths in two bathrooms was above the recommended level to prevent a risk of scalding. 01/08/06 14. OP27 18(1)(a) 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 monitored and recorded. The staffing rotas show that 31/10/06 many staff work very long hours, long shifts, and do not have sufficient time off between shifts. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. Only 25 of the care staff have NVQ qualifications. 15. OP28 18(1)(a) 18(1)(c) (i) & (ii) 31/10/06 16. OP29 19(1)(b) The registered person must put measures in place to increase the number of qualified staff working in the home. A POVA check was not completed 31/08/06 for one new member of staff, and there was no evidence of their work permit or immigration status. The registered person must ensure that no-one starts work in the home without satisfactory evidence of their fitness and their right to work. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 29 17. OP30 18(1)(c) (i) There is no record of staff training, which shows the mandatory training completed and when updates are due. 31/10/06 18. OP33 24 The registered person must ensure that all staff complete regular mandatory training. All new members of staff must complete a comprehensive induction training programme that meets the Skills for Care requirements. There is no structured system for 31/10/06 monitoring the quality of the care provided by the home. A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. The lack of a quality monitoring system has been highlighted in inspection reports for the last three years. Regulatory action will be considered if this requirement is not met within the timescale. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 30 19. OP33 26 The reports of the proprietor’s monthly monitoring visits are of variable quality, and several had no mention of the views of the residents. No report has been sent the home or to the Commission since March 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. 31/08/06 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 OP9 Good Practice Recommendations Some prescriptions have been written on the MAR chart by hand. This is good practice, but the record should be checked and countersigned by a second member of staff to ensure that the details have been copied accurately. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 31 2. OP9 The policy of the home is that respite clients should bring their medication in the original container. If this does not happen, a procedure should be put in place to ensure that an accurate record is maintained that does not require the staff to sign that they are administering a medication for which they have no evidence of identity. Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillview DS0000019430.V299368.R03.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!