Inspection on 21/04/06 for Hilsea Lodge

This inspection was carried out on 21st April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hilsea Lodge 09/11/07

Hilsea Lodge 11/10/05

Hilsea Lodge 27/01/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Hilsea Lodge London Road Hilsea Portsmouth Hampshire PO2 OTX Lead Inspector Mark Sims Unannounced Inspection 21st April 2006 08:55 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 Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hilsea Lodge Address London Road Hilsea Portsmouth Hampshire PO2 OTX 023 92 660152 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) www.portsmouthcc.gov.uk Portsmouth City Council Mrs Joan Patricia Tidd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Seven service users in the category DE(E) may be accommodated, within one group living wing of the home 11th October 2005 Date of last inspection Brief Description of the Service: Hilsea Lodge provides accommodation and personal care for up to thirty-nine older persons and is owned and managed by Portsmouth City Council Social Services Department. The home has recently registered a condition of registration with the Commission for Social Care Inspection, to accommodate seven residents with dementia in a wing of the home. The Commission has also been advised of longer term plans to develop the home into a specialist dementia care home. The home is single storey and is broadly divided into five units, all bedrooms are single occupancy. Each wing of the home has a dining and sitting area, and there is a large communal lounge in addition to this, and a specified smoking area. Service users have their meals in the dining rooms in the designated units, provided from the main kitchen by heated trolleys. There is recreational space outside, with seats, a fishpond and fountain. Gardens surround the home and consist of courtyards with shrubs, trees and plants; there is a lawned area also. Service users who use frames and wheelchairs are able to access the garden via ramps. At the time of the inspection the Commission was advised of plans to develop the home into a provision solely accommodating older people with varying degrees of dementia. This will call for further variations in the home’s registration, and a clear plan of action stating how the transition to dementia care is to be managed, and existing residents consulted about the future of their home. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first key inspection for Hilsea Lodge since the introduction of a new inspection process. As part of the new inspection programme, all core or key standards are to be reviewed and at this inspection all of those standards were considered. The fieldwork visit, the actual visit to the site of the home, was conducted by two inspectors, myself and Janet Ktomi, where in addition to any paperwork that required reviewing the inspectors met with service users, relatives, staff, etc. and undertook a tour of the premises to gauge its fitness for purpose. What the service does well: What has improved since the last inspection? In response to concerns raised by inspectors visiting PCC homes, the provider (PCC) has introduced a new system of care planning into the homes, the new system including an updated pre-admission assessment tool that requires the compiler to gather information under three broad headings. It is evident that the intention is for the information collected using this new assessment process to filter into the care planning system, although the observational evidence suggests that this is not yet occurring as a combination Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 6 of inexperience and lack of training has left the staff unaware of how the new service users’ plans are to be managed. Staffing levels have been maintained at the same level despite one unit being closed, which means adequate numbers of staff are available to meet the service users’ needs. However, careful consideration as to how staff are to be deployed and in what numbers should be given prior to opening the new unit, it is suggested as a guide that six care staff be available thus allowing one person in each unit plus the additional support of a floater. The recruitment and selection process would appear to have been reviewed with general improvements made to how the service obtains the information required under Regulation 19, Schedule 2 of the Care Homes Regulations, although evidence from other services within the PCC group of homes indicate that some Protection of Vulnerable Adult (POVA) and Criminal Records Bureau (CRB) checks are from previous employers and this practice should not be repeated at Hilsea Lodge. A major concern for the Commission has been the PCC’s practice of depositing service users’ monies in PCC accounts, these accounts neither belonging to the client nor bearing any interest. However, shortly before the inspection took place this issue seemed to have been addressed and the PCC introduced new client held accounts, although money is initially still paid into a PCC clearing house before the home’s administrators transfer funds to client accounts. This practice was discussed with a senior PCC manager, who has undertaken to check how this is occurring as the reason for making the changes to the system was to eliminate such situations. He did add that the PCC might have set up two accounts, one at the finance house and one at the home. A final concern identified during the last inspection was the proximity of the laundry to a door accessing the kitchen, the inspector fearful of cross contamination, etc. In order to address this concern the kitchen door has been fitted with a self-closing device and signage requesting that the door be kept shut at all times. The PCC has also purchased new laundry bins, for transporting laundry around the premises, which are fitted with lids, further reducing the chance of cross contamination. What they could do better: Whilst improvements were noted generally to the recruitment and selection procedures of the home, one staff member was noted to have been recruited without the appropriate reference having been taken up and this along with ensuring the Schedule 2 information is correct should be addressed by the manager. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 7 Some concerns were also noted around the reporting of incidents and/or accidents under Regulation 37 of the Care Homes Regulations 2001, the inspectors noticing that some clients had fallen, sustained minor injuries, etc. and these were not being forwarded to the Commission, although in the defence of the manager this was because of advice provided by a Commission Professional Advisor, who in an attempt to clarify the issue for providers had created a rigid reporting criteria, which is not meant to be the case, different events affecting people’s wellbeing in different ways and their requiring the managers to use their professional judgement more. The PCC is in the process of issuing new guidelines for staff around the management of service users’ monies and is arranging for training to be provided to all managerial grades. However, on inspecting the home’s medication system issues of concern were identified, these including: • • The medication policy had not been replaced. Gaps appearing in the Medication Administration sheets. The newly introduced care planning documentation was found to contain no moving and handling assessments for staff, which are vital parts of any care planning programme, as are general risk assessments. The latter documents also noted to be missing from the newly introduced system and which should be included to ensure any potential harmful or dangerous activities entered into by the service users are identified and plans to minimise the impact reduced. The final issue for consideration by the PCC is how it intends to ensure service users and/or staff can alter the temperature settings within the home, which on the day of the fieldwork visit was noted to be excessively hot or warm. In conversation with the manager the biggest problem would appear to be the inability of staff to turn the heating system off, as this is run by an automotive system. 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. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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 Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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): St 3 & 6. Quality in this outcome area is good. This judgment has been made using the available evidence, including a visit to this service. Whilst a new assessment programme has been introduced staff have yet to receive training on how the system is to be fully implemented and used. The home does not provide an intermediate care service. EVIDENCE: Portsmouth City Council (PCC) has introduced a new care planning system, for use within all of its services, this new system including an updated and/or revised assessment tool, which should be completed prior to admission and is designed to aid the decision-making process, around the suitability of the service to meet the person’s needs before the offer of accommodation is made. During the fieldwork visit the inspectors had the opportunity to review a number of these newly completed files, including the assessment tools, as part of the case tracking process and whilst the assessment sheets are reasonably detailed the inspectors felt that because the staff lack experience in using Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 10 these new forms, the result of training being scheduled after the implementation date, the information gathered was not always being used appropriately, as the care plans being generated following the assessments lacked detail. However, with training, which is planned for later this month, any glitches in the system or lack of experience within the staff should improve and it would be expected that better linking between the assessment process and care plans will lead to noticeably more detailed instructions for staff. From the perspective of the service users, it was clear that the assessment process meant very little, in as much as they had little idea that meetings with staff prior to admission had been to assess their needs, etc. However, people generally recalled meeting with members of the staff team prior to admission, and some people spoken with confirmed that they or their relatives had visited Hilsea Lodge before moving in. A clear benefit of working for the PCC is the access the management have to ‘Swift’, which is the Social Services database for recording all contacts and assessments undertaken with clients. Access to this system clearly enables the management to gather information relating to any person referred to them by Care Managers, and is another useful tool for gauging people’s needs and abilities prior to admission. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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): St 7, 8, 9, 10. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The home’s new care-planning programme does not clearly identify or set out the needs of the services, specifically around moving and handling and risk assessment. Service users receive adequate and appropriate support when accessing both health and social care services. The staff’s approach to managing service users’ medication is not meticulous and errors in practice were noticed. Service users feel they are treated with respect and dignity and that their rights to privacy and self-determination are upheld. EVIDENCE: As previously identified the PCC has introduced a new care-planning process, which for the staff at Hilsea Lodge was implemented prior to training being delivered, although it is understood from conversations with the manager and a senior manager of the PCC, this is due shortly. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 12 However, to their credit the care staff at Hilsea Lodge and the management have embraced the introduction of the new system and have already transferred all existing client information (from previous care plans) onto the new records, as evidenced during the case tracking process, all new service users automatically have their care planning needs documented onto the new records. Conversations with service users indicated or suggested however, that whilst they are fully aware of their keyworker and the tasks this person completes for them, etc., they knew little about the care planning records maintained by the home or the content of these files. It was also evident on reading through files selected as part of the case tracking process that work is still required on certain aspects of the new systems, as none of the files contained a moving and handling assessment, although staff had highlighted where people had problems with regards to their mobility. Risk assessments, whilst available, were not being used effectively and perhaps should be reviewed to ensure the risk is clearly identified along with a rating of the risk and an appropriate plan to manage the potential dangers, etc. The forthcoming training event might prove a suitable forum to discuss such shortcomings and/or issues. Access to suitable health and social care support does not appear to be an issue with good record keeping practices in place to ensure all contacts with health and social care professionals are recorded. The manager was also able to produce a letter that had arrived that morning from a local general practitioner, which had been written thanking and praising the home for the care and attention given to a 94 year old client who had recently died in their care. The service users also commented on how staff support them in accessing health care services and confirmed that they only have to ask and arrangements for a general practitioner’s visit are made. The inspectors also had the opportunity to meet with a member of the community nursing team and to seek their view on the service, which was described as nice with approachable staff that seek advice and guidance appropriately. The home was also described as ‘one of the best locally’ and the type of environment ‘you would happily admit your grandmother to’. An issue the inspectors did not discuss with the Community Nurse team member was their practice of drawing up multiple syringes of insulin and leaving these with the home’s staff to dispense to the service users for administration, several days worth of syringes often being pre filled at a time. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 13 This practice could conceivably be considered to be a form of secondary dispensing, as the nurse takes on the responsibility for drawing up the insulin and the carer has the responsibility of ensuring the correct syringe is delivered to the client. Secondary dispensing is not good practice and it has long been the advice of professional bodies that this form of medication management system be ceased. Concerns also persist for the inspectors over the safety of this system, which has largely been introduced to save time for the Community Nursing Staff and could if an error occurs during the preparation phase result in several incorrect doses of insulin being delivered before being detected. It is also the inspector’s understanding that any medicine dispensed from its original container, etc. should only be stored twenty-four hours in advance of administration. Inspectors at several different PCC homes have identified these concerns; and whilst individual staff and/or managers may not be in a position to influence the practice the Senior Management should be taking action to discuss the matter with their health colleagues, especially as their recently re-drafted medication policy clearly states that this practice cannot be supported. On a level more specific to Hilsea Lodge, a number of minor issues were noted to require addressing with regards to their own medication management approach, as eight medication administration records (MAR) were noted to have gaps in them, the medicine fridge’s temperature – (whilst being completed) – did not record the highest and lowest temperature achieved that day, PRN medications dispensed but then not administered or taken by the service user must have a code entered onto the MAR sheet and the newly drafted medication policy should be made available within the home, as the version on file is no longer current or accurate. On a more positive note both the staff and their training records provided evidence that medication training is being provided, although initially this is being rolled out to managers and relief managers. The home was also noted to be facilitating self-administration of medicines with at least one client noted to be responsible for his own medication during the visit, although the importance of keeping his medications stored appropriately does need to be discussed with him and should form part of any assessment undertaken to ensure the person is capable and responsible enough to self-administer their medication. During the fieldwork visit one of the inspectors spent time with the management checking records and documents, whilst a second inspector spent time meeting and conversing with service users, visitors and staff. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 14 Feedback from the residents and to a larger extent their relatives or visitors creates a picture of a service where mutual respect and courtesy are a common feature: • • • • • Relatives discussing how they are always made welcome and the staff are friendly. The service users describing the staff and management as approachable and supportive. Visitors also describing the staff as friendly and approachable. Observations revealing how staff use appropriate terms of address or means of communication when interacting with service users. The home’s records documenting preferred forms of address, likes and dislikes and pen pictures of the person, which is designed to aid relationship building. All bedrooms were noted to be single accommodation rooms and small fanlights above the doors had been subtly fitted with curtains to promote privacy and dignity for the occupant. The environment is also well laid out and affords people the opportunity, should they wish, to either socialise with others residing at the home or to locate a quiet corner, etc. where they can sit relatively undisturbed, this including a smoking area for those who wish to indulge in this habit. • • Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 12, 13, 14, 15. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The home’s activities programme lacks variety. Relative and visitors are actively involved in the home. Independence and choice are promoted within the home. Meals are well presented, individually portioned and menus varied. EVIDENCE: In addition to promoting independence through practices such as the selfadministration of medicines, enabling of smoking in designated areas and the provision of choice of meals, etc., the home and/or staff also work hard at gathering useful and important information pre-admission: people’s likes and dislikes, hobbies and interests and a pen picture or social history. They also arrange residents’ and relatives’ meetings, which are planned and minuted, all attendees and non-attendees receiving copies of the minutes Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 16 produced; and have a range of questionnaires for service users, their relatives and staff, all of which cover a wide range of topics: • • • • • • • • • • • • • Comfortable and friendly environment Sleep and rest Access to health care Meals and Menus Religious observances Leisure Variety of activities Access to publications Staff hours and flexibility Laundry Access to service users Appearance Keyworkers, etc. The service users also during conversation stated that they had choice and control over their day-to-day activities, where they sit, what they eat, where they go (within the home’s general environment), etc .and confirmed that they had completed questionnaires on the service provided at Hilsea Lodge. The most consistent message being fed back via the questionnaires and supported by service user comments on the day, however, is that the activities programme lacks variety. Although in discussion with the manager it was ascertained that various activities had been tried but the general response of the residents was often less than enthusiastic. However, at a recent team meeting one of the assistant managers has agreed to undertake a review of the home’s activities programme, with a view to developing something more tailored to the needs and wishes of the residents, evidence of this commitment was seen in the minutes of the team meeting. Mealtimes were observed to be social occasions, when residents return to their individual units, each unit comprised of between 7 and 8 bedrooms, meals taken around tables sitting approximately 3 to 4 people. Meals are served from heated trolleys within the dining areas and are portioned according to the person’s preference at the time, enabling the individual to vary the size of their meal depending on their appetite. In conversation with the service users it was established that the meals provided at Hilsea Lodge are very good and that people felt generally that they were provided with choice and variety. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 17 These testimonies were supported by evidence from the sample menus, which contained details of the range of meals provided and the variety of meals offered to clients at Hilsea Lodge. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 16 & 18 Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users are confident that complaints or concerns are handled appropriately. Appropriate measure is taken to ensure service users are protected from abuse. EVIDENCE: The manager uses both the available meetings (residents’ and/or relatives’) and questionnaires to encourage people to raise concerns or complaints about the service, as evidenced via minutes of meetings and questionnaires inspected. It was also noticeable on entering the home that a wide range of documents is made available to visitors and that amongst these documents was a copy of the statement of purpose, which contains details of the home’s or PCC’s complaints process. In discussions with both service users and their relatives it was established that they would feel confident in bring a complaint or concern to the attention of the management and/or staff, as they felt the matter would be appropriately addressed. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 19 One relative actually stated that they had no complaints or concerns at this time and confirmed that a previous issue of concern had been well managed and resolved to their satisfaction. Adult protection training is available to the staff of Hilsea Lodge, as is more specific training around issues such as: management of challenging behaviour, etc. All new employees are required to complete a full and detailed induction programme, which considers various topics including: moving and handling, health and safety, food hygiene and abuse. In discussion with staff, whilst none specifically mentioned the abuse training, it was established that the PCC provided access to numerous educational and skills development courses. It is also evident from the training records that the management and staff are committed to training and that staff have completed both mandatory and additional training events. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 19 & 26. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The premises is reasonably well maintained, although an inability to control the temperature of the radiators does result in the home being extremely hot on spring days. The home was clean, tidy and free from offensive odours. EVIDENCE: A tour of the premises was undertaken, as neither inspector had visited the home before and so knew nothing of the layout or design of the property. During the tour the inspectors were shown a newly converted unit, which is waiting the processing of a variation application, which should determine how the unit is to be used. The unit was well finished and nicely decorated. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 21 New carpet has also been fitted in the main lounge and entrance hallway, which is a large open plan area. Other parts of the premises whilst slightly older in decorative style were clean and tidy and finishing touches, such as the curtains fitted above fanlight windows, etc. gave the home a sense of easiness and warmth. The grounds whilst still in the full flush of spring, were tidy and well maintained, with a variety of shrubs, trees and flowerbeds creating a mature garden that is accessible to service users. In discussion with the manager it was established that maintenance issues are managed via the PCC’s estates department, which at times can be a little slow and laborious but generally things are attended to within good time. However, discussions with the service users and staff did not necessarily support this view, as people felt at times the home was too hot; and whilst an engineer had been sent to look at the problem, which centres around an inability to turn off the boilers within the house, his response was there was nothing he could do, as the timer was centrally controlled. Obviously this type of response is not adequate and the PCC senior management should look into how control over the heating system can be returned to the residents and/or staff directly. According to the domestic staff interviewed there are three domestics on duty Monday, Tuesday and Wednesday but only one available Thursday, Friday, Saturday and Sunday. Whilst this may appear to be a sufficient number of domestic staff, whilst one of the units is closed, it may not continue to be the case and the manager and PCC may need to review the domestic staffing arrangements once the new unit opens. Generally the premises was noted to be clean and tidy throughout and whilst odours were detectable early in the visit these had been addressed and properly managed later in the day. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 27, 28, 29 & 30. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Staff are deployed in sufficient numbers to meet the needs of the current service user group. Staff have access to good levels of educational, vocational and skills development courses. The home’s recruitment and selection strategy is not being followed appropriately and therefore cannot guarantee the safety and wellbeing of the service users. EVIDENCE: The duty rosters indicate that sufficient staff are employed within the home to meet the needs of the current service user group, although as previously indicated the PCC may have to review how its staff are deployed and in what numbers once the new unit opens. In conversation with staff, Hilsea Lodge was described as a good place to work, with staff acknowledging that a good camaraderie exists between all carers and that people support each other throughout their shifts, as some areas of the home can be busier than others at times. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 23 Staff also commented on their opportunities for training and development and stated that they feel the PCC provides access to ample training events, a statement supported by the training plans and training records submitted prior to the inspection. On comments from external professionals involved in the home, who described the staff as knowledgeable and well-informed, it was also pleasing to hear a visiting health care worker describing the staff as always willing to seek advice on subjects they were unsure of, as this is indicative of a service and staff team willing to learn and prepared to develop. The training co-ordinator for the home was also fortunately on hand within the home during the fieldwork visit and was able to discuss forthcoming training events: • • Medication training - 06/05/06 Care planning - no set date. And recently completed courses: • • • Valuing Diversity Assertiveness skills Challenging behaviour, etc. She also discussed the home’s National Vocational Qualification (NVQ) strategy and confirmed that 25 staff currently possess an NVQ at level 2 or above, which out of 30 care staff and assistant managers provides the home with a percentage rate of 83 , which is well in excess of the 50 ratio recommended. The figures quoted by the training co-ordinator were also verified via the training records provided prior to the fieldwork visit, which documented the NVQ status of the staff. The home’s recruitment and selection process is generally overseen by the PCC personnel department, with the manager required to identify positions to be filled and to notify her line manager, who in turn agrees with the personnel department how the position is to be advertised. All potential applicants are required to collect application form, job description and person specification forms from the home directly, enabling the management to provide a brief tour of the premises and discuss the service provided. The registered person, who sits in on all interviews, manages the short-listing of candidates. All interviews are documented. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 24 Whilst the personnel department oversees checks run on the applicants prior to the offer of employment, the manager has devised a checklist for documenting when references, Criminal Record Bureau (CRB) and Protection Of Vulnerable Adults (POVA) information is received. However, part of the recruitment strategy of the PCC and the management should be the interrogating of the application form, as it is important to ensure that references are taken up from the person’s last employer. During the inspection of the staffing records maintained at Hilsea Lodge it was noted that two recently recruited staff had not given their last employers as references and that the PCC had not approached these people for references. It has also been established at other PCC establishments that some of the POVA and CRB information used to support appointments of staff have been adopted from their pervious employment, which is a breach of the Regulations, as employers are required to undertake their own checks. However, this particular issue was not identified at Hilsea Lodge, although the manager should seek clarification from the PCC’s personnel department as to the source of the CRB and POVA checks for her staff. All staff successfully recruited by the home and PCC are subject to a 6 month probationary period and are placed on a five day induction course aimed at introducing them to care work, evidence of people having completed this course is retained on the training records and additional dates for the induction courses are included on the training plan for the forthcoming year. In addition to completing the induction programme all new staff are shadowed during their first two shifts on duty and are appointed an assistant manager to oversee their induction period. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 25 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): St 31, 33, 35, 36 & 38. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The manager is both suitably experienced and qualified to run Hilsea Lodge. The home’s quality assurance systems ensure the home is run in the best interests of the residents. Improvements have been made to the way service users’ monies are handled. Staff receive appropriate supervision and support. The health and safety of the service users and staff is not appropriately promoted. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 26 EVIDENCE: The manager possesses both care and management qualifications at National Vocational Qualification level 4, plus an additional certificate in management attained in 2005. The evidence to support this statement was received prior to the inspection, in the form of the pre-inspection returns, which included details of all staff qualifications and testimony from the manager who discussed with the inspectors her current qualification status. The manager is also an experienced leader who has worked within the social care field for a number of years and has been registered manager at Hilsea Lodge since July 2005, registration being the legal date from which the manager achieved registration with the Commission, according to the database. In addition to the registered manager the home also employs four assistant managers, which based on evidence from other PCC inspections, would appear to be the norm for staffing arrangements at PCC establishments, the staffing rosters indicating that at least two assistant managers are on duty each day, in addition to the Registered Manager. Service users and relatives are afforded the opportunity to discuss concerns with regards to the day-to-day operation of the service at various meetings and via the home’s questionnaires, which are periodically circulated to gather additional feedback from the clientele and/or their relatives. In discussion with service users it was established that at least two clients recalled receiving service user questionnaires within the last year, all meetings alluded to are minuted and copies of the minutes were made available on the day of the inspection. One of the most significant outcomes from any of the recent meetings, specifically a staff team meeting, was the acknowledgement that the home’s activities programme required reviewing and that an assistant manager was appointed to undertake this task. This is important, as it evidences that the home’s quality auditing system is working, as both minutes from relatives’ meetings and comments on service users’ questionnaires indicated that the lack of activities was a concern, a fact determined on the day of the visit, as both service users and relatives commented on the lack of activities. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 27 Staff meetings and questionnaires are also used in house, as part of the quality auditing system, all meetings being minuted as discussed above and the questionnaires addressing such issues as: • • • • • • • • • • The environment and atmosphere Time spent with service users Availability of snacks, etc. for service users Choice of meals Management team support Supervision Experience of supervision Induction Training and development Value and abilities to contribute to service development, etc. Copies of both blank and completed questionnaires were made available to the inspectors during the fieldwork visit. Staff supervision is a key system available for supporting staff, both in the delivery of care and the development of skills and knowledge. In discussion with the manager it was established that the home operates a hierarchical system for delivering supervision, with the Registered Manager providing supervision for all assistant managers and the assistant managers providing the supervision for all other staff. In discussion with members of the staff team it was established that supervision occurs on a regularly planned or scheduled basis and is viewed as a useful tool. Whilst no supervision records were inspected (the choice of the visiting officers), copies of supervision files were made available, it was also ascertained that supervision sessions are used to plan and monitor staff development issues. The manager also operates an annual appraisal, which includes a selfassessment element for staff and this process helps to influence the yearly training and development strategy and career pathways. A big concern at the last inspection was how the PCC was supporting service users manage their monies, as the PCC was banking all (residents’) incoming monies within its own accounts. This issue has now largely been addressed with the PCC opening ‘client national accounts’, which are individual accounts operated on behalf of the service users and pays interest. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 28 During the fieldwork visit the inspectors were provided with sight of the new statements provided with these accounts and managed to discuss at length, with the home’s administrators the day-to-day operation of the accounts. One issue that did cause some concern for the inspectors was the fact that monies belonging to clients, whom the PCC act as appointees for, have their money paid to a PCC finance house, whom the home’s administrators are having to approach to draw down service users’ monies before paying it into the ‘client national accounts’. On the day of the visit a senior PCC manager was available to discuss this issue with, as it would appear to the inspectors that clients’ monies, initially, are being paid to into PCC accounts before reaching the client held accounts, which if this is the case is no different than previously was in place. The senior manager undertook to check this out for the inspectors, although he stated he believed both the staff at the finance houses and the administrators had access to accounts set up for each individual. Generally no health and safety concerns were identified with regards to the fabric of the premises (during the tour of the property) and full health and safety policies, etc. are made available to staff by the PCC. However, as highlighted earlier within the report the new care planning process is lacking a moving and handling assessment and plan for use with new and/or current residents. This issue is directly linked to health and safety, as the 2002 manual handling regulations are produced by the health and safety executive (HSE) and are one of a number of regulator instruments devised by the HSE that directly impact on this area. The concern identified within the environment section of this report regarding the lack of control over the temperature within the home should also be considered as a health and safety issue, given there are stated temperatures between which staff should be expected to operate and continuously high temperatures (drier air) can increase the essential loss experienced by service users and may increase dehydration rates. The manager should also review the home’s reporting strategy under Regulation 37, accident reporting being an important instrument for regulators in monitoring trends in falls, injuries, etc. Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 29 Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 30 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation Requirement Timescale for action 15/06/06 2 OP9 3 4 OP12 OP19 Regulation The PCC must ensure that the 13 new care planning system introduced includes moving and handling assessment tools and appropriate risk assessment tools. Regulation The medication administration 13 sheets should be accurately maintained and must contain no unexplained gaps. Regulation Service users must be more 12 involved in generating activity plans to meet their needs. Regulation The concern expressed with 23 regards to the lack of control over the home’s heating system must be addressed, to ensure control is restored to the home. 15/06/06 15/06/06 15/07/06 5 OP29 6 OP38 Details of the action planned to be provided in writing by 15/07/06. Regulation The home’s recruitment and 15/06/06 19 selection procedure must be reviewed to ensure all Schedule 2 information is available prior to employing new staff. Regulation The PCC must ensure the moving 13 and handling tools are provided, DS0000044077.V288225.R01.S.doc Version 5.1 Page 32 Hilsea Lodge as highlighted above. 15/06/06 Regulation 37 reporting must be reviewed, as this is an important tool for monitoring trends in incidents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Hilsea Lodge DS0000044077.V288225.R01.S.doc Version 5.1 Page 34 - 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. 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