Inspection on 21/03/06 for Hilton Brook House

This inspection was carried out on 21st March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Hilton Brook House 05/02/08

Hilton Brook House 28/09/06

Hilton Brook House 08/07/05

Hilton Brook House 22/09/04

Hilton Brook House 28/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Hilton Brook House Hilton Bridgnorth Shropshire WV15 5PE Lead Inspector Keith Salmon Announced Inspection 21st March 2006 09:30 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 Hilton Brook House DS0000020716.V275891.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. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hilton Brook House Address Hilton Bridgnorth Shropshire WV15 5PE 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) 01746 716577 NONE Mr Dennis Jones Mrs Jennifer Grace Jones Mrs Jennifer Grace Jones Care Home 31 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (21), Physical disability (1) of places Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 31 Service Users, of which no more than 9 Persons may be suffering from Dementia, 1 Person may have a Physical Disability, and the remainder being Older Persons. 8th July 2005 Date of last inspection Brief Description of the Service: Hilton Brook House is a residential Home situated in the village of Hilton, near Bridgnorth, South Shropshire. Owned by Mr. Dennis Jones and Mrs Jenny Jones, who is also the Registered Manager, it is registered to provide care for a maximum of 31 older people, up-to nine of whom may have dementia. Having been considerably extended and converted, the Home provides accommodation comprising 19 single bedrooms (5 en-suite) and 6 double bedrooms, located over two floors with the upper floor being accessed via two passenger lifts. The Home benefits from pleasant, well-maintained, easily accessible gardens offering open views across neighbouring countryside. Residents can also enjoy the use of Mr and Mrs Jones’ own garden, which adjoins the Home, where there are a variety of pet animals and birds. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Announced Inspection commenced at 09.30, lasted 4.5 hours, and was undertaken by one Inspector. The aim of this Inspection was to assess progress made by the Home in meeting ‘Requirements’ cited at the previous Inspection and all ‘key’ Standards not addressed at that time. This Report is a product of discussions with the Owner/Manager, Mrs. Jennie Jones, several members of Care Staff, 7 Residents and 2 Relatives, together with observations made during a tour of the Home. In addition, a review of documentation/records was undertaken, including Resident’s Care Plans, Staff recruitment/deployment records, and a range of documents/ records reflecting the general operation of the Home. Good standards of direct care are provided in an open, well organised and supportive atmosphere, all of which were reflected in written comments set out in ‘Comment Cards’ completed by Residents (11), with the assistance of a visitor from the local Church, Relatives/Visitors (6) and visiting Clinical Professionals (2). Comments made included: - “…Our relative is well looked after and is very happy here”, “…We all look forward to our food and if we don’t fancy something Cook does something we do like”, “…Hilton Brook House has always contributed positively to the effective care management of clients with mental health needs”. What the service does well: What has improved since the last inspection? Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 6 Since the previous Inspection the Home has changed the allocated function of each of the three main communal areas. Prior to this change communal provision comprised two separate lounges and one large dining room. The Home now has three combined lounge/diners. Discussion with Residents, Visitors and Staff strongly supported the view the change was for the better, in that the new arrangement was ‘more homely’ and also lends itself to the more effective meeting of the care needs of the differing client groups within the Home. Observation at the time of the visit suggested there is no detriment to the effective deployment of Staff. At the beginning of March 2006 a new (replacement) passenger lift was installed and commissioned – the Home now benefits from two passenger lifts. What they could do better: 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. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 7 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 Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 8 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): These Standards were not fully assessed at this Inspection. EVIDENCE: Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 9 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): 7,8,9,10 The model of Care Plan utilised by the Home is of good design and generally effective in aiding provision of care pertinent to Residents’ assessed care needs. Staff relate to Residents in a friendly and respectful manner. Practices relating to storage, administration and disposal of medicines are in accordance with accepted good practice. EVIDENCE: A review of 8 randomly selected Residents’ Care Plans showed them to be well organised, current, clearly written and to comprehensively encompass the range of ‘care areas’ necessary to ensure delivery of care appropriate to the needs of each Resident. Three ‘Requirements’ were cited at the previous Inspection with regard to shortfalls in the care planning documentation. Specifically, these related to the signing and dating of written entries, the need for the deployment of a recognised tool to assess risk of pressure sore development and the need to record dietary intake. All of these issues have been effectively addressed and the ‘Requirements’ are considered met. A review of medicine storage provision and medicine administration records demonstrated the Home’s practices meet the guidelines of the Royal Pharmaceutical Society. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 10 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): 13,14,15 Where Residents’ capabilities permit, the Home works with Residents to enable good contact with family and friends, and the continuation of preferred leisure, social and religious activities. The Home provides nutritionally balanced meals based on the type of food preferred by the Residents. EVIDENCE: Visitors who spoke with the Inspector, and ‘Comment Cards’ received, confirmed they are always made welcome at the Home and are kept well informed regarding the well-being of their Relative/Friend. The Home provides a printed menu, the contents of which appeared well-balanced, nutritious and varied. Residents were unanimous in their comments that the food was plentiful and to their liking. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 11 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): 16,18 The interests of Residents are protected through ready access to the Home’s Complaints Procedure and information relating to advocacy services. Staff are clearly aware of their role in protecting Residents from abuse. EVIDENCE: There are policies and procedures in place to facilitate protection of vulnerable people, which meet the requirements of this Standard, e.g. posters relating to the complaints procedure and local area adult protection information are prominently displayed in communal areas of the Home. Evidence was observed in Staff files confirming this topic is covered at induction and through on-going staff training. The Report from the previous Inspection noted the local Area Adult Protection Procedure had been initiated following a reported incident within the Home. The recommended outcome was for Staff to receive training in dealing with ‘challenging behaviour’ – this has been completed. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 12 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): 19,20,22, 23,25,26 Whilst Residents live in a generally safe, well-maintained and clean environment, there is the possibility of risk to some Residents from hot water outlets which are not thermostatically regulated. Generally, bedrooms meet the requirements of Residents’ individual needs with Lounge/Dining areas offering a pleasant ‘domestic’ ambience. Specialist equipment is available to facilitate provision of care consistent with the needs of Service Users. The standard of cleanliness in the Home is generally excellent. EVIDENCE: The tour of the Home demonstrated the communal rooms and bedrooms are comfortably furnished, in good decorative order and provide a clean, warm and welcoming atmosphere. The Home has recently changed the allocated function of the three main communal areas. Whereas, previously this comprised two separate lounges and one large dining-room, there are now three combined lounge/diners. Residents, Visitors and Staff strongly supported the view that the change was for the better, creating a ‘more homely’ environment which also lends itself to Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 13 more effectively meeting the care needs of the different client groups within the Home. Since the previous Inspection an old lift, which had a reported tendency to break down, has been replaced and fully commissioned. Testing a number of hot water from taps, situated on wash-hand basins in bedrooms, found the water temperature to be above the accepted temperature of ‘about 43o Celsius’, and that the taps were not fitted with thermostatic regulators. It is a ‘Requirement’ of this Inspection that thermostatic valves must be installed to regulate all hot water outlets, accessible to Residents. Given that this may take some time, and involve unplanned expenditure, it is acceptable for the work to be incorporated into the Home’s Building Works Programme. However, it is also a ‘Requirement’ that risk assessment to determine which Residents may be at risk from accidental scalding is undertaken, and taps directly accessible to those Residents e.g. in bedrooms should receive thermostatic valves as soon as possible. The remainder are to be fitted in accordance with the ‘works programme – a copy of which must be submitted to CSCI for agreement. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 14 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): 27,29,30 Staff numbers and skill-mix on duty were consistent with those shown on the rota, and were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are consistent with safeguarding Residents. The commitment of the Home to providing training for Care Staff is excellent. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. Staffing numbers and skill-mix enable a service provision, which meets the care needs of Service Users. Observation suggested there is no detriment to the effective deployment of staff arising from the recent modification in function of the communal lounge/dining areas. Staff Personnel Files demonstrated evidence of full compliance with the Standard/Schedule 2 of the Regulations, and further confirmed Staff are subject to a thorough, relevant orientation/induction programme. This is then supplemented by a comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’, ‘health and safety’, ‘first aid’, ‘challenging behaviour’. In addition, the Home enjoys an excellent record for the continuing development of Care Staff, and for supporting Staff in undertaking appropriate training, based on a well-structured plan for determining individual training needs. The current very high level of NVQ Level 2 attainment (72 of Care Staff) reflects a very positive approach to enabling skills development. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 15 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): 32,33,36,38 The Home has excellent leadership from the Owner/Registered Manager who, in turn, is well supported by a fairly recently appointed Deputy Manager, and several longstanding and experienced Care Staff. Operationally, the Home is very well organised and provides an ambience, which is warm, friendly and inclusive. Staff are subject to effective support, with regular supervision, and appeared involved and happy in their work. There is evidence some Residents may be at risk from accidental scalding. EVIDENCE: Residents and Staff were observed to approach the Manager with a range of issues, which were received in an interested manner. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and COSHH data sheets are up-to-date. Staff personal records showed evidence of regular ‘supervision’. The testing of hot water from taps situated on wash-hand basins in bedrooms found the water to be 10o Celsius Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 16 above the accepted level of ‘about 43o Celsius’ and said taps were not fitted with thermostatic regulators. (See Standard 25 above). Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 X 2 3 STAFFING Standard No Score 27 3 28 X 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 3 X 2 Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 18 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 OP25 Regulation 13.(4)(a)(c) Requirement Timescale for action 14/04/06 2. OP25 13.(4)(a)(c) 3. OP25 13.(4)(a)(c) To complete a ‘risk assessment’ survey of all hot water taps in Residents’ bedrooms to determine which Residents are most at risk from accidental scalding. Then as determined above, and 12/05/06 as a priority, to undertake the fitting of thermostatic regulator valves to hot water taps on wash-hand basins in the bedrooms of those Residents most ‘at risk’. To submit to CSCI, for 14/04/06 agreement, a ‘works’ programme proposing a time frame that completes the installation of thermostatic regulator valves to all hot water taps accessible to Residents. Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 19 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 Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Hilton Brook House DS0000020716.V275891.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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