Inspection on 08/07/05 for Hilton Brook House

This inspection was carried out on 8th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 21/03/06

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 Hilton Bridgnorth Shropshire WV15 5PE Lead Inspector Rosalind Dennis Unannounced 8 July 2005 10.30 th 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 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 E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hilton Brook Address Hilton, Bridgnorth, Shropshire, WV15 5PE Telephone number Fax number Email 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 Mr Dennis Jones Mrs Jennifer Grace Jones Older People 31 Category(ies) of Dementia (9) registration, with number Old Age (21) of places Physical Disability (1) Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) The home may accomodate a maximum of 31 service users, of which no more than 9 persons may be suffering dementia, 1 person may have a physical disability and the remainder being older people. Date of last inspection 22/09/04 Brief Description of the Service: Hilton Brook House is a residential home situated in the village of Hilton, South Shropshire. It is owned and managed by Mr and Mrs Jones and is registered for 31 older people. Nine of these places are specifically for older people with dementia. The home has been considerably extended and converted to provide the current level of accommodation. The upper floor is available via a passenger lift. The gardens outside Hilton Brook are pleasant, well maintained and easily accessible. Residents also have the use of Mr and Mrs Jones garden, which adjoins the home, where there are a variety of pet animals and birds. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 8th July 2005 and lasted for a period of five hours. The inspection involved a tour of communal and individual bedrooms, observing activity within the home, looking at care records and observation of documents. The inspector spoke with five residents and four members of staff that work at the home. The manager was on duty at the time of inspection and offered her co-operation throughout the inspection. The inspection was undertaken in response to a complaint raised via the local adult protection procedure and is still under investigation. A recent incident also raised via the local adult protection procedure has been concluded with a satisfactory outcome. What the service does well: What has improved since the last inspection? What they could do better: Care plans are drawn up with residents, however the home is required to ensure that they are signed and dated by staff and kept securely within the home. The home is required to assess each resident’s skin using a recognised skin assessment tool and record all residents dietary intake in order to demonstrate that it is meeting the nutritional needs of residents. Four requirements and six recommendations were made at this inspection. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 6 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 E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 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 standard(s) 3 and 5. The home has an admission procedure that is effective in ensuring that individuals moving into Hilton Brook House know that the home will meet their needs. EVIDENCE: The manager assesses all prospective residents prior to admission to the home, observation of the daily living and needs assessment contained within care files confirmed this. The care plans contained within each file reflected the most of the residents assessed care needs and there was evidence within two of the files to confirm that the resident and their significant other had been involved in the care planning process. Trial visits to the home are also encouraged and this was confirmed through discussion with one resident who also commented on how the staff had made her feel welcome during her recent admission to the home. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 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 standard(s) 7 and 8. Residents have care plans in place that are written in a personalised way, however by not having a complete range of risk assessments, staff may not be provided with all the information they need to meet the residents needs. By not maintaining records of diet taken by residents, the home is unable to demonstrate that it is meeting the nutritional needs of residents EVIDENCE: Four care files were examined. Care plans contained within each file are computer generated, written in a personalised way and reflect the residents initial assessed care needs. There was evidence within two files to confirm that the resident and their significant other had been involved in the assessment process. Not all documents contained in care files had been signed or dated by staff, for example care plans had been signed by the key worker but the actual date of signing had not been entered and a falls monitoring form had not been signed or dated by staff. The procedure for care planning and reviews was discussed with the manager as it was observed that all care plans had been reviewed on a monthly basis up Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 10 until May 2005 but had not been reviewed in June. The deputy manager left the home recently and prior to leaving was responsible for monthly care plan review, the procedure for which was for care staff to verbally feedback their views on residents care and this was then entered into the care file by the deputy manager and/or a new care plan generated. Residents are allocated a key worker and it is recommended that the key worker take responsibility for care plan review, as they are the person directly involved in the day-to-day care of the resident. It is also recommended that a more factual account of the care given is included in the daily report sheets rather than the phrase “as per care plan”. Risk assessments for falls and moving and handling risk assessments were present on the files seen. Reference to susceptibility to pressure sores is recorded in the care plan however a separate skin assessment is required on admission to the home and reviewed on a regular basis. The home does not currently maintain records of the actual diet taken by residents and this was discussed with the manager for staff to commence monitoring dietary intake with priority placed on commencing records for those residents that are unable to communicate their needs. The residents weight charts show that most residents are weighed monthly however gaps in some records were noted and the manager was advised to record the reason for not weighing individual residents. The manager is also advised to enhance the procedure for nutritional screening such as through the introduction of a recognised nutritional screening tool. Care staff document in the daily records when healthcare professionals visit the home such as the residents GP. District Nurses maintain a separate file that confirms that they attend the home on a regular basis. Five residents that were spoken with confirmed that staff treated them well and commented positively about the care they receive. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 The home provides social and recreational activities that provide variation and interest for people living at the home. EVIDENCE: Observation of the activity notice board in the reception area demonstrates that the home provides a range of activities in-house for residents to take part in if they choose. An external entertainer visited the home during the inspection, residents commented that they had enjoyed the session and one resident commented that the session was not long enough. Other residents reported that they had chosen not to take part, preferring instead to sit quietly knitting in another lounge and that staff had respected their decision not to take part. It is advised that a record is kept of attendance/non-attendance at activities. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 The arrangements for the protection of residents from abuse are satisfactory. EVIDENCE: The home has a policy in place with regard to the protection of adults from abuse and a copy of the local area adult protection procedure was observed to be readily available within the home. Four members of staff confirmed that they would report any allegation or suspicion of abuse immediately and through discussion with the inspector demonstrated their awareness of the adult protection policy including whistleblowing The local area adult protection procedure has been initiated and followed for one recent incident within the home, the recommended outcome of which is for staff to receive training in dealing with challenging behaviour and the manager is in the process of arranging this in-house. A recent complaint raised via the adult protection procedure is still under investigation. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 The home provides residents with a safe, well-maintained environment in which to live. EVIDENCE: The home has completed maintenance work identified at the last inspection including the instillation of a second lift to improve access to the first floor. The home offers 19 single bedrooms and 6 double bedrooms, which have adequate screening to maintain privacy and are personalised depending on residents wishes. Individual and communal rooms were decorated to a satisfactory standard and residents spoke of their satisfaction with their bed– rooms. The home has fitted fire resistant floor covering and an extractor fan in the reception area, which is the area provided for residents that smoke. The inspector was surprised that this is the designated area for smoking as it is the main entrance to the home; the manager reported that it had previously been agreed with CSCI. The manager is advised to keep this under review, as the smell of cigarette smoke was noticeable in the main corridors of the home. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 14 The sign on the door which offers an alternative entrance to the home for people that do not smoke should be enlarged and consideration given to moving the visitors book to a designated non-smoking area. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 30. The home employs appropriately skilled staff to meet the needs of residents. EVIDENCE: Observation of the training matrix and discussion with the manager demonstrates that staff are supported in achieving their NVQ Level 2 and some staff are in the process of studying for or have attained NVQ Level 3. Training in safe working practice topics has been provided and in meeting residents specific needs such as dementia care. Induction training meets the required level. One member of staff that has recently started work at the home confirmed that staff do not ask or expect her to complete any tasks that she has not yet received training for, such as the moving and handling of residents. Discussion with three members of staff was positive regarding training opportunities provided by the home. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 By not ensuring that records are kept securely, the home is unable to provide documentary evidence that the care received during one resident’s stay at Hilton Brook was satisfactory. EVIDENCE: Care records in general were well organised. As previously mentioned in this report care plans had not been updated for one month and although it is acknowledged that there has been some changes in the management structure it was discussed with the manager that alternative systems must be put in place to rectify this deficit. Complete care records for one resident recently admitted to hospital could not be located within the home and an immediate requirement notification was subsequently issued as the inspector was unable to evidence the care that had been given during the residents stay at Hilton Brook. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 17 Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x 1 x Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 19 No. Are there any outstanding requirements from the last inspection? 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. 2. Standard 7 8 Regulation 15, 17. 13 (4) Requirement The registered person must ensure all care documentation is signed and dated by care staff. All residents must be assessed using a recognised skin assessment tool on admission and on a regular basis. Records must be kept of residents dietary intake. Records required by regulation must be kept securely within the care home. Timescale for action 8/10/2005 8/10/2005 3. 4. 8 37 Schedule 4 (13) 17. 8/10/2005 Immediate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 7 8 8 Good Practice Recommendations It is recommended that the care staff involved in the residents care take responsibility for reviewing care plans. A factual account of the care given should be recorded in the daily report sheet rather than the phrase as per care plan. If it is not appropriate to weigh a resident then the home should record the reason why the resident has not been weighed. The registered person is advised to consider introducing a E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 20 Hilton Brook 5. 6. 12 19 recognised nutritional screening tool for residents. The home is advised to maintain a record of residents attendance/non attendance at activities. The registered person is advised to keep under review the area provided for people that smoke, enlarge the sign on the door directing people to an alternative entrance to the home and move the visitors book to a designated nonsmoking area. Hilton Brook E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 2nd Floor, St Davids Court Union Street Wolverhampton WV1 3JE 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 E56 s20716 Hilton Brook v237900 UI 080705 Stage 4.doc Version 1.40 Page 22 - 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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