Inspection on 14/08/07 for Hilton Park Care Centre

This inspection was carried out on 14th August 2007.

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

Hilton Park Care Centre 09/06/08

Hilton Park Care Centre 10/05/06

Hilton Park Care Centre 02/12/05

Hilton Park Care Centre 25/04/05

Hilton Park Care Centre 09/11/04

Hilton Park Care Centre 14/05/04

Hilton Park Care Centre 10/02/04

Similar services:

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Hilton Park Care Centre Bottisham Cambridge CB25 9BX Lead Inspector Elaine Boismier Key Unannounced Inspection 14th August 2007 9:45 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 Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilton Park Care Centre Address Bottisham Cambridge CB25 9BX 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) 01223 811256 01223 812692 www.barchester.com/hilton Barchester Healthcare Homes Limited vacant post Care Home 93 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (55), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (55), Old age, not falling within any other category (55), Physical disability (23), Physical disability over 65 years of age (15) Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Clients 18 years and over with a physical disability One named person under 65 years of age but over 55 years with dementia (DE) for the duration of their residency only 10th May 2006 Date of last inspection Brief Description of the Service: Hilton Park Care Centre is owned by Barchester Healthcare Homes Limited and is registered as a care home with nursing. The home is situated in the village of Bottisham and is 7 miles from the centre of Cambridge and 6 miles from Newmarket. The home is arranged into four units called Trinity Unit, Churchill Unit, Kings Unit and Queens Unit. There are 91 bedrooms of which 2 provide shared occupancy. All bedrooms have en-suite facilities. The home provides accommodation, support and care, including personal care and nursing care, for people between 18 and over 65 years of age, some of whom have mental health needs and physical disabilities. Current weekly fees range from £535 to £1155. Additional costs include those for aromatherapy and hairdressing. A vacancy has arisen for a registered home manager. Copies of the last inspection report are available in the main foyer of the home or via the CSCI website on www.csci.org.uk Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This summary includes references to information received before the day of the inspection and the day after the inspection. This information has been provided to us from external agencies such as people who work in health and social care services and from information provided at meetings that we have attended. These meetings have been held under the Protection of Vulnerable Adults Against Abuse (POVA) procedures. June to July 2007 On the 8th June, 5th and 23rd July 2007 we attended meetings held under the POVA procedures. These meetings have been held to investigate concerns, made to the home, from an external, confidential source. The allegations made were about the standards of care provided to people living at the home. The home reported these allegations in line with the correct reporting POVA procedures. Investigations have been carried out by all agencies represented at the POVA meetings, including reviews of residents and their care. As a result of these reviews there are serious concerns about the standard of care that has been provided by the home, up to the date of our inspection of 14th August 2007. Inspection 14th August 2007 This report is of the key unannounced inspection that was carried out on the 14th August 2007 by three Inspectors between 9:45 and 16:00 and took 6 hours and fifteen minutes to complete. Whilst assessing the key standards we also focussed on information provided at the POVA meetings, of June and July 2007, and from reviews carried out by health and social care professionals. We assessed what progress had been made by the home since these meetings have been held. We sent out 93 surveys for residents to complete and 12 of these were returned to us. Of the 50 relatives’/visitors’/advocates’ surveys we received 19 of these. The Home Manager completed an Annual Quality Assurance Assessment (AQAA) and information provided in this document has been referred to in this report. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 6 There were 87 people living at the home and a number of these were spoken to. We spoke also to staff, including the Home Manager and Deputy Manager (referred to in this report as the Management Team). We visited three of the four units, namely Trinity Unit, Churchill Unit and Kings Unit. We carried out a tour of the building with the exception of the kitchen and laundry areas. We examined documentation and compared this to our observations of, and discussions with people. Since the POVA meetings we have found evidence to suggest that action has been taken to improve this poor level of care and we have assessed that Hilton Park Care Centre currently provides an adequate quality service. Improvements that have been made are to continue and become part of the care practices of the home to ensure that these improvements are sustained. Should these improvements be sustained by internal management (rather than by reliance on the support from external agencies and/or from requirements being made by us) then Hilton Park Care Centre could return to the previous assessed quality rating of good. For the purpose of this inspection report those living at the home are referred to as “people”, “person”, “resident/s” and “service user/s” What the service does well: What has improved since the last inspection? What they could do better: People must not be admitted to the home unless it is registered to do so. A requirement has been made about this. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 7 Care records including risk assessments must be accurate, detailed and reviewed at least every month if not sooner. A requirement has been made about this. The accuracy of records made when people are given medication must be improved and a requirement has been made about this. Confidentiality about people’s conditions must be maintained at all times. We expect the home to manage this issue. Activities provided at the home should take into account people’s desires and aspirations. We expect the home to manage this issue. People’s choices of how they wish to live are to be respected as much as possible with regards to when they wish to get out of bed. We expect the home to manage this issue. The record of complaints should be made clearer. We expect the home to manage this issue. We must be notified of any untoward incident with regards to a resident. A requirement has been made about this. Lockable facilities on all bedroom doors should be provided. We expect the home to manage this issue. All areas of the home are to be free of offensive odour and to be kept clean. We expect the home to manage this issue. People must have suitable equipment that allows them to call for assistance at any time. A requirement has been made about this. Staff must be competent and suitable to work at the home. We expect the home to manage this issue. An investigation should be carried out to explain the discrepancies between peoples’ personal monies, which are kept at the home, and the associated records. We expect the home to manage this issue. An immediate requirement has been made regarding the prevention of the spread of fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 9 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 Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4 Quality in this outcome area is adequate. There is a good standard of information about the home to assist prospective people in their decision where to live but people’s specialist and cultural needs might not always be considered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine of the 12 residents’ surveys said that the person had enough information about the home before they moved in whereas the remaining 3 people claimed that they did not have such information. The AQAA states, “Hilton Park provides an extensive pre-admission assessment ideally in the prospects own home from which a detailed individual care plan is prepared along with relevant risk assessments. … This assessment Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 11 also reviews the prospective residents needs in relation to MUST and WATERLOW. Following this assessment it is confirmed to the prospect whether a suitable placement can be met”. (Note for the reader: MUST is an assessment tool for nutrition and WATERLOW is an assessment tool for the risk of pressure sores). People’s care records that we saw indicated that pre-admission assessments of prospective residents are carried out before they move into the home. It was noted, however, when examining these records that the home has not been mindful of the categories and conditions of registration. It appeared that the home had admitted at least one, if not more, people, that the home is not registered for. This is an offence against Section 24 of the Care Standards Act 2000. We have made a requirement about this. A relative wrote in their survey, “We’ve never been asked about mum’s religious beliefs i.e. she wants to take part in communion etc.” We discussed this with the Management Team at the time of the inspection and we were informed that communion is held at the home on a frequent basis. The home provides care for people from a range of cultures although we could find no evidence if these people had religious beliefs other than Christian beliefs. We expect the home to consider how a person’s cultural needs, including religious beliefs, are identified and how these can be met. Copies of the report of the last inspection carried out by us were available in the main reception area of the home. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. Some people have, until recently, received a poor standard of health care that has since improved to become that of an adequate standard of care, thereby reducing the level of risk to their health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the AQAA notes, “The pre admission assessment forms the basis for the writing of each residents Care Profile (Care Plan). This is a comprehensive document with contirbutions made by the resident, family members and support specialists. The Care Profile reflects the nursing, personal care, risk management and social needs of the resident. The Care Profile is a living document that is updated on a daily basis and reviewed monthly or as required” it is our expereince at POVA meetings during June and July 2007, and during this inspection, that this is not always the case. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 13 Audits of care plans had been carried out, by Barchester Healthcare Homes Ltd, although a local authority review carried out on 10th July 2007, of a person with complex nursing needs, demonstrated care plans were not up to date and did not contain up to date information. Care plans were found not to be consistent. For example it was unclear to the reader if the person, who was being reviewed, could feed himself or herself or needed assistance with this. The continence assessment for this person had not been updated since April 2007 and there was no care plan for the management of their incontinence of faeces. There were no assessments for the risk of them choking and no care documentation was available with regards to their weight loss. There was anecdotal evidence that a Speech and Language Therapist had been referred to but there was no record of this. Risk assessment for falls had not been updated. The activities care plan was not followed through e.g. the care plan said that the person would like to be taken out into the garden but the person never had been take out. We have been informed by a visiting healthcare professional that short term care plans have not been implemented. Examples given to us include when a person developed hallucinations, had diarrhoea and had pain. There were no care plans developed to provide staff guidance in how this person’s changes of needs were to be met. The AQAA states that, “Residents have access to a wide range of additional healthcare services through the community”. During a review carried out by the local authority, of a person with complex nursing needs, demonstrated however, that this was not always the case. This review showed that that no dietician had been contacted for the person with unintentional weight loss of 9.4kgs between 1st April and 8th July 2007. No weight of the person had been recorded for June 2007. The GP was not informed of person’s vomiting and there was no monitoring of this for trends. The person had been under the care of a Community Psychiatric Nurse (CPN) before moving in to the home but no referral to a CPN had been made, since the person had moved into the home, even though their mental health needs had deteriorated. A POVA meeting was held on 5th July 2007 where it was found that the home had failed to provide proper care for a person who was admitted to hospital. The person’s admission to hospital was partly as a result of this failure to provide proper care. Although care records suggested that care had been carried out with regards to hydration and management of the person’s bowels the person had proven clinical signs that these two areas had not been Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 14 managed appropriately. During this meeting, of the 5th July 2007, we met with the Tissue Viability Nurse (TVN) who confirmed that when she writes a care plan for the home, the care staff follow this care plan without any deviation and as such the TVN had no concerns about this area of care practice that is carried out in the home. However we have been informed since this discussion, by a health care professional that a person had acquired a pressure sore that developed to a grade 4. We were told that there was no recorded evidence that this person had a change of position to relieve pressure to help with healing and promote comfort. During this inspection, of the 14th August 2007, we examined a number of care records and found evidence that, as a result of the POVA meetings and support of the home by the local authorities, some care records, with particular regard to Trinity Unit, had been updated and there was sufficient detail to guide staff in how to meet the specialist needs of people, such as diabetes. We noted however that not all care plans had been reviewed on a monthly basis. Talking to both people and staff we noted that in some instance the care plans did not accurately reflect the person’s condition. For example we were informed in the care plan that the person we had visited could move both arms and hands and they could communicate, by voice, in a clear way. We found that this was not the case. Care records that were seen on Churchill Unit were of a good standard although there was a lack of detail about the person’s interests and social needs. There was clear evidence that people had been consulted about their care plans. Risk assessments had been carried out and recorded and those risks assessments identified by care managers following reviews had been implemented. We noted however, during the tour of the premises, a person had a hot water bottle in their room. The care plan told us that this person was dependent on staff to provide all their care needs. There were no assessments for the use of this hot water bottle, to identify the risk and the occasions when the person needs this. Where care plans had been reviewed it was not possible to determine if these reviews were meaningful as there was no record of what these reviews consisted of. This might be attributable to the current paperwork used by Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 15 Barchester Healthcare Homes Ltd. We have made a requirement, based on the evidence provided before and during this inspection, for risk assessments to be carried out and recorded and care plans to be accurate, detailed and reviewed each month if not sooner. We compared care plans with care records of some of those people who had acquired pressure sores, either in the home or elsewhere. We noted that people were receiving pressure area care according to the care plan and there was evidence that the pressure sores either had remained the same without deterioration or were showing signs of healing. People who had been identified as at risk of dehydration had records to indicate when they had been offered drinks and the amount of drinks taken. These amounts that were recorded were sufficient to prevent the risk of dehydration. We examined the care records of a person identified to be at risk of unintentional weight loss. Following a recent review by the local authority, we noted that a community dietician had been contacted and as a result of this contact and subsequent assessment by the dietician of the resident, we saw that this person had gained weight and that their weight was currently stable. Eight surveys for relatives’, carers, and advocates said that the home always provides the level of support that is expected by the person; eight surveys for relatives’, carers, and advocates said that the home usually provides the level of support that is expected by the person. Five people in the residents’ survey considered that they always received medical attention if they needed it; 3 people in the residents’ survey considered that they usually received medical attention if they needed it; one person in the residents’ survey considered that they sometimes received medical attention if they needed it; the remaining person considered that they never receive medical attention when they needed it. Three residents’ surveys said that the person always received the care and the support that the person needed; 7 of the residents’ surveys said that the person usually received the care and the support that the person needed; one person in the residents’ surveys said that sometimes they received the care and the support that they needed. A Specialist Pharmacist Inspector inspected practices and procedures for the safe handling and use of medicines. There are clear written procedures for the handling of medicines to safeguard residents. Each unit has dedicated and independent storage for medicines. Facilities provided for the storage of Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 16 medicines were adequate and in all areas the temperature of the storage rooms were adequately controlled and regularly monitored. Stocks of medicines in use were minimal but in one unit some medication, which is used by staff to treat common ailments without the need to call a doctor, were out of date. There are good records of the receipt and disposal of medicines providing a clear audit trail but the records made when medicines are administered to residents must be more accurate. There were a number of records in Churchill unit that did not clearly indicate whether medicines were administered or not. When medicines are given in variable doses e.g. “one or two tablets”, the record did not clearly indicate the quantity given. Such a record is important to make sure that residents do not receive too much or too little medication for their needs. When residents regularly refused to take their medication, this needs to be reported to the GP. In once case there was no record made that this was the case although nursing staff reported that it had been done. A relative of a resident said in their survey that the home “Treats everyone with respect and compassion.” Another relative in their survey told us “…care staff are very caring and respect my mother’s dignity at all times.” During this inspection we saw that staff interacted with people in a respectful way and people told us that staff were respectful. We saw that personal care was provided in a way that respected the person’s privacy and dignity Another resident provided us with confidential information about residents’ formal diagnoses. We were informed that they had obtained this information from staff. We expect the home to remind staff about maintaining confidentiality, rather than we make a requirement at this stage. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. People’s quality of life could be better with an increase in in range of suitable activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six people in the residents’ survey considered that the home always provided suitable activities; 2 people in the residents’ survey considered that the home usually provided suitable activities; 2 people in the residents’ survey considered that the home sometimes provided suitable activities. The AQAA notes that, “A wide range of activities is available throughout the home and family and friends are encouraged to attend. There are 2 vehicles available for residents to be taken out on trips, one of which is wheelchair accesible.” A comment received in a survey for relatives, carers and advocates said, “Hilton Park is ‘home for the residents due to the very hard work done by the Activities Co-coordinator and also the hairdresser.” A relative in their survey suggested that the home could improve by providing, “Possibly more out of home activity.” Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 18 Discussion with people and examination of their care records indicates that the range of activities attended was limited. Activities that we saw recorded were limited to watching television and DVDs, particularly for those people living in Churchill Unit. One person told us that they had previously grown their own tomatoes but no opportunity had been provided to them this year. We noted also that there is a range of activities provided although it was not clear from the records that we had seen if any of these had been attended. Information about the availability of activities was seen in those bedrooms that we had visited. We discussed our findings with the Management Team and we were informed that it is their intention to improve the activities within the home. We expect to see an improvement in this area of care at a later inspection. A relative of a resident said in their survey that the home, “Make (sic) friends and family very welcome.” We saw people receiving guests in the home and one of the visitors told us that they had just finished playing a game of bingo whilst visiting. We saw records of people’s contacts with their families and friends and people confirmed that they received guests where they liked and are able to visit families and friends outside of the home. Examination of their care records indicated that they are supported in making friends, and supported in sustaining the friendships. People considered that generally they were offered choice of how to live their lives. It was notable, however that recorded choices of times when the person chose to get out of bed were not respected. For example we found the person in bed at 11:20 although the care plan stated that the person liked being out of bed between 7:00 and 7:30. Another person told us that they were assisted out of bed when staff came to their room, rather than at a preferred time. People stated that they were able to choose the clothes that they wanted to wear. In one of the surveys for relatives, carers and advocates we received the following comment, “Food could be improved, not always hot and sometimes burnt.” In other surveys we were told that the food was “Good” as was the choice of food. Four people in the residents’ survey said that they usually liked the food; 5 people in the residents’ survey said that they sometimes liked the food; one person in their survey said that they never liked the food. People who were spoken to said that the food was good. We saw people eating breakfast and lunch whilst seated in the atrium area of the home. Tables were pleasantly presented with tablecloths and flower decorations. People were eating their meals in a leisurely manner and food that was offered, including vegetables and desserts, were appetising. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 19 The AQAA notes that “Our chef prepares fresh home cooked food on a daily basis and a number of choices are available at each mealtime. A wide range of dietary needs can be met and all meals are served with a selection of drinks. According to the AQAA improvements that have been made include an introduction of new cold drinks service and new coffee bar in the Atrium and an improved selection of desserts at mealtimes and more home made sweets. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. People are generally listened to but have not always been safe from the risk of abuse due to poor recording of complaints and reporting of allegations of abuse. Some improvement has now been made in these areas but still could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people in the residents’ survey said that they always knew who to speak to if they were unhappy about something; 6 people in the residents’ survey said that they usually knew who to speak to if they were unhappy about something; 2 people in the residents’ survey said that they sometimes knew who to speak to if they were unhappy about something. People we spoke to said that they knew who to speak to if they were unhappy about something. One of these people felt that he was not being listened to. We observed that on the day of the inspection this person’s complaint had been responded to. Seven of the people in the residents’ survey said that they knew how to make a complaint although 5 people in the residents’ survey said that they did not know how to make a complaint. The majority of surveys for relatives’, carers, and advocates said that the person knew how to make a complaint. Ten of these surveys said that the Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 21 home had always responded to their concern appropriately; 5 of these surveys said that the home had usually responded to their concern appropriately. Seven residents’ surveys said that staff always listened to the person and acted on what was said to them; one residents’ surveys said that staff usually listened to the person and acted on what was said to them; 2 residents’ surveys said that staff sometimes listened to the person and acted on what was said to them; one person in the residents’ survey considered that staff never listened to the person, “…because they don’t understand English properly.” (See Standard 27 of this report). Information provided by the Manager in the AQAA notes that 9 complaints have been received in the last 12 months and 88 of these have been resolved within 28 days. Five of these 9 complaints were proven. An examination of the record of complaints was carried out. It was not always clear when complaints had been received, what elements of the complaint had been made, what the responses were to the complaints and whether the complaints were proven or otherwise. We expect this to be managed by the home, rather than we make a requirement at this stage. During the POVA meetings held in June 2007 it became clear that the home had not followed correct recording and reporting procedures when a complaint had been made, in September 2006. POVA reporting procedures had not been followed by the home after an untoward incident had occurred, in May 2007, between two residents. We reminded the home what they needed to do. These omissions and our concerns were shared with representatives of the home during these meetings. Following this we received notification of this untoward incident, of May 2007, that had occurred between 2 residents. However this improvement has not been sustained. On the day of this inspection of 14th August 2007, we were informed, by the local authority, of incidents of allegations of abuse that had occurred two days before the inspection. The day following the inspection we spoke to the Deputy Manager and we received confirmation from the local authority that the home had followed correct reporting POVA procedures and had taken some action to reduce the risk of further (alleged) abuse. Nevertheless we had not been informed of these untoward events and as a result of this a requirement has been made. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 22 In the surveys for relatives, carers and advocates we received comments about people’s personal laundry. One person considered that the home could improve by “Taking care of my mother’s clothes, sometimes they get lost.” Similarly a relative in their survey also suggested that the home could improve, as “Some clothes get lost even when marked with one owner’s name.” The Management Team reported to us that they were aware of these issues and had taken action to rectify the situation. Examination of the staff training matrix indicated that staff attend training in POVA and this was confirmed by speaking with staff themselves. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 & 26 Quality in this outcome area is adequate. People live in a home that is welcoming and comfortable and generally wellmaintained. People are sometimes placed in a vulnerable position due to reduced access to call bells. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative of a resident said in their survey that the home could continue to improve accessibility to all areas of the home to the outside areas “….from patio doors in patients’ rooms.” Another relative in their survey told us that, “I feel that every effort has been made to make the building bright, interesting and stimulating.” The AQAA notes that an improvement could be made in this area and that Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 24 within the next 12 months it is the intention of the home to provide new pathways to the gardens. This was also confirmed by the Management Team at the time of the inspection. The AQAA notes also that within the last 12 months there has been an improvement in the home environment that includes, a new seating area near to the laundry area that is wheelchair accessible; there is Sensory Herb Garden and a new secure entrance to Trinity Unit has been built. On the day of the inspection the home was well furnished and had a welcoming atmosphere. There was evidence that redecoration was ongoing. During the visit to Churchill Unit we noticed that none of the bedroom doors had locks provided. Following the inspection, we made a telephone call to the home and we were told that plans had been made to replace these bedroom doors although it appeared from the conversation that these plans had been made a while ago and nothing had happened. We expect that this issue is managed by the home to ensure that all bedrooms doors are provided with a lockable facility. A person told us in their survey “I wait long time for transferring because somebody using the same hoist like me. We have only one big hoist on our floor.” We received a similar comment in a survey from relatives, carers and advocates that said, “They don’t have enough hoists and have to wait for long periods to get on/off commode.” During the tour of the premises we saw a number and range of hoists and people, when calling for assistance to be transferred, were responded to in a timely manner (we timed it to be less than three minutes on two occasions). During the tour of the premises we visited a number of bedrooms and spoke to residents. Some but not all of the people had their call bells to hand. A requirement has been made about this. Five people in the residents’ survey said that they considered the home was always clean and fresh; 6 people in the residents’ survey said that they considered the home was usually clean and fresh; one person in the residents’ survey considered the home was sometimes clean and fresh. On the whole the home was clean and fresh although we noted smells of stale urine that was evident in one of the bedrooms and the carpet was heavily stained. We expect the home to manage this, without a requirement being made at this stage. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. People have been placed at risk to their health and welfare due to the level of competencies of nurses. People are generally protected from the risk of abuse from staff and are provided care from staff who receive an improved standard of training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven residents’ surveys said that staff were usually available when the person needed them and 3 residents’ surveys said that staff were sometimes available when the person needed them. One person wrote, “Sometimes I need to wait 30 min to used (sic) the commode. Sometime (sic) it’s (sic) not enough staff.” Another person wrote in their survey, “I have to wait long time with my buzzer get answer (sic).” We spoke to people and they told us that sometimes they felt “rushed” by care staff. At the time of the inspection we timed the response of care staff in responding to call bells. The response time was less than three minutes. Staff considered that they had enough staff to meet the needs of the people, including escort duties for residents going out of the home. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 26 We shared the views of people with the Management Team and it was considered that responsiveness of staff to meet people’s needs and their requests might be hampered, not by lack of staff, but by the organisation of staff. We expect the home to manage this issue. Seven surveys for relatives’, carers, and advocates said that the staff always have the right skills and experience to look after people properly; eight surveys for relatives’, carers, and advocates said that the staff usually have the right skills and experience to look after people properly. During the POVA meetings of June and July 2007 we considered that due to the poor outcomes of people and poor assessments and poor record keeping that these findings cast doubts on the competencies of nurses when caring for people with complex medical and nursing conditions (see also standard 7 & 8). Comments made in the surveys were sometimes related to communication and language abilities of staff who do not have English as their first language. Such comments included, “The only comment I can make here is the problem with language….Some …. dialects are difficult to understand….” and “Some care staff do not have a good grasp of the English and it is difficult to get them to understand what is wanted/needed.” We spoke to people about the views on staff and we were told that they could understand what staff were being told to them. We observed that the majority of staff, who do not have English as their first language, could understand what we said to them and we could understand what they said to us. We observed there to be an exception to this and reported this finding back to the Management Team. We stated that although this person was not a member of care staff, there is a risk to residents, due to language difficulties, when any member of staff comes into contact with people who live at the home. We expect that the home takes this into account when recruiting staff to work at the home. We acknowledge that the home has recruited staff from overseas to match residents’ communication needs where English is not their first language although the staff recruited did not have knowledge of the dialects that the residents had. The AQAA notes that 71.7 care staff have NVQ level 2 qualification in care and 4 care staff are working towards this qualification. Examination of three staff files indicated that the home has a generally good recruitment procedure and an audit of staff files has been carried out. We noted in one of the files that gaps in employment history of one person had Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 27 been identified from this audit. We noted that in one other file that all required information was available with the exception of satisfactory confirmation of a nurse’s current registration. We expect the home to take action to ensure that all files comply with the regulations to contain full and satisfactory information about people working at the home. The AQAA notes also that staff receive, “Specialist training in Infection Control, Moving and Handling, Personal Care, Dementia Training, POVA, Fire, Health & Safety, Food Hygiene amongst others”. According to the AQAA 65 staff have attended training in infection control. Speaking to staff and examination of the staff training matrix indicates that staff attend training in a range of subjects. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 35 & 38 Quality in this outcome area is adequate. People benefit from a home that is adequately managed but could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA notes that, “The home is managed by an experienced Home Manager with over 3 years experience in Senior Care and over 20 years management experience in the hospitality industry”. He informed us at the time of the inspection of his intention to apply to be registered as the Manager for Hilton Park Care Centre. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 29 Minutes of the last two residents meetings were seen and residents’ views and opinions about subjects such as food, equipment and staffing were recorded and who was to be responsible in taking action in response to the person’s views. During the meetings and contacts with the Management Team, including during this inspection, we have found that there is an open and positive approach in responding to people’s views and suggestions. We receive copies on a monthly basis of reports of visits of the home carried out by a representative of the Company and, as noted in the AQAA, “The Company also has a compliance team who carry out audits, both announced and unannounced, in line with the NMS and Care Home Regulations.” During a POVA meeting we posed a question to representatives of Barchester Healthcare Homes Ltd about the existing internal audits of the home, including audits of care records. We expressed our view, during this meeting, that we expect that quality assurance systems are robust, to identify issues before they become subject to POVA investigations and without requirements being made by us to drive up improvement. The Management Team explained that views of people are taken and that action is taken in response to these views. The Management Team suggested that where concerns are made then these might be considered transferring these to the record of complaints. The AQAA, which we have received before the inspection, was detailed and showed areas where there is a system in place for self-auditing and areas where the home could improve upon. Three people’s personal monies, which are kept by the home for safeguarding purposes, were counted and compared to the record of the balances. One of the three monies reconciled with the balance. The two remaining monies indicated that one person had £2 at least more than the record said that they should; the second person had £25 less in there money that was available than what the associated records said that they should have had. We checked the records with a member of staff and we noted that there were errors in the record keeping, although because of the inaccuracies we were unable to tell if people’s monies are truly safeguarded by the home. We expect that action is taken by the home to investigate this issue, rather than we make a requirement at this stage. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 30 The AQAA notes that staff receive, “Specialist training in Infection Control, Moving and Handling, Personal Care, Dementia Training, POVA, Fire, Health & Safety, Food Hygiene amongst others” and “First Aid Training Courses - we have 12 First Aiders covering shifts and in addition our Administrator has attended 4 day course.” The AQAA aso notes that 75 of catering staff and 87.5 of care staff have attended training in safe food handling. We spoke to staff and examined the staff training matrix and identified that staff have recently attended training in first aid procedures and how to care for a person with difficulties in swallowing. An immediate requirement was made as a number of fire doors were held open by methods other than those approved by the fire safety officer. Items used inluded a metal object, an item of furniture and disposable paper towels. Records for checks on temperatures of hot water (that is accessed by residents), fire training, fire drills, fire alarm checks and emergency lighting checks were seen and these were satisfactory. Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 31 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 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x 2 x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 2 x x 3 Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 32 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 OP4 Regulation S 24 CSA 2000 15 Requirement Service users must not be admitted outside categories of registration unless the home is approved fit to do so. Service users must be protected from harm to their health and safety by the keeping of detailed, accurate and current care records. Complete and accurate records must be kept of all medication administered, or not, together with a reason why the medicine was not given, in order to demonstrate that service users receive the medicines prescribed for them. Notifications of untoward incidents, such as allegations of abuse, must be made, to ensure the protection of service users. Service users must be provided with suitable equipment that enables them to call for assistance at any time. Service users, visitors and staff must be protected from the risk of fire at all times. Timescale for action 15/08/07 2. OP7 30/09/07 3. OP9 13(2) 30/09/07 4. OP18 37 15/08/07 5. OP22 16(2)(c) 15/08/07 6. OP38 23(4)(c)(i) 14/08/07 Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 33 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 Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Cambridgeshire and Peterborough Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hilton Park Care Centre DS0000038514.V347698.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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