Inspection on 09/06/08 for Hilton Park Care Centre

This inspection was carried out on 9th June 2008.

CSCI found this care home to be providing an Adequate service.

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 14/08/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Hilton Park Care Centre Bottisham Cambridge CB25 9BX Lead Inspector Elaine Boismier Unannounced Inspection 9th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hilton Park Care Centre DS0000038514.V365772.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.V365772.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/oulton Barchester Healthcare Homes Ltd Manager post vacant 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.V365772.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 7th December 2007 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 £541 to £1100. 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.V365772.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Since the last key inspection, of 14th August 2007, we have carried out additional, random unannounced inspections and have attended meetings held under the safeguarding procedures. (Safeguarding was previously known as protection of vulnerable adults or POVA). We have received information about Hilton Park Care Centre from external agencies and from the care home itself. 23rd August 2007 We were notified by an external agency that some of the nursing staff were not competent to administer medication in a special way. External health care professionals became involved to ensure the safety of the person receiving this medication. 21st September 2007 We were notified by an external agency that staff continued to work, on Churchill Unit, 12-hour shifts and were working extra hours to fill in gaps. 21st September 2007 We received a telephone call from a visitor who had concerns about the number of staff on duty with particular regard to night duty. 25th October 2007 A random unannounced inspection was carried out on the 25th October 2007. There were two reasons for this inspection. Firstly to assess the progress made, with some of the standards that had not been met at the key unannounced inspection of Hilton Park on the 14th August 2007. Secondly to assess areas of concerns discussed at recent safeguarding meetings and to consider other information that we had received. We noted that weights were stable and people were given food and drink in a manner that should not compromise their health; we found no evidence of any breach of confidentiality; we visited Churchill Unit and noted that all bedroom doors had locks provided; it was clear that some staff were working long hours (and therefore posed a risk to the health and safety of the residents) and we Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 6 observed that fire doors were held open in ways that are approved by the fire safety officer. No new requirements were made as a result of this inspection. 28th November 2007 We attended a safeguarding review meeting and we were informed that, on Queen’s Unit, although care plans needed to become more person centred and detailed, staff were receiving training in how to care for people with dementia; there was an improvement in the environment (Queen’s Unit) and that a visiting social worker had seen “positive work” with residents on their visits to the Queen’s Unit. 7th December 2007 We carried out a random unannounced inspection on the 7th December 2007. The reason for this random unannounced inspection was to assess what progress had been made in the some of the national minimum standards for older people. We assessed that standards had been met with regards to admission of people that the home is registered for, care planning, medication, notification of untoward incidents (to us) and residents being able to access call bells. There were some deficiencies in care planning and medication records although we expected the home to manage these issues. We noted that people remained at risk because staff some staff continued to work 12-hour shifts, for consecutive periods with minimal time off in between these shifts. Copies of the reports of the random unannounced inspections carried out on the 25th October and 7th December 2007 can be obtained, on request, from our local office. 9th June 2008 We, The Commission for Social Care Inspection, carried out this key unannounced inspection by Inspectors between 10:00 and 15:30 by three Inspectors and it took 5.5 hours to complete. We looked around the home, examined documentation, spoke with staff and the Manager, observed staff working, including the use of a short observation framework for inspection (SOFI) on Queen’s Unit and watched the activities of the people on Churchill and Kings Units. Before this inspection we received a completed annual quality assurance assessment (AQAA) and surveys from residents, staff and visitors/relatives. For the purpose of this report people who live at Hilton Park Care Centre are referred to as “person”, “people” or “resident/s.” Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? There has been a continued improvement in the standard of care planning and risk assessments. The requirement about the accuracy of medication records has been met. Staff have become more competent in administering medication with the use of a syringe driver. There has been an improvement in the amount and range of activities. People have the choice of a cooked breakfast and a varied range of menu, including a vegetarian option. There is an improved method of recording of complaints. Staff are not working so many long hours and are having longer time off between shifts. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 8 What they could do better: The home is providing care for at least one person that they are not registered for. We expect the home to manage this, rather than we make a requirement on this occasion. There was no care plan to guide staff in how to manage a person’s challenging behaviours. We expect the home to manage this, rather than we make a requirement on this occasion. A requirement has been made for people to receive safe care with regards to mental health needs, the risk of choking, risk of pressure sores and unintentional weight loss. Due to the concerns we have about the standards of care provided on Queen’s Unit, we have made a requirement that people are given their medication as prescribed. A requirement has been made for staff to respect people’s dignity at all times. We expect staff to be mindful to interact with people to meet their social needs. People should always be offered a choice of what they would like to drink. We expect the home to manage this rather than we make a requirement on this occasion. A member of staff was not always washing their hands between attending to residents. We expect the home to manage this, rather than we make a requirement on this occasion. Observation carried out on Queen’s Unit indicated that some training has not always become embedded into practice and we have made a requirement about this. Not all of the required information about staff has been obtained and a requirement has been made about this. All fire doors, that were held open, were done so by means approved by the fire safety officer with the exception of the doors to the laundry area. We expect the home to manage this issue rather than we make a requirement on this occasion. The staff were observed to use an unsafe moving and handling technique. We expect the home to manage this issue rather than we make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 9 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 be made available in other formats on request. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 10 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.V365772.R01.S.doc Version 5.2 Page 11 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): 1, 3 & 4 Quality in this outcome area is adequate. People have an adequate standard of information to assist them in their decision where to live although this could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received a copy of the revised Statement of Purpose in April 2008. We looked at this information and we considered that most of it provided information about what Hilton Park Care Centre offered. We noted however, by comparing this information in the Statement of Purpose and the information provided on the certificate of registration that there was a discrepancy. The Statement of Purpose stated that the home is registered to provide care for people with a prime need of sensory impairment (SI) although this Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 12 category of registration was not detailed on the current certificate of registration. According to staff the home continues to provide care for at least one person with the prime need of SI. We spoke with the Manager about this and we expect the home to take action to ensure that the home operates according to Section 24 of the Care Standards Act 2004. Although 9 of the 15 residents’ surveys said that the person had received enough information about the home before they moved in, one of the residents’ surveys said that the person did not receive such information although they wrote,” …but I like this home.” According to the AQAA, “Residents are fully assessed ensuring appropriate admission to the home. A four week trial period is offered” and the areas that the home has improved upon within the last 12 months the AQAA told us “We do not admit to the home clients whose needs we are unable to meet. We do not admit to the home clients who we are not registered to take.” The records of people that we examined indicated that there have been no new admissions that the home is not registered for. Although none of the records we saw had pre-admission information about the person the Manager produced this information about one of the people who had been admitted to the home since our last inspection in December 2007. This information was satisfactory and the assessment was carried out, before the person came to live at the home. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 13 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, but not all, of the people’s dignity are valued and there remains risks to some of the people’s health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eleven residents’ surveys said that the person always received the care and support that they needed; 3 of these surveys said that the person usually received the care and support that the person needed and one of these surveys said sometimes the person received the care and support that they needed. The majority of the residents’ surveys said that the person received the medical support that they needed. Following our inspection in August 2007, a relative about the circumstances surrounding the death of a resident contacted us. We instigated safeguarding procedures and this ultimately resulted in a public enquiry. Some of the outcome of this enquiry showed that care plans and risk assessment for Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 14 choking, were not up to date. Examination of the care plans for Churchill, Kings and Queen’s Units was carried out and evidence suggests that care plans and risks for choking were up to date and there was detailed guidance for staff in what to do should a person have a choking episode. On Queens Unit care plans were generally detailed although it was observed that a person was showing signs of challenging behaviours; there was no care plan to guide staff in how to manage this person’s behaviours. We expect the home to manage this, rather than we make a requirement on this occasion. Examination of people’s care records, and discussion with staff, indicated that people have access to a range of healthcare professionals to include GPs, tissue viability nurses, speech and language therapists, podiatrists and chiropodists. In December 2007 and January 2008 we attended 2 safeguarding meetings to consider allegations made against the home with regards the standard of care provided to a resident. It was shown that some areas of the person’s care had improved with the person gaining weight and the pressure sores that the person had acquired during a hospital stay, were healing following their hospital discharge back to Hilton Park Care Centre. It was considered, however, that the standard of care could have improved in certain areas such as mouth care and management of the person’s constipation. People we spoke with told us that they knew about their care plan and there was evidence that they, or their relatives had been actively consulted about the care plans. Examination of people’s care records on Churchill Unit and Kings Unit indicated that people’s management of the mouth care and bowel care had improved with closer monitoring and appropriate action had been taken in response to when a resident was showing signs of constipation. It was observed, on Queen’s Unit, that the care plans are not always followed. For example a person’s care plan told staff what to do should a person throw things to the floor i.e. to remove such an item away from the person. Although a blanket was put on the person’s table, and they threw this on the floor, staff continued to replace the blanket back on to the table. For a second person their care plan told staff how to relieve a person’s anxiety “by empathy and a hug” although staff did not follow this care plan and the person showed signs of anxiety, by shouting out and this continued for half an hour. For a third person, assessed as at risk of choking, the care plan stated the person should have pureed food all the time and be supervised when eating their meal. The person was seen eating a pureed lunch whilst staff were in the dining area. The person was given biscuits to eat and was seen to be coughing, as a result of this unsuitable food. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 15 The AQAA informed us that 12 people have acquired pressure sores whilst living at the home. The Manager informed us that this number has reduced to 6. We examined one person’s care records and information provided indicated that the pressure sore was acquired whilst living at the home and this was now healing. The records indicated that, however, this pressure sore, could have been prevented. Care records, for people living on Churchill and Kings Units noted that people’s weight had been recorded each month and action had been taken, including the acquisition of new scales. Examination of a person’s care records, on Queen’s Unit indicated that this person had unintentional weight loss. The care plan noted that the person was to be weighed every month although the person was not weighed in January or May 2008. The records indicated that within the last 12 months the person had an unintentional weight loss of 9.8kgs. A requirement has been made for people to receive safe care with regards to mental health needs, the risk of choking, risk of pressure sores and unintentional weight loss. The AQAA told us that there have been serious incidents, involving controlled drugs, within the last 12 months. Following our inspection in August 2007 we were notified of two separate incidents regarding medication, during August 2007. Firstly during a review by the local health care team it was noted that the nursing staff on one of the units, were not competent in safe administration of a controlled medication via specialist equipment. The home, sought advice from external healthcare professionals and this is considered within the guidance of the nurses’ governing organisation, the Nursing and Midwifery Council (NMC). Secondly we were notified by the home that there was medication missing. An internal investigation was carried out although the outcome of this investigation was unable to prove the reason for the discrepancy in the amount of medication that was available. A specialist pharmacist inspector examined the practices and procedures for the safe handling and use of medicines. The storage of medicines and the records of medication were inspected on Churchill, Trinity and Kings Units. All storage areas were secure with the temperatures well controlled and recorded. The quantity of medication in stock was reasonable. The home has good and clear written procedures for staff on the safe use of medicines which have recently been updated to provide guidance on the administration of medication via specialist equipment. Staff told us that they were aware of what these procedures contained and where to find them. In all the units inspected there were good records of medicines coming into and leaving the home and good records kept of when medicines were given (or not) to residents. This provides Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 16 a good audit trail of medicines used and demonstrates that people receive the medicines prescribed for them. The requirement made for complete and accurate records to be kept of all medication administered, or not, together with a reason why the medicine was not given, has therefore been met. We watched some residents being given their medication at lunchtime and the nurse was seen to do so with regard to the person’s dignity and personal choice. We noted on Queen’s Unit that when a person removed their knee blanket a tablet rolled from this onto the floor. One of the Inspectors informed staff about this and the person was given another tablet. Due to the concerns we have about the standards of care provided on Queen’s Unit, we have made a requirement that people are given their medication as prescribed. People on Churchill and Kings Units told us that staff were good and that they respected the residents’ privacy and dignity. We saw staff knocking on people’s doors before entering and speaking with residents in a kind and respectful way. On Queen’s Unit we noted that this was not always the case; staff were observed not to respond to the residents in a warm and responsive manner. For example one resident said, “Use you discretion you might not know what that means.” Staff were heard to say, “Yes we do” and “We did go to school.” A requirement has been made for staff to respect people’s dignity at all times. Hilton Park Care Centre DS0000038514.V365772.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 good. People have opportunities to live a good quality of life that could be even better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA, “Residents have the opportunity to enjoy a variety of activities, social contact internally and externally and the opportunity to express their own choices throughout”. Speaking with people, including staff and examination of people’s care records evidence suggests that there has been an improvement in the range of activities provided, since our inspection of August 2007. People told us that they are encouraged to help with these activities such as collecting bingo cards and pens. One of the people was helping fold table napkins with the supervision of a member of care staff. “Rummage boxes on Memory lane to encourage residents to partake in sensory stimulation.” One of the residents’ surveys said about activities, “There is hardly anything I like” although the other residents’ surveys told us Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 18 that the person considered that the home provided suitable activities that they could take part in. People told us, and care records confirmed this, that residents can receive guests at any time. People also told us that they could get up and go to bed when they like. Staff told us that for people who have difficulty in communicating their wishes, staff try and understand what the resident is wanting, from the interpretation of people’s body language. The speech and language therapist has attended the home to assist at least one of the people to help them with communication with the staff and this evidence was recorded in the person’s care records. One of the residents’ surveys said about the food “They don’t always make what I like” whereas another of these surveys said about the meals “There (sic) lovely.” The majority of the residents’ surveys said that the person always/usually liked the food although three of these surveys said that the person sometimes liked their food. A relative’s survey said, “My mother have (sic) a tummy problem with some foods. They always (sic) try to provide food she can eat.” The AQAA told us that, by listening to what residents said there has been a change of menu and “Residents on Memory Lane offered visual choices of menu at each meal time”. People we spoke with said that on the whole the food was good. Menus were on display in each of the units and these told people that the home offers a wide range of choice, including a cooked breakfast and vegetarian options. On arrival to the home we saw some people having breakfast, including eating scrambled egg, in the atrium of the home. On Queen’s Unit we observed a person was given a drink of tea. The person’s care plan said that the person preferred cold drinks although there was no choice offered to this person. We expect the home to manage this rather than we make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 19 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 good. People are listened to and are safer due to improved safeguarding procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six of the seven staff surveys said that the member of staff knew what to do if a resident or visitor had concerns about the home and 11 of the 15 residents’ surveys said the person knew how to make a complaint although the remaining four residents’ surveys said that the person did not know how to make a complaint. People we spoke with said that they knew who to speak with if they were unhappy about something. Six completed residents’ surveys told us that the person always knew who to speak to if they were unhappy; three of these surveys said that the person usually knew who to speak to if they were unhappy whereas 2 of these surveys said that the person did not know who to speak to if the person was unhappy. The remaining surveys were not completed in this part of the survey. The AQAA told us that the home has received 6 complaints and all of these complaints were responded to within the 28 day required period of time. Four of these complaints were proven. Examination of the record of complaints indicated that there has been an improvement of how these are recorded, including what action has been taken and when. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 20 Speaking with people and examination of the minutes of the last two residents’ meetings indicated that people have the opportunities to express their views about the home and what they would like to see happen e.g. the repair of the coffee machine. The minutes of the meetings indicated that action is taken in response to what people have said. During the last 12 months there have been 14 safeguarding referrals of which 13 of these have resulted in strategy meetings. Information about some of these meetings can be found in our previous inspection reports for 2007. Arrangements are in place for staff to attend training in safeguarding procedures. We asked some staff what they would do if they witnessed any abuse against a resident and the responses they gave were satisfactory. Although staff were aware of internal safeguarding reporting procedures and information of external contacts, there was no clear awareness of who to contact outside of Barchester Healthcare Homes Limited, such as the police and local authorities (information of such contacts was on display in Churchill Unit). We expect through improved training, staff would become more aware of whom they could speak to, outside of Barchester Healthcare Homes Limited, should they choose to do so. From our records we note that the home has continued to improve its reporting procedures to the safeguarding team. The AQAA informed us “Whistle blowing policy – staff have been issued with an individual copy, for which they have signed.” Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 21 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 & 26. Quality in this outcome area is good. People live in a clean and comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found the home to have a good standard of décor and that communal areas, with particular regard to the atrium were well used by the people. Bedrooms that we visited had people’s personal items such as televisions, radios, pictures, photographs and ornaments. Garden areas were not visited on this occasion. All of the residents’ surveys said that the home was always/usually clean and fresh and we found this was the case. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 22 Staff told us that they have attended training in infection control and training records confirmed that this was the case. On Queen’s Unit we noted that a member of staff was providing hand massage to two residents on a 1:1 basis. The member of staff failed to wash their hands between the first resident and attending to the second resident. We expect the home to manage this issue rather than we make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 23 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 are at some risk of harm and abuse due to the level of staff competencies and the standard of recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five of the seven surveys from staff said that generally there was a sufficient number of staff to meet the individual needs of the people whereas the other 2 staff surveys said that there was not enough staff. One of these latter surveys said, “I don’t think our staff is enough to meet individual needs due to time constraints and we are always short staff (sic).” We found that people were having their care needs met in an unhurried manner. One resident said that, during 2007, they had to wait for more than half an hour for assistance although this had improved following the acquisition of an additional hoist, rather than the shortage of staff numbers. One of the resident’s surveys considered that some of the staff, who’s first language is not English, were not able to actively listen to what the person was saying to them and a resident also told us the same. Examination of one of the staff recruitment files indicated that the candidate was assessed as having a good understanding of the English language and was able to speak this Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 24 language clearly. When recruiting staff, we expect the home to be mindful that the candidates’ language communication skills do not pose any risk to residents’ health, welfare and safety. The AQAA told us that there has been an increase in the number of staff so that the amount of consecutive hours staff have had to work in the past, has now been reduced. Examination of the roster of staff working on Queen’s Unit confirmed that this was the case. Staff told us that following the issues with administering medication via a syringe driver they have received training in this area and felt more confident when they were providing this type of care. Although, according to the Manager, staff have attended training in how to care for someone with dementia, the observation carried out on Queen’s Unit indicated that such training has not always become embedded into practice. Evidence of this is provided in other standards of this inspection report e.g. standards 8 & 10. A requirement has been made as a result. The AQAA informed us that of the 64 members of care staff 33 of these have an NVQ level 2 in care or equivalent i.e. 51.5 and 4.5 of care staff are attending training to achieve this qualification. Examination of three staff recruitment files indicated that all required information was available with the exception of the following: 1) For one person there was an unexplained gap of employment between October 2004 and the signing of the application form of March 2006 (the start date of employment was not available). 2) For the second person there was an unexplained gap in employment history between March 2006 and June 2006 and again between May 2007 and April 2008. The two written references for this person were available although they provided insufficient information about the suitability of the person. For example one of the references was from a friend who said that they considered the member of staff as a child of their own. A requirement has been made about this. According to the AQAA,” Staffs (sic) receive a thorough induction in accordance with skills (sic) for Care and Barchester’s induction policies and protocols.” The majority of the seven surveys from staff said that the person had received an induction training programme that covered everything the member of staff needed to know how to do their job when they started and all of these surveys said that they received on going training. Staff we spoke with said that they had attended staff training to include care of the person with incontinence, Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 25 care of the person with swallowing difficulties and, according to the Manager, staff have attended training in care of people with dementia. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 26 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): 31,33,35 & 38 Quality in this outcome area is adequate. People benefit from a home that is adequately managed but could be safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received a copy of the revised Statement of Purpose, in April 2008 and this informed us that there had been a change of manager for the home. The Manager, although not on duty, made the decision to attend the inspection. She told us that currently a team of three nurses, including her, is managing the home. Although the standards of Hilton Park Care Centre have improved, in the last 12 months, the evidence we have found, with particular Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 27 regard to the standard of care on Queen’s Unit and the standard of recruitment practices, suggests that the management of the home could be better. The AQAA was completed within the timescale that we set and it was completed in a detailed way. It told us what the home does well, areas that have improved, within the last 12 months, and areas that could be better and how these are to be improved. The AQAA told us, as part of the home’s quality assurance, “Monthly internal audits are undertaken as directed by the Director of Quality and Care. Regulation 26 visit by a senior Barchester manager is carried out monthly and an action plan devised for any issues that need addressing. A Compliance Officer visits and undertakes audits in line with NMS and Care Home Regulations. All of the above ensures that Hilton Park provides effective quality assurance procedures and assists the home in meeting aims and objectives, ensuring good outcomes for residents”. Copies of the last two regulation 26 reports were seen and these contained details of audits of care records, the environment, medication and people’s views about the home. Following on from our key unannounced inspection of August 2007 we expected the home to investigate the discrepancies we found when we counted some of the people’s monies and compared these amounts to the record of balances. The home did as we expected and although there was some difference between our findings and the findings of the home, there remained the same discrepancies. According to staff Barchester Healthcare Homes Limited has changed the policy in safekeeping people’s monies; no personal monies are kept in the home but pooled into one, no–interest, bank account. Records of this were seen and accounts and transactions were recorded in individual people’s names and receipts were held on individual people’s files. According to the AQAA 100 of catering staff and 64 of care staff have attended training in safe food handling and 18 members of staff have attended training in infection control. The AQAA also told us that service checks for portable appliance equipment and hoists and lifts have been carried out in 2008 and records of these confirmed what the AQAA told us. Records for temperatures of the main kitchen’s food fridges and freezers, fire training, fire alarms and emergency lighting checks and temperatures of hot water were seen and these were satisfactory. According to staff the home expects an inspection by the environmental health officer in July 2008. Staff told us that they had attended training in fire safety, safe moving and handling, infection control, safe food handling and records of these were seen Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 28 to support what staff told us. The Manager told us arrangements are being made for fire drills to be carried out. All fire doors, that were held open, were done so by means approved by the fire safety officer with the exception of the doors to the laundry area; the outside door was held open with the use of a brick and the inner door was held open with the use of a wooden wedge. We expect the home to manage this issue rather than we make a requirement on this occasion. On Queen’s Unit we saw a person being assisted by two members of staff from sitting down to standing up. The staff were observed to use an unsafe technique as they were seen to lift the resident from under their shoulders, until they were able to stand up from their chair. We expect the home to manage this issue rather than we make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 29 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 2 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 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 x 3 x 3 x x 2 Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 12 Requirement Residents’ physical and mental health and welfare must be safeguarded with regards to the management of their skin integrity, their weight, the risk of choking and any distress caused due to anxiety. Medication must be given as prescribed to safeguard residents’ health and welfare. Residents’ human rights to dignity must be respected at all times Residents’ must receive safe and proper care to meet their assessed needs by competent staff. Full and satisfactory information about staff must be obtained before they work at the home to protect residents from the risk of abuse from unsuitable staff. Timescale for action 23/06/08 2. 3. 4. OP9 OP10 OP27 13(2) 12(4) 18(1)(a) 23/06/08 23/06/08 30/08/08 5. OP29 19 14/07/08 Hilton Park Care Centre DS0000038514.V365772.R01.S.doc Version 5.2 Page 31 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.V365772.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Eastern Regional Contact 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. 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