Inspection on 12/12/06 for House On The Hill

This inspection was carried out on 12th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

House On The Hill 23/06/08

House On The Hill 03/12/07

House On The Hill 02/05/06

House On The Hill 17/01/06

House On The Hill 01/12/04

House On The Hill 12/09/04

House On The Hill 25/02/04

House On The Hill 06/08/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE House On The Hill 61 Rosemary Hill Road Little Aston Sutton Coldfield West Midlands B74 4HJ Lead Inspector Ms Wendy Jones Key Unannounced Inspection 12 December 2006 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address House On The Hill DS0000005119.V319228.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. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service House On The Hill Address 61 Rosemary Hill Road Little Aston Sutton Coldfield West Midlands B74 4HJ 0121 353 0464 0121 353 0464 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) Bonehill Limited Mrs Gerlinde Taylor Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13), Physical disability over 65 years of age (3) of places House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last key inspection 2nd May 2006 Brief Description of the Service: House on the Hill is a residential home that provides a service for up to 13 older people. The home is registered to provide care for three people who have a physical disability. The home is an attractive building located in a residential area within Little Aston. Two lounges provide an area for service users to relax in. Communal areas are comfortable and personalised by the service users. All the bedrooms are located on the ground floor, each one for single occupancy; six of the bedrooms have an en-suite facility. Individuals are able to furnish their rooms. Bathing facilities are located at each end of the home. There is a small laundry and storage room used for hairdressing. Located off the dining room is a wellappointed kitchen; all of the meals are prepared and served from the kitchen. Parking for visitors and staff is available at the front of the home on the gravel drive. The front entrance has steps and a ramp and there is a secure mature garden to the rear with a seating area. The demography of the local community reflects the service users living in the home. The registered provider is Bonehill Ltd who has overall responsibility for the home; a new manager was appointed to the home in April 2006 and has completed the Fit Person process for registration. The manager informed the Commission for Social Care Inspection on 12 December 2006 that the fee level for House on the Hill is between £440 and £520 per week. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out over a period of three day’s including pre visit planning, a visit to the home and report writing. The visit to the home took place between 13.30 and 17.30 on 12 December 2006, the care manager Mrs G Taylor was in charge during this period, inspection methodology included, analysis of the outcomes of previous inspections, discussion with the care manager, interview of a care worker, discussion with two residents and conversation with a third resident and relative. Inspection of care assessments, care and health records, staff roster, staff recruitment records, staff training records, menu’s, records of residents/relative and staff meetings. Inspection of the quality audits conducted by Mrs Taylor, the records of monthly visits to the home by the provider (Regulation 26 visits), records of complaints, medication records and storage and a short tour of the building. At the time of this visit, there are 11 residents in the home, the majority of whom are privately funded, the age range of the current resident population is between 71 and 92 years, dependency was described as low. What the service does well: What has improved since the last inspection? House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 6 Since the last key inspection there has been a number of (3) unannounced random inspections undertaken to ensure that the all the areas identified to be improved have been sorted out. It has been confirmed form this visit that all necessary action has been taken to address all of the requirements of the previous key and random inspection visits. The provider is continuing to upgrade the environment of the home. The staffing situation has stabilised, the home currently has one staff vacancy that has been advertised and offered to on potential candidate. The Commission for Social Care Inspection has approved the manager as a fit person. Residents have more opportunities to be involved in activities in the home. What they could do better: The Statement of purpose and Residents guide have improved and information was provided that all residents have a copy of the guide. A couple of minor areas need to be addressed in the Statement of purpose before it can be issued as a final copy. The manager was also asked to write to prospective residents following assessments to confirm that the service could meet their needs if this was the case. There were many positive areas to note concerning the health and personal care needs of residents. Although some areas of concern relating to medication recording and storage were identified. The service has been required to deal with these as requirements of this report. The manager was asked to amend the Complaints procedure and to ensure that all staff have received training in the protection of Vulnerable adults and recognising and reporting abuse. Although the manager had made arrangements for some training she had not been able to access all the training needed, so there are some areas that require further action, these are identified in the main body and requirements of this report. During this visit there was information in records about inadequate room temperatures this was also evidence in one bedroom on the day of the visit, although it was promptly addressed. The manager was reminded about he need to maintain a good ambient temperature throughout the home in all areas used by residents. Fire safety matters have also been dealt with in the main, but the manager must ensure that all staff have taken part in at least two fire drills. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 7 The provider has been asked to provided evidence to the Commission for Social Care Inspection of financial viability due to concerns raised and recorded in a relative/ residents meeting. 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. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service the will receive. EVIDENCE: Since the last inspection all previous requirements relating to these standards have been addressed. The service has produced an updated version of the Statement Of Purpose and Service User Guide in July 2006. As part of this inspection the quality of information given to people about the care home was looked at. The information included the aims and objectives and philosophy of care of the service, “ House on the Hill Residential Home aims to provide a contented, caring and companionable environment for our residents, which promotes their independence and which respects and retains their individuality”. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 10 The Service User Guide, (sometimes called a brochure or prospectus) included a statement of terms and conditions (also known as a contract of care) and the complaints procedure. Since the last key inspection in May 2006, the manager has confirmed that each resident has been provided with a copy of the guide. Further work is required to the Statement of Purpose to ensure that all relevant information is included, for example bedroom sizes are not included. The manager stated that she would assess any prospective resident she receives a referral for. To do this the individual is invited to visit the home for a period of time, which may included staying for a meal and can have an over night stay should they wish to during this assessment period. Mrs Taylor has produced an assessment tool based upon a well-established model of, Activities of Daily Living that reflects the recommendations from the National Minimum Standards for Older people. A sample of an assessment showed that residents are involved in the process, and are asked a range of questions to establish their personal, physical and healthcare needs and to establish their wishes in respect of spiritual needs, rising and retiring times, food likes and dislikes, if they want a key to their bedroom among others. Once the assessment has been completed and decision made that the home can meet the needs of the individual they are invited via letter to move into the home. This usually entails a four-week period of on-going assessment and review of placement to ensure that all parties are happy. A requirement was made that the letter confirming that the assessment has been completed should state explicitly that the home can meet the needs of the individual. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The systems for the administration of medication can be improved, to ensure the wellbeing of residents. EVIDENCE: A sample of a residents care plan showed that the plans were based upon the assessed needs of the individual, there was a clear plan of action in place to support the resident with each identified need. The service standard is for care plans to be reviewed monthly, the example seen showed that these reviews had been carried out up until September 2006. Mrs Taylor explained that there had been a turnover of staff during the summer months and some reviews had not taken place, but hoped that now the service had introduced a key worker system and was mainly fully staffed that the monthly standard would now be met. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 12 There was evidence in the records that residents had been involved with the care planning process. Health needs are recorded and there was evidence that residents are supported to access or receive health care from the appropriate professional. The home currently has residents registered at two local GP practices. Medication: Mrs Taylor stated that the majority of staff had received accredited training in the management, storage and administration of medication. This was confirmed form discussion with a care worker, who described the five important rules on a checklist relating to safe administration practice as taught on the training course: Resident, medication, time, dose and route. She also confirmed that the manager has assessed her competence in practice following the training and was able to give a good account of the procedure for safely administering medication. Medication at this home is stored in a locked cabinet that is fixed to the wall and a locked trolley, which has also has an anchorage point to the wall when not in use. An additional locked and secured facility has been provided in the trolley for the storage of controlled medication. Changes in guidance regarding this method of storage for controlled medication means that is should be reviewed to ensure that it meets the requirements of the Misuse of Drugs Act(storage) 1973. A sample of medication administration records (MAR), showed that they were mainly appropriately maintained with staff signing the records on each occasion that medication was administered. In two examples a signature had not been recorded, although it was established that the medication had been administered. In two examples the Controlled drug register had not been counter signed by a second member of staff, although again it was established that the medication had been administered, and there was evidence of good practice such as a running total of stock and regular audits of the records and stocks. Mrs Taylor stated that she was planning to introduce a quality audit tool, which would help to identify these types of errors in the future. Good practice issues included, regular audits of medication, samples of staff signatures and initials, which should be stored in the medication file, topical applications such as creams, ointments and some eye drops had the date they were opened recorded on them to ensure that they were used with the directed period. Some of these types of medication have short shelf (therapeutic) lives, which can be as little as 28 days. Although there was some information in a file in the office about the purpose and effects of medication, it did not include all the medication currently prescribed. The manager was asked to ensure that an up to date medication reference book or file of information is maintained in the home preferable in the area where the medication is stored and administered. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 13 It was also of concern that one resident had a prescription for a medication usually used as an anti-convulsant, but I was told that there was no known relevant health history that could explain it. The manager was again asked to ensure that the health history of the resident was accurate and to ensure that information about the purpose of the medication is available in the home. At least one resident self medicates topical and other medication, currently the service does not provide lockable facilities in the bedrooms for the safe storage of medication or valuables, this should be considered. A resident confirmed that she feels well treated and cared for. She confirmed that her privacy is respected by staff and she is able to make choices regarding her lifestyle. During this visit staff were observed to knock on residents doors and waiting to be asked in before entering the bedroom. All residents have been asked if they want a bedroom door key, some have chosen to. Residents can and have chosen to have their own private telephone line fitted in their bedrooms at an additional cost to their care fees. During the initial assessment and initial care planning all residents are asked if they want discuss their preferences or pre planned funeral arrangements in the event of their death. It was also noted that residents don’t have to discuss this often-sensitive matter if they choose not to. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: Information received since the last key inspection indicates that the service had now addressed outstanding issues. The evidence of this inspection concluded that residents have been asked about their lifestyle choices and these are respected, the records showed that previous interests and religious needs are known and efforts have been made to meet these. Mrs Taylor said that one care worker had been nominated as the activity coordinator for the home, she is responsible for ensuring that residents know what planned activity sessions there are for the week and, when on duty in the afternoon will help and motivate residents to get involved with them. Records of residents engagement in activities were included in care files. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 15 During this visit there was a clothing sale taking place, many of the residents and their relatives took advantage of this and comments were favourable in relation to the price and quality of clothing, it is also a means for the home to fund raise as it receives a percentage of the total sale on the day, towards the residents comfort fund. Records showed that relatives and residents meetings were held approximately every two months. The most recent meetings (during November) had identified concerns about staff turnover and the possible reasons for this, proposals for retention of staff and concerns about the viability of the home. In one example the records indicated that another of the company’s homes financially supported the service. This is of concern and the provider is required to provide evidence of financial viability. It was noted that the occupancy of the home at this inspection visit was 11 out of 13 possible residents. A thorough examination of menu planning and food storage was not undertaken in this inspection. It was established that a recent quality audit had been undertaken, and based upon the residents responses a change to the menu’s had been made. The manager intends to repeat this exercise regularly. There was evidence of meal choices for each main meal, today’s lunchtime choices included, Salmon and Mushroom pie with vegetables or a pasta dish. The evening meal choices included bacon sandwiches. Residents spoken to confirm that the meals provided are of good quality, one said “I have no complaints” another commented on the quality of the homemade pastries and cakes they were offered. The home also ensures that residents are aware of the available meals for the day by supplying menu’s on each of the dining tables. Supper is also now offered to residents today’s planned supper was a bowl of chips. The general appearance of the dining room tables could be improved to make them more attractive, the current wipe able tablecloths are practical but could be changed to provide more visually pleasing table settings and accessories. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. But staff must be trained in recognising and reporting suspected abuse. EVIDENCE: The service has a complaints procedure that is displayed in the home and is included in the Statement of Purpose for the home. A complaints and compliments book is located in the main foyer. A sample of the contents showed that usually the manager checked the book a couple of times a week, and made every effort to resolve any issues to the satisfaction of the person raising the concern. Examples include concerns about lost clothing and concerns about room temperatures. Matters arising included the need to amend the complaints procedure to show that the Commission for Social Care Inspection could be contacted at any time and not just when the complainant was dissatisfied with the outcome of any investigation by the home. It is recommended that where there are concerns about matters such as maintaining adequate room temperatures a system for immediately notifying the person in charge should be adopted. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 17 Protection of Residents: Care workers have not received training or proper guidance in recognising and reporting abuse, there is a copy of the Vulnerable Adults(VA) procedures agreed locally in the office, but this is not adequate on it’s own to provide staff with the information they require to offer protection to residents. The manager stated that she had recently received training in Recognising and reporting suspected abuse via a distance-learning training provider and felt able to cascade some of this information to care workers. Since the last key inspection two allegations of verbal or physical abuse have been reported action has been taken to investigate these matters and one member of staff has been dismissed. It was not established if these matters had been referred using VA procedures agreed in Staffordshire. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 18 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, 24, 25 and 26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. But room temperatures must be maintained sufficiently to provide a comfortable environment for residents. EVIDENCE: This visit did not include a detailed inspection of the environment. A number of improvements include redecoration and re carpeting, plans include continued development and replacement of some furniture and carpets, during this visit, new chandeliers were being fitted. The home has two lounges and a spacious dining room. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 19 Matters arising include the need to supply lockable facilities in bedrooms, continue with the programme of refurbishment and replacement of carpet’s throughout. Issues relating to the temperature in the home were discussed. The manager stated that the radiators throughout the home had been guarded to protect residents from the hot surface temperatures, but the radiator covers also restricted residents or staff access to the thermostatic controls of radiators. The manager stated that she had made maintenance requests for this access to be provided. On the day of this visit a bedroom at the front of the home was noted to be cool, the thermometer recorded the temperature at 62f, the manager was asked to ensure that a more acceptable temperature was maintained in this room. The provider must ensure that residents are able to control their bedroom and radiator temperatures. During this visit the electrical switch to the main ceiling lights to the bedrooms to the rear of the property had tripped off and could not be reset. Residents all had bedside lights that provided adequate lighting in the short term. The manager stated that she would request a visit from the contractor that evening to resolve this. She confirmed after the visit that this had been resolved. The bedrooms to the rear of the property all had en-suites and were well presented. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are supplied in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Recruitment practice was good, but some areas of training need to be addressed. EVIDENCE: Staffing two throughout the waking day one sleep in and one waking night staff, plus managers, cook and domestic hours. Currently a cook is off sick, a domestic is covering her hours. The manager stated that she has plans to offer temporary domestic post, to ensure that she has sufficient hours. The service has provided a home for a family in a flat on the first floor, this arrangement includes providing all the sleep in shifts per week and one shift of domestic hours. Appropriate checks have been carried out as required at the last key inspection. The manager was asked to ensure that this arrangement was not in breach of any working time directives. The on call system had been improved since the last inspection. The cook is employed until the lunchtime period is completed. After that time the meal preparation and cooking is undertaken by care staff. It was established that not all care staff had received training in basic food hygiene. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 21 The manager stated that she had plans to ensure that all mandatory training was completed and provided evidence of some of the training events she had organised. This included a Manual handling and Health and Safety course scheduled for January 2007. Currently staff are shown how to use hoists during induction and given basis instruction about good manual handling practice, a care worker gave a good account of this instruction. She also stated that she had received a very good induction to the home that included a week working in a supernumerary capacity with a mentor and completion of basic induction programme. She stated that she was currently undertaking the SCILS induction; this was confirmed from the information seen. And also stated that she had received a good support from the manager for the service. A sample of recruitment records showed good recruitment practice, with evidence of appropriate checks and documentation, including application forms, evidence of work history, 2 written references, health statements Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. In addition there was evidence of identity, job descriptions and terms and conditions of employment. A recommendation was made that a record of the CRB number was retained on file, with the outcome of the check. The manager provided evidence of regular staff meetings arranged 2 monthly she also stated that a programme of 2 monthly, 1:1 supervision sessions had been introduced. Information in the records showed that the number of staff trained to or undertaking National Vocational Qualification (NVQ) at level 2 has improved with 5 staff now reported to have achieved this and 4 other undertaking this training. Only 3 staff were trained in first aid, the manager was asked to ensure that the numbers of trained staff are improved, preferable to provide in trained staff pre shift. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 22 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Areas identified under health and safety must be addressed to ensure the safety and well being of residents. EVIDENCE: Manager stated that she completed a National Vocational Qualification in care at level 4 and intends to enrol on a Registered Care Managers Award course. Since the last key inspection that took place in May 2006, Mrs Taylor has formally been approved as the registered care manager for the service. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 23 During discussion Mrs Taylor stated that she had a number of years experience in care. I was told that staff received a 1:1 supervision session once every two months, a care; staff confirmed this. In the records of a relative/resident meeting held in November 2006, it stated that another of the company’s care homes currently supports the home financially. This was of concern. Issues relating to fire safety matters were discussed during this visit. A number of doors are fitted with Dorguards, a device for retaining the door in the open position, but, when the fire alarm is sounded, automatically close too. I was told that the devices are checked weekly when the fire alarm is tested to ensure that they operate correctly and that they are always closed at night. We discussed the changes in fire safety regulations that came into force in October 2006, changes required include ensuring that the current systems complies with the new requirements of these regulations. Mrs Taylor stated that she had a fire safety risk assessment which identifies the support needed to evacuate the home in an emergency, this also includes a phased evacuation of the home and an emergency contingency plan in the event the home becomes inhabitable for a short period of time. A copy of this document was provided, it was suggested that a copy is forwarded to the Fire Safety Officer for comment. Mrs Taylor showed that a certificate that the indicated that the system was routinely serviced. It was established that fire drills had not taken place recently, Mrs Taylor was advised to ensure that at least two fire drills were undertaken with all staff, including night and sleep in staff. She stated that all staff had received fire training. Quality Assurance: Mrs Taylor stated that she has made arrangements to undertake quality audits in a number of areas, activities, menu’s and to seek the opinions of relatives, residents, staff, health professionals and outside agencies about the service delivery. At the time of this visit she was in the process of analysing the outcomes of the survey’s and working out the action to be taken to ensure the continued improvement and development of the home. During discussion about quality we discussed the current arrangements for requesting maintenance support, Mrs Taylor stated that she would make a verbal request for work to be done but then the matter would be out of her hands, it was suggested that a maintenance record is introduced which would show the date of any request and could included the date the work was undertaken. This could also be used in the quality monitoring process. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 24 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 3 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 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 2 2 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x X 3 x 2 House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4(1)(a)(b) (c), schedule 1 14(1)(d) 17 Requirement The Statement of Purpose must include all areas identified in the Care Homes Regulations. The registered must confirm in writing that the service can meet the assessed needs of residents. Medication records must be properly maintained, with staff signatures on every occasion medication is administered. Records of controlled medication must be properly maintained and appropriate storage facilities provided. The registered person must ensure that all areas of the home are maintained at suitable temperature. The registered person must ensure that access to the thermostatic controls on radiators is provided. The rolling programme of refurbishment must be continued. All staff must receive training in recognising and reporting suspected abuse. DS0000005119.V319228.R01.S.doc Timescale for action 12/01/07 2. 3 OP4 OP9 12/01/07 12/12/06 4 OP9 17 12/12/06 5 OP26 23 12/12/06 6 OP26 23 22/12/06 7 8 OP20 OP18 23 13 12/02/07 12/02/07 House On The Hill Version 5.2 Page 26 9 OP38 23 10 OP33 24 11 OP30 18 12 OP27 18 13 OP34 25 The registered person must ensure that all staff have been involved in a fire drill at least twice per year. This must include the individual currently undertaking the sleep in shifts. The registered person must ensure that the outcomes and the development plan of the quality audit currently being undertaken are made available to the Commission for Social Care Inspection, resident and their representatives. The registered person must ensure that staff have received training in first aid, infection control, health and safety. The registered person must continue to keep staffing levels under review to ensure appropriate deployment. The registered person must provide evidence of financial viability. 24/12/06 12/01/07 12/02/07 12/02/07 12/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP28 OP20 OP38 OP9 OP24 Good Practice Recommendations The service should continue to promote National Vocational Qualification training to ensure that 50 of the work force have this qualification at level 2. Consideration should be given to improving the appearance of the dining room tables. A copy of the fire safety risk assessment should be forwarded to the fire safety officer. The provider should provide a lockable facility in each residents bedroom. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 27 5 OP16 Consideration should be given to ensuring that if families or residents have got concerns that need immediate action they are provided with a method, which would bring them to the attention of the provider or manager. House On The Hill DS0000005119.V319228.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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