Inspection on 30/08/06 for Keep Hill Rest Home

This inspection was carried out on 30th August 2006.

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

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

Other inspections for this house

Keep Hill Rest Home 09/07/08

Keep Hill Rest Home 20/07/07

Keep Hill Rest Home 07/02/06

Keep Hill Rest Home 14/12/04

Keep Hill Rest Home 16/06/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Keep Hill Rest Home 17 Keep Hill Drive High Wycombe Bucks HP11 1DU Lead Inspector Christine Sidwell Unannounced Inspection 30th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Keep Hill Rest Home DS0000022983.V300815.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. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Keep Hill Rest Home Address 17 Keep Hill Drive High Wycombe Bucks HP11 1DU 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) 01494 528627 keep_hill@surefish.co.uk Mr Grahame Robinson Mrs Gillian Robinson Grahame James Robinson Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Keep Hill Rest Home is a care home registered to provide care and accommodation to nine older people. It is privately owned and is located in a residential area on the edge of High Wycombe, close to local amenities, shopping and public transport. Keep Hill Rest Home was originally a semi-detached, double fronted house, which has been extended to accommodate nine residents. All bedrooms are single and two are fitted with en-suite facilities. Other bedrooms are close to bathrooms and toilets. The home has a limited number of car parking spaces at the front of the home and there is a compact, but accessible, garden with a patio area and pergola at the rear of the home. The fees range from £360 to £450 per week. Information about the home can be obtained by contacting the home. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three days were spent on this key, unannounced inspection, which included a full day visit to the home. Comment cards were sent to residents their families and care professionals prior to the visit. Two family members returned their cards. Resident and home records were reviewed. A tour of the building was undertaken. Residents, managers and care staff were spoken to and care practices were observed. What the service does well: What has improved since the last inspection? What they could do better: It is recommended that a copy of the original prescription is kept with the medication administration records and that the medication entries on the home’s medication administration record are signed and dated. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 6 Menus should be reviewed and more choice made explicit on the menu. The tables could be laid more attractively with residents being given the opportunity to serve themselves and participate in menu planning. All staff should have protection of vulnerable people training. Hot water should be stored at a temperature of at least 60C, distributed at 50C and to prevent risks from scolding, pre-set valves should be fitted to all water outlets where there is a risk of submersion i.e. baths and showers. Individual risk assessments should be undertaken for all other water outlets. All staff must have POVA first checks undertaken before they commence work and must be supervised until the full Criminal Records Bureau Disclosure is received. Staff personnel and recruitment files must be reviewed to ensure that they contain the documentation specified in Schedules 2 and 4 of the Care Homes Regulations 2001. 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. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. Resident’s needs are assessed prior to their moving to the home in order that both they, their families and the home can have confidence that their needs can be met. The home does not offer intermediate care. EVIDENCE: The care of three residents was case tracked, including the care of the last resident to move to the home. These residents had had a care needs assessment prior to moving to the home. One resident confirmed that she had been visited prior to moving to the home and that she had stayed initially for a trial period to see if she liked it. A second resident confirmed that she had had time to consider whether the home was right for her and although she missed her own home said that ‘it was the best thing that she could have done’. The care needs assessment documentation met the recommendations of the National Minimum Standards and had been completed fully. The home does not offer intermediate care. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Resident’ health and personal care needs are met and staff take care to respect their privacy and dignity. Medication management has improved and residents’ medication needs are met in a safe and timely way. EVIDENCE: The care plans of the residents whose care was being tracked were examined. These were comprehensive and had been updated monthly. Daily records of care given are kept. A summary of resident’s preferred daily routines was included. Two of the residents spoken to said that their care plans were reviewed with them on a regular basis. One had been reviewed with her social care manager. Residents can remain with their own General Practitioner if they wish or register with the local practice. No residents had pressure damage at the time of the visit and the care manager said that they would receive support from the district nursing team if necessary. At present the district nurse also assesses residents who require continence aids and these were provided when necessary. Nutritional assessments are undertaken and residents are weighed regularly. None were seen to have lost weight. The home has implemented a Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 10 falls assessment and a falls diary is kept where relevant. One resident was noted to have fallen and the appropriate action was taken by the home to have her care reviewed by the doctor and to amend her care plan to reflect the additional care needed. The manager stated that the home has good support from the local general practice and that residents are referred to secondary health care services when necessary. There was evidence in the records that residents had seen the optician and chiropodist regularly. The home’s medication policy has been reviewed since the last inspection when a number of requirements were made to improve medication management. The key to the main medication cupboard is stored securely. Two residents continue to manage their own medication and they have discrete storage within their rooms. Neither wished to lock their medication away as they were concerned that they might lose the key. Risk assessments were in place and the manager said that no other residents were at risk as currently no one would inadvertently wander into another resident’s room. There was no one on controlled drugs at the present although the appropriate storage and recording facilities were available. Records are kept of medication entering the home and leaving the home. The details of medication to be given were written, by the care manager, on a medication administration record, using the original box supplied by the chemist. It is recommended that a copy of the prescription is kept with the medication records and that the care manager dates and signs the entries. The medication records were seen to be completed correctly. There was no evidence that correction fluid had been used to make alterations to the charts. Medication was administered from the original boxes and was not ‘potted up’ in advance. There was evidence in the care records that the general practitioner reviews medication on a regular basis. There was also evidence that staff had had training in medication administration. Personal care is given in resident’s own rooms and the staff were observed to be respecting resident’s privacy and dignity. Service users were wearing their own clothes, which were in good repair and had been washed and ironed well. There are no shared rooms. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. There is a limited activities programme although residents are encouraged to keep in touch with their families and friends and to exercise choice in their lives. Residents’ nutritional needs are met and mealtimes were observed to be a sociable occasion. EVIDENCE: The residents spoken to said that they had a choice as to when they got up or went to bed and although mealtimes are regular the manager and staff said that meals would be provided at any time if a resident wished. Residents are encouraged to remain in contact with their families and one continues to attend a day centre. One resident spoken to said that there were only occasional activities provided by the home but that she was quite content with her puzzle books reading matter and the television. Resident’s interests were recorded in the care plans. The manager said that he and the care manager had recently visited another care home, which has a good activities programme, and that he is planning to use the knowledge that they gained to implement an activities programme at Keep Hill. The relatives who returned the comment cards said that they were welcome in the home at any time and that they could visit their relative or friend in private. The home does not manage resident’s finances on their behalf. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 12 There was a two-week menu plan in place, which appeared varied and nutritionally sound. On the day of the inspection the main meal consisted of soup, fish pie with three vegetables and a sweet. The residents spoken to said that they enjoyed their meals and that they had enough to eat. The manager said that breakfast was served in residents’ rooms if they wished and that they could have cereal, toast or a cooked breakfast if they wished. High tea was served at 5.00pm and a milky drink and biscuits at 8.00pm. There were drinks available throughout the day and the care manager stated that they had made additional drinks available during the very hot weather. A formal choice of main meal is not recorded on the menu plans although the manager said that if a resident wanted an alternative it would be provided. It is recommended that the choice of main course is made explicit and that residents are involved in menu planning. The table could be laid up more attractively and residents be given the choice of serving themselves. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. The complaints policies and procedures give residents confidence that their views will be heard and acted upon. EVIDENCE: There are complaints policies and procedures in place. Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. The staff spoken to were aware of the complaints procedures as where both of the family members who returned the comment cards. One resident spoken to said that she knew who to raise concerns with and that any issues would be addressed promptly. There are Protection of Vulnerable Adults policies and procedures in place. Some but not all staff have had training in this topic, which the manager is addressing and plans are in place. There have been no referrals under the Buckinghamshire County Council safeguarding policies and procedures. Not all staff have had a Criminal Records Bureau check prior to starting work. This is described in the staffing section of this report and must be addressed. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 Quality in this outcome area is adequate. Residents have a comfortable, personalised and well maintained home in which to live. Their safety would be improved by fitting thermostatically controlled valves to showers and baths and by completing the programme to protect radiator surfaces. EVIDENCE: There is a programme of routine maintenance and the pre-inspection documentation provided by the manager showed that all routine maintenance activity had been undertaken. The grounds are tidy and there is a patio for residents although some would need assistance to go into the garden as the ground is uneven and there are small steps. The last fire officer’s report was on the 31st July 2006 when all fire matters were described as satisfactory. The Environmental Health officer made recommendations regarding recording food temperatures and implementing the new guidance on safer food at her last inspection and these are being addressed. There are no CCTV cameras. All rooms are individually lit and have natural daylight. A programme is in place to cover the radiators, which will be complete by the winter. The water outlets do not have thermostatically controlled valves. Records were seen to show Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 15 that the boiler runs at temperatures of between 41C and 45 C. Whilst this controls the temperature of the water at the water outlets it may not prevent risks from Legionnella. It is a requirement of this report that water is stored at a temperature of at least 60C, distributed at 50C and that to prevent risks from scolding, pre-set valves should be fitted to all water outlets where there is a risk of submersion i.e. baths and showers. Individual risk assessments should be undertaken for all other water outlets. The home should also have a Legionnella assessment. The home was clean and tidy on the day of the inspection. The member of staff spoken to had had infection control training and the training records showed that all staff had had this training. The laundry was now locked and housekeeping chemicals were stored securely. Residents’ rooms were pleasantly furnished and most had brought their own furniture and had personalised their rooms giving the home a comfortable and personalised feel. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. There are sufficient staff in place and training programmes to give staff the skills and knowledge that they need to care for residents. The recruitment procedures must be improved if residents are to be fully protected from unsuitable carers. EVIDENCE: A staff rota is kept. On the day of the visit there were two carers on duty in addition to the manager and care manager. The residents spoken to said that they felt there were sufficient staff and that their needs were addressed promptly. There is one waking night staff. The staffing numbers met those recommended by the Department of Health. All staff are over 18 and no one under 21 is left in charge of the home. Three care staff hold the National Vocational Qualifications in Care at level 2 or above and two more are undertaking this course. The home has nearly met the standard that 50 of staff hold this qualification. There is a system in place to ensure that all staff have mandatory training although not to ensure that they have had the necessary annual updates. Three recruitment files were examined. They all contained application forms and two references. None of the staff concerned had had POVA first or Criminal Records Bureau (CRB) disclosures undertaken before they commenced work, although they were all in place by the unannounced visit. This must be addressed and all staff must have a POVA first check and be supervised until the full CRB disclosure is received. It is also recommended that the recruitment files be reviewed in line with guidance recently issued by The Commission for Social Care Inspection, to ensure that they contain the information required to ensure that staff are recruited safely. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 17 There is an induction programme and one new member of staff spoken to said that she was undertaking this. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. There is a stable, experienced management team who provide continuity for residents. Developing the quality assurance programme and regularly reviewing the home’s approach to health and safety to ensure that resident’s needs are met safely would improve the management of the home. EVIDENCE: The manager is experienced and holds the National Vocational Qualifications in Management and Care at Level 4. He is responsible for one care home. The staff spoken to said that both the manager and care manager were approachable. One family member who returned the comment card said that her relative receives ‘professional and loving care as part of the Keep Hill family’. This is a small home and there are clear lines of accountability within the home. The manager said that he is currently preparing a development plan and reviewing the finances of the home. The care manager undertakes a monthly review of all aspects of individual care with residents as part of the Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 19 quality assurance programme. The quality assurance programme could be further developed by implementing a programme of regular self-audit of all aspects of the homes operation. This might include self-monitoring of recruitment files and training records, audit of kitchen and safer food processes and environmental audits. There are policies and procedures in place governing the management of the home and these have been updated within the last year. The manager stated that they do not handle any money on behalf of residents but that residents or their families undertake this. Any purchases made on residents’ behalf are invoiced to the families. There is system of staff supervision in place and records were seen to confirm this. There are moving and handling policies and procedures in place and training records were sent to confirm that staff have had basic manual handling training. The member of staff spoken to said that she had received this training. A fire risk assessment has been undertaken and records were seen to show that fire drills and fire alarm checks are made regularly. No fire doors were propped open at the time of the inspection. The staff spoken to understood the fire evacuation policy. The Environmental Health Officer had asked that the temperature of food be recorded at the point of serving and this had partially been complied with. It is recommended that the carers who serve the food be trained in this task and that temperature records are kept in the kitchen for them to do this. There are generic risk assessments and hazardous chemicals are stored securely. The need for the home to regulate water supplies and undertake a Legionnella assessment is described in the environmental section of this report. There is an accident book. The home has a copy of the Health and Safety Executive’s guidance entitled Health and Safety in Care Homes. It is recommended that the home use the self–audit checklist that is described in appendix 1 to review the health and safety systems. Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 2 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 21 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 2 Standard OP12 OP25 Regulation 16(2) 13(4) Requirement The manager should develop the activities programme in line with residents’ wishes. Thermostatically controlled valves should be fitted to all showers and baths. Risk assessments should be undertaken for all other hot water outlets. Care staff should record the temperature of the shower before assisting residents. All staff must have a POVA check before commencing work and must be supervised until the full Criminal Records Bureau Disclosure is received. The recruitment files should be reviewed to ensure that they contain the documents specified in Schedules 2 and 4 of the Care Homes Regulations 2001 Timescale for action 31/01/07 31/03/07 3 4 OP25 OP29 13(4) 19 30/09/06 30/09/06 5 OP29 19 30/10/06 Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 22 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 5 Refer to Standard OP9 OP15 Good Practice Recommendations It is recommended that a copy of the original prescription is kept with the medication administration records and that the medication entries are signed and dated. It is recommended that a choice of main meal be offered and that the recommendations of the CSCI publication ‘highlight of the day’ are implemented. Mealtimes could be improved by laying the tables more attractively and by providing residents with the opportunity of serving themselves. The quality assurance programme should be further developed to include self-monitoring or the homes major policies and procedures. The homes health and safety policies and procedures should be reviewed in line with guidance from the Health and Safety Executive. OP15 OP33 OP38 Keep Hill Rest Home DS0000022983.V300815.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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