Inspection on 07/02/06 for Keep Hill Rest Home

This inspection was carried out on 7th February 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 30/08/06

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 Mr Guy Horwood Unannounced Inspection 7th February 2006 09:40 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.V280212.R01.S.doc Version 5.1 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.V280212.R01.S.doc Version 5.1 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 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.V280212.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: Keep Hill Rest Home is a care home registered to provide care and accommodation to nine older people. The home is a privately owned establishment, which is located in a residential area on the periphery of High Wycombe, close to local amenities, shopping and public transport. Keep Hill Rest Home was originally a semi-detached, double fronted property, which has been extended to accommodate the 9 residents. All bedrooms provide single room accommodation and two are fitted with en-suite facilities. Residual bedrooms are within close proximity to all 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. Mr and Mrs Grahame Robinson are the homes proprietors. Mr Robinson is the registered manager of the home having applied and been successfully interviewed in line with the ‘Fit Person’ process. Mrs Ruth Denslow is employed as the “Care Manager” of the home, overseeing the management of service users care. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Keep Hill Rest Home on the 7th February 2006, between the hours of 09.40 and 11.55. The lead inspector was Mr Guy Horwood. Upon arrival Mrs Ruth Denslow, the homes care manager, met the inspector. The home’s registered manager Mr Grahame Robinson, was on a training day at the time of the visit and was therefore not present during the inspection. Mrs Denslow was able to present all documentation and information requested during the course of the inspection, and demonstrated a high degree of knowledge of all residents and their care needs, and with regards to the general running of the home. At the conclusion of the visit, the inspector discussed the inspection findings with Mrs Denslow who said that she would liase with Mr Robinson. The inspection consisted of meeting with residents and staff, viewing specific records and documents pertaining to the provision of care and the running of the home. The inspector toured the building and viewed residents bedrooms and communal areas. At the time of the visit the home was accommodating nine residents. Seven residents were met in the lounge, where care staff were providing hot drinks and biscuits. Staff were noted to take time to sit in the lounge with the residents to chat, and the inspector took the opportunity to sit with them. It was evident from the resulting conversation that staff and residents were very comfortable in each other’s presence, knew a great deal about each other, and that staff were friendly, polite and respectful towards the residents. All residents looked well cared for and were wearing co-ordinated clothing, with glasses, where worn, clean. Residents comments included that “They (staff) are lovely”, that “The staff are always happy”, and that the residents had “no complaints”. The inspector found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents for their time, conversation and company, and for allowing the inspector into their home. What the service does well: Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 6 Resident’s appear to be treated with dignity and respect by a kind and caring staff team. Care plans are well maintained, give good directions as to how residents care needs are to be met, and record care provided. No residents had pressure ulcers at the time of the visit. Staff are aware of the risk of falls within their resident group and what is to be done to minimise this risk. Residents are provided and assisted with appropriate and meaningful activities and outings. Residents may receive visitors at times convenient to them. Resident’s preferences and choices are adequately catered for with a balanced and varied selection of food and drinks. Residents live in a clean, comfortable and homely home. Residents are able to customise their rooms with personal possessions. What has improved since the last inspection? What they could do better: Medication could be stored, administered and disposed of in a manner more in keeping with best practice and therefore reduce the associated risk to residents. Medication records could be completed and better audit trails formed through the review of disposal procedures. Radiators are to be fitted with low surface temperature covers to reduce risks to residents. Doors must not be held open with other than devices agreed with the fire officer, as this presents a significant risk to the safety of staff and visitors. Chemicals must be stored with regards to the health and safety of residents and visitors. Please contact the provider for advice of actions taken in response to this Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 7 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.V280212.R01.S.doc Version 5.1 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 Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 10 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): 7,8,9,10. Residents are well cared for and their healthcare needs are met. Staff have developed positive relationships with residents, thus allowing residents to be open in expressing their thoughts, feelings and needs. Care plans are maintained, up to date and subject to regular review. This ensures that the resident’s current care needs are known to staff to enable them to provide the required care. Residents have access to NHS entitlements and external healthcare services in order to meet healthcare needs. Procedures and practices for the storage, recording, administration and disposal of medicines do not follow best practice, and as a result place resident’s health and welfare at risk. Residents are treated with dignity and respect with their entitlement to privacy respected. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 11 EVIDENCE: A random selection of care records was viewed. Care plans appeared user friendly and held good detail. A very useful record of preferred daily routines forms part of these care plans. All residents are registered with a General Practitioner of their choosing, and district nurses visit the home on a frequent basis. At the time of the visit no residents were said to have pressure ulcers or dressings. Mrs Denslow stated that pressure relieving equipment, when required, is provided by the district nurses. All residents are weighed on a regular basis with records kept. Risk assessments pertaining to falls and fall prevention form part of residents care plans. The inspector viewed medication storage and administration charts, and discussed the procedures for the distribution of medicines with Mrs Denslow. It is acknowledged that medication procedures and practice within the home have been audited and reviewed over the past 18 months, yet some areas have been identified which require further work. Where residents choose to self medicate, a risk assessment is conducted, discussed and signed between the resident, their General Practitioner and the care manager. These risk assessments were found to be of a good standard and had been fully completed. Medicines held by residents for selfadministration are audited on a weekly basis. Lockable storage for selfadministered medication is not present in all rooms. All staff receive training with regards to the handling of medication, and a process of internal and external audit is undertaken. Medication is stored securely within the first floor office, however it is a requirement that keys to this cupboard are not left unattended in the drawer in the office, as was the case at the time of the visit. A member of staff must hold the keys to medication storage at all times. Medication administration records were viewed. Unexplained gaps were present on some records, and correction fluid, (“Tippex”), had been used. Through discussion with Mrs Denslow, it was ascertained that staff undertake the practice of putting medication out into pots for all residents at the same time. This practice is undertaken in the office where medication is stored. Individual labels are put with the pots as they are potted out, and all of the Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 12 pots are then taken around the home to residents on a tray. This system of administering medicines does not follow best practice guidelines and presents a significant risk to residents. It was ascertained that wasted or refused medication is not returned to the pharmacist, but is thrown away within the home. This is not best practice and does not provide an audit trail of wasted medication. All wasted / refused medication is to be labelled and recorded within the home and returned to the pharmacist for disposal. Following the inspection Mr Robinson provided written details to the inspector pertaining to some of the issues described above. The additional information provided by Mr Robinson has been considered in the production of this report and the subsequent requirements and recommendations, and is held on file by the Commission for Social Care Inspection. All residents were seen to be treated with dignity and respect during the visit, with interaction between staff and residents being friendly, caring, kind and polite. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 13 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, 14,15. The resident’s ability and care needs, and social, religious and recreational interests are taken into consideration for the provision of a meaningful activities programme. Residents are able to receive visitors at any time. Resident’s preferences and choices are adequately catered for with a balanced and varied selection of food and drinks. EVIDENCE: Residents informed the inspector that staff provided in house entertainments such as quizzes and bingo; the home was seen to possess a number of books, including some with large print; music was playing in the lounge and residents were consulted as to the choice of music. It was stated that a record of activities undertaken is maintained. Mrs Denslow stated that she sits with residents on a monthly basis to enable them to raise any issues they might have and to discuss care needs, general well being and activities provided. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 14 Some residents commented that they are escorted out to a local church group, and some residents participate in in-house religious services with the assistance of staff. Residents said that time for family and friends to visit is not restricted. At the time of the inspection drinks were provided frequently and upon request, and a staff member was noted to be preparing lunch. Residents were presented with a choice for lunch, and requests to change what was on offer were accepted and provided by the care staff without question. Residents commented that some staff were slightly better cooks than others, but all were happy with the choice, presentation and quality of meals, snacks and drinks. Residents commented that it was usual to be offered a choice of meal by staff, and that meals included seasonal variation and reflected personal taste. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: These standards were not assessed at this inspection. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 16 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): 19,22,25,26 Residents live in homely, comfortable and pleasant surroundings, which are kept clean and tidy, are odour free, and are subject to a process of on-going repair and maintenance. Radiators are not fitted with low surface temperature covers and are extremely hot to the touch. This presents a significant risk to residents. EVIDENCE: At the time of the inspection the home was clean and tidy throughout, with no unpleasant odours noted. Cleaning and housekeeping duties are undertaken by care staff. The home presents as a very homely environment, with furnishings, curtains and carpets of a domestic design. All resident’s bedrooms were seen to contain personal belongings, were homely in appearance, and conveyed the character and interests of the occupant. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 17 The home is fitted with a through floor lift, disable bathing facilities and residents possess a variety of walking aids. The home was warm throughout and residents commented that they were comfortable. It was noted that the home has a large number of radiators that are not fitted with low surface temperature covers. Upon checking some of these radiators, several were found to be extremely hot to the touch, and as such to present a significant risk to residents. At the conclusion of the inspection the care manager was advised that a requirement of the subsequent inspection report would be for the undertaking of a programme of fitting radiator covers throughout the home. Following the inspection a letter was received from Mr Robinson, (Registered manager / provider), stating that the home has experienced some recent problems with the heating system creating fluctuations in radiator temperatures, and also agreeing to commence with a programme for the fitting of radiator covers. Mr Robinson’s prompt attention to this issue is welcomed. All rooms are fitted with call bells, and once activated, staff need to enter the residents bedroom to turn these off. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 18 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): EVIDENCE: These standards were not assessed at this inspection. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 19 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): 31,32,38. The management approach of the home is focused on the provision of good quality care, by a kind and caring staff team, within a pleasant and homely environment. The practice of holding open fire doors with inappropriate devices, places residents, staff and visitors at significant risk. Potentially harmful chemicals are not stored securely, potentially placing residents and visitors at risk. EVIDENCE: The homes registered manager, Mr Robinson was not present at the time of this inspection. Mr Robinson has been registered under the Care Standards Act 2000, and along with his wife is recorded as the homes proprietor. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 20 Mr Robinson is not involved in the personal care of residents, but instead has appointed a “Care Manager”, Mrs Denslow. Mrs Denslow has a background in care work, and is responsible for the assessment, provision and review of resident care. Mr and Mrs Robinson and Mrs Denslow appear to work together effectively to create a homely and residents focused service. During the inspection Mrs Denslow was able to provide all requested documentation and information, and was aware of all residents care needs and matters pertaining to the general day-to-day running of the home. It was noted upon arrival that a number of doors within the home were being held open with wedges, most significantly the laundry room door. The care manager stated that the fire officer had agreed that during the serving of meals the kitchen to dining room doors could be held open, but must once again be closed when meals had been served. The use of door wedges presents a significant risk with regards to fire safety within the home, and an immediate requirement was served for the removal of all door wedges and the practice of holding doors open, with other than devices sanctioned by the fire officer, to cease immediately. The laundry room was noted to be the homes storage area for cleaning products and other chemicals. The laundry room door is unable to be locked / secured. This presents a potential risk to residents and visitors to the home. Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 21 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X 3 X X 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4)a)&c ),23(4)(c) i Requirement Immediate requirement served 07/02/06: Doors must not to be held open by other than devices agreed with the fire officer. Agreement for the use of hold-open devices such as “Dorgards”, should be obtained in writing from the fire officer. A programme of fitting all radiators with low surface temperature covers is to be commenced. (The providers have stated that this should be completed within a 12 month period). Medication is to be stored securely within the home at all times. The keys to medication storage facilities are to be held by a member of staff at all times, and are not to be left unattended in unlocked desks or offices. NMS 9(2). Where residents are supported to self-administer medication, they must be provided with lockable facilities within which to store their DS0000022983.V280212.R01.S.doc Timescale for action 07/02/06 2 OP25 13(4)(a and c) 01/06/06 3 OP9 13(2) 01/04/06 4 OP9 13(2) 01/05/06 Keep Hill Rest Home Version 5.1 Page 23 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 10 OP38 OP38 13(4)(a and c) 13(4)(a and c) medicines. NMS 9(3). All wasted / refused medication is to be placed in individual envelopes, which must be labelled with the residents name, drug name, date and time of refusal and staff signature. These envelopes are to be stored in the medication cupboard until returned to the pharmacist for disposal. NMS 9(3). A record must be maintained of all wasted/refused/excess medication returned to the pharmacist by the home. Medication administration records must be completed fully with no unexplained gaps present. Correction fluid must not be used on medication administration records. Medication must be administered to one resident at a time from the original packet/container. The “potting up” of all medicines at one time is unacceptable practice and is to stop. The laundry room door must be fitted with a lock or other means by which it can be secured. Chemicals must be stored securely within the home. 01/05/06 01/05/06 01/04/06 01/04/06 01/04/06 01/04/06 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 Keep Hill Rest Home DS0000022983.V280212.R01.S.doc Version 5.1 Page 24 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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