Inspection on 31/10/06 for Hill House

This inspection was carried out on 31st October 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill House 03/03/06

Hill House 29/07/05

Hill House 25/02/05

Hill House 31/08/04

Similar services:

Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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

CARE HOME ADULTS 18-65 The Hill Newcastle Road Sandbach Cheshire CW11 1LA Lead Inspector Joan Adam Key Unannounced Inspection 31 October 2006 09:30 The Hill DS0000018792.V303930.R01.S.doc Version 5.2 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 The Hill DS0000018792.V303930.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 Adults 18-65. 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. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hill Address Newcastle Road Sandbach Cheshire CW11 1LA 01270 762341 01270 527414 hill@wwm.leonard-cheshire.org.uk www.leonard-cheshire.org.uk Leonard Cheshire 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) Mrs Jean Parry Care Home 33 Category(ies) of Physical disability (33), Physical disability over registration, with number 65 years of age (6) of places The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 33 service users to include:* Up to 33 service users in the category of PD (Physical disability aged 18 to 64) * Within the maximum of 33, up to 19 service users in the category of PD who need nursing care may be accommodated * Within the maximum number of 33, up to 6 service users in the category of PD(E) (Physical disability aged 65 years and above) may be accommodated 3rd March 2006 Date of last inspection Brief Description of the Service: The Hill is a care home registered to provide both nursing and personal care for adults who have a physical disability. The home is situated approximately one mile from Sandbach town centre and is set in its own extensive grounds Residents are accommodated on the ground and the first floor. Access to first floor is via passenger lift or staircase. Residents’ accommodation comprises thirty-four single bedrooms, one of which has an en-suite facility. There are two lounges, a dining room and an occupational therapy room. The cost of care at The Hill is based on an individually assessed need approach. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on the 31st October 2006 and lasted 8 hours. The visit was carried out by one inspector. This visit was just one part of the inspection. Before the visit the home owner/manager was also asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were also made available for residents, families, health and social care professionals to find out their views. Other information received since the last key inspection was also reviewed. During the visit various records and the premises were looked at. A number of residents and relatives were also spoken with and they gave their views about the service. What the service does well: Care plans have improved at the Hill to enable staff to be guided as to how to meet the needs of the residents living there. Care plans had been signed by the residents and they felt they were involved in their care. Social activities take place following full discussion with the residents and they feel that their needs are met. The bedrooms are well personalised with residents’ own items such as televisions, ornaments and pictures. Staff were friendly and attentive to the residents and had a good knowledge of the residents needs and the character and history of the residents in their care. The home was clean and free from any unpleasant odours. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of people’s care needs are carried out before they move into the home so there is information to show that their needs can be met. EVIDENCE: The files were looked at for two residents who had been recently admitted to the home. Preadmission assessments had been carried out prior to the residents being admitted to the home. Supporting documentation from social services and hospital staff were present in the files. These contained adequate detail to enable staff to write a comprehensive care plan. Residents spoken with said that staff from the home visited them prior to admission. A project manager and care manager have been recently appointed who are at present setting up a multidisciplinary admission panel to enable the needs of prospective residents to be more fully assessed before admission to the home. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Details within the care plans needs to be checked and updated to ensure the up to date needs of residents are met. EVIDENCE: Files for four residents were looked at. Care plans at the home have improved. The individual plans were signed by residents or their relative and personal goals were documented. Residents spoken with said that they were involved in their individual plan of care. The physical needs of the residents were assessed and detailed to guide staff as to how to meet the residents’ needs. However, one resident had a pain assessment chart in place that had not been completed since February. The resident had been receiving regular pain control medication. Care plans for residents with pressure sores were detailed and visits by other supporting professionals such as the tissue viability nurse, G.P and district nurses were recorded. Notes were in place from the physiotherapist and occupational therapist. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 10 Risk assessments were present to enable support for the residents so that their independence was maintained. One resident was under discussion with the staff and a local gym to enable them to attend the gym on their own. Residents spoken with felt they were informed and are involved in making decisions about the day-to-day running of the service. They said that the new changes were a “bit unsettling “ and “ it was too soon to make any real judgement on the new management structure”. The new project manager has held two meetings with residents and minutes were available. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are supported to make choices so they maintain control over their lives within their individual abilities. EVIDENCE: The home maintains good links with community support services to ensure residents’ health needs are met The home maintains good links with community support services to ensure residents’ health needs are met The home has an activities organiser in post and offers a range of daytime activities. A new large screen television has been purchased for the lounge at the front of the house and residents felt that this was very positive. One resident said” I spend most of my day here now” another said “ I didn’t use this room before but this tele is great” Residents spoken with said that they enjoy going to the local pubs, leisure centres and shops. “ we go out quite often to local markets” The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 12 One resident was under discussion with the staff and a local gym to enable them to attend the gym on their own. One resident is attending the local college. A tutor comes to the home each week to support the residents to use their computers. A volunteer visits the home to assist the residents to cook in the occupational kitchen. The home is close to Sandbach town centre and a short ride to Crewe. The home has its own mini bus or residents can hire transport through community or private hire. The home has international volunteers who can accompany residents when they go out. One resident has recently been to France. Residents felt that their needs were being met. Three residents have been assessed for an” environmental controller”, technology to enable them to use their televisions, computers and telephones unaided. One resident was very excited “ this means I can answer the phone myself” The home has an open visiting policy and relatives spoken with said they could visit at any time. Life-long learning is encouraged and the home has its own computer suite. Occupational therapists and physiotherapists are involved in the assessment of residents living at the Hill. Residents said that the food was good and plentiful. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Medication is not being properly managed to ensure the safety of the residents living at The Hill. EVIDENCE: Staff support some residents with all aspects of their personal care. The level of assistance required is dependent on their assessed needs. Care plans looked at provided evidence that the residents receive advice and treatment from a number of health care professionals, eg: doctors, physiotherapists, continence advisors and community nurses. Residents spoken with felt that their physical needs were met very well at the Hill. One resident that had completed a questionnaire sent to them by CSCI said that they felt their emotional needs could be better met but felt the physical care they received was excellent. Comments such as “ the staff work very hard” “ care is excellent” were made by residents living at the home. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 14 Medication recording, management and storage were looked at. Medicine Administration Records were examined and there were some unexplained gaps in the recording of medications. Medicines were stored and disposed of appropriately. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure in place. Staff training is in place to ensure that the residents are protected from abuse. EVIDENCE: Complaints recorded at the home have been dealt with under the company’s complaint procedure. A copy of the complaints procedure is available in the service users guide. Residents and relatives spoken with said that they had no complaints and that they were aware of whom to speak to if they were unhappy about any aspects of the home. Residents’ meetings take place on a regular basis and residents spoken with felt that their views were listened to. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance “No Secrets”. Staff receive regular training and up dates for the protection of vulnerable adults. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The quality rating for this outcome area is adequate . This judgement has been made using available evidence including a visit to the service. Improvements to the home have been made to ensure that the residents live in a comfortable environment. EVIDENCE: The requirements regarding the environment issues have been met. New flooring has been laid in the upstairs corridor and in some areas in the downstairs corridor. Residents spoken with said that the new flooring made the use of their wheelchairs easier. Four bedrooms have been completely refurbished with new carpets and curtains. Overhead room hoists have been fitted in two bedrooms to enable staff to move the residents appropriately. A new large TV has been purchased for the lounge at the front of the home. Lockable drawers have been provided for all residents’ bedrooms to enable them to keep personal belongings secure. New bed linen and towels have been purchased. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 17 The entrance hallway to the home has had the floor re-varnished. The manager’s office, the residents’ smoke room and the nurse’s office has been relocated to make better use of the space available in the home. The front office is now a training room. More notice boards have been put up to display information for residents and visitors regarding the proposed new build that is planned. It is proposed that all the bedrooms at the home will be individually assessed and redecorated with the residents input in the near future. Residents are pleased to see some improvements being made to the environment but are waiting for the new build to begin. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 The quality rating for this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Recruitment procedures need to improve to ensure the safety of the residents. EVIDENCE: There were adequate numbers of staff on duty to meet the needs of the residents living at the home. A new project manager and care manager have recently been employed. Trained staff spoken with felt unsettled at present due to the changes taking place. Carers spoken with felt that the home “didn’t feel any different”. Meetings have been held with all grades of staff to keep them up to date with changes in the management structure. Minutes have been taken and are available for staff to read. The staff confirmed that they had received training in adult protection, Moving & Handling, fire, first aid, infection control Diabetes care, tissue viability, nutritional support and NVQ in care. Thirty three per cent of care staff are qualified in NVQ level two in care. Staff felt that they had a good understanding of the needs of the residents in their care and had a good relationship with them. The residents living at the home confirmed that staff were aware of their needs. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 19 Staff files for three recently appointed staff were looked at. Only one written reference had been obtained for each staff member and two references must be obtained. These staff members had been employed prior to the new manager commencing and she said she would address these issues and audit all personnel files to ensure that all relevant information was present. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Monitoring of the homes’ policies and practices needs to be in place to ensure the home is run in the best interests of the residents living there. EVIDENCE: There is a new project manager in place at The Hill. She is an experienced manager and has various management qualifications. The care manager is also new in post and has applied to be registered with CSCI. She is an experienced nurse who has worked at The Hill for some time. Residents and staff saw her appointment as positive. Team leaders have been appointed and will commence training for this role on twenty second of November. Care plans have improved and residents’ choices are recorded. The fire log was checked and staff training is recorded. Fire alarms were being checked and recorded appropriately. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 21 The proprietor or his designated representative visit the home on a monthly basis, unannounced, to check on health and safety, property and equipment and staffing issues. Discussion with residents, relatives and staff take place during these visits. The company has a self-audit tool however this has not as yet been used at the Hill. The new project manager intends to complete this self-audit in the near future and a copy will be sent to CSCI. Residents’ said that they feel they are involved in the running of the home. One resident commented that “ the new manager walks around the home each day to chat and ask us how we feel.” Meetings have been held with residents and minutes have been taken. Some residents said that they felt the new management structure was positive “ but it is a bit too soon yet to make a judgement” Information sent to CSCI prior to the site visit recorded that safety certificates were in place for items of equipment such as hoists and passenger lifts. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 3 x The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 23 YES 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 YA6 Regulation 15(20 (b) Requirement The registered person must ensure that care plans are up dated to ensure the home meets the changing needs of the residents. The registered person must ensure that all medication administration sheets are signed by staff when a resident has been given medication ( timescale of 21/04/06 not met) The registered person must ensure that new staff employed have two written references before commencing work at the home. The registered person must ensure that a system for evaluating the quality of services provided at the home. Timescale for action 31/12/06 2. YA20 13(2) 31/12/06 3 YA34 19(1) (b) 31/12/06 4 YA39 24(1)(2) 31/12/06 The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 24 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 YA32 Good Practice Recommendations 2. The home must have 5o of care staff qualified to NVQ level 2 or equivalent. The Hill DS0000018792.V303930.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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