CARE HOMES FOR OLDER PEOPLE
The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ Lead Inspector
Joanne Pawson Unannounced 13 May 2005 @ 09:30 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 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. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Hillings Address Grenville Way, Eaton Socon, Cambridgeshire, PE19 8HZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01480 214020 01480 475755 The Hillings Limited Mrs Margaret Fuggles Care Home Category(ies) of Old age, not falling within any other category registration, with number (OP) 46 of places Dementia – over 65 years of age (DE(E)) 20 The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 5th October 2004 Brief Description of the Service: The Hillings is registered to provide accomodation and support for 46 people over 65 years of age(20 of whom may have dementia). The home offers single storey accomodation in five units each comprising of single bedrooms, a lounge/dining room, kitchen, toilets and bathroom. There is also a main kitchen, a laundry, staff facilities and sluices. Two of the units are for people who need extra care due to dementia (up to twenty residents) and there are several respite care places. A large conservatory links the two extra care units and is used as an activity centre.The home is situated at the end of a cul-desac in a quiet residential area of Eaton Socon, a few minutes walk from local shops and about two miles from the busy market towm of St.Neots. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection for The Hillings for 2005/06. This unannounced inspection took place for four hours and was carried out by one inspector between 9.30 and 13.30. On the day of inspection eight residents were spoken to. The relatives of one resident were also spoken to. Other methods used for the inspection included reading documentation, speaking to staff (on their own and in groups), speaking to the manager and a tour of the home. What the service does well: What has improved since the last inspection?
The staff files looked at now contained the required information which to ensure the protection of residents (references, police checks and application forms). The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 6 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 Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 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 standard(s) These standards were not inspected this time. EVIDENCE: The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 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 standard(s) 7,8,9,10 The homes care plans are inadequate. This could lead to staff not providing the right level of assistance to meet residents needs. The lack of up to date training for the staff responsible for administering medication could be putting service users at risk. A resident was left in pain due to staff sending his medication home with another resident. Staff respect the service users privacy. There were examples of staff carelessness resulting in lack of dignity for residents. EVIDENCE: One care plan tracked stated “painkillers must be given regularly at the families’ insistence even though the resident will always refuse”. Residents should be encouraged to make their own choices. Prescribed painkillers were not available for one resident resulting in that service user experiencing distress. The error was corrected before the end of the inspection but the inspector was concerned that prompt action to rectify the situation had not been taken. One service users risk assessment stated ‘to keep free from falls’ but did not state how this was to be achieved.
The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 10 Residents stated that they had not been asked if they would like to read their care plans. One resident stated that she would like to look at her care plan but didn’t know if she was allowed to. A residents weight chart was monitored and found to have numerous inaccuracies. The manager had written on the weight chart that the weight recorded must be wrong but the resident was not weighed for a further eighteen days. Evidence was seen of care plans being reviewed regularly. Service users spoken to stated that staff always knock before entering their bedroom. The medication trolley was left unattended and open for a short period of time whilst the person responsible administered medication in the next room. The member of staff administering the medication on the day of inspection stated that she had not received medication training since her initial nurse training over 45 years ago. The staff members training record stated that she had worked at the home for 22 years but there was no record of medication training. Care plans were found on the kitchen worktop in one of the units. In the other units they were locked away. Notices about residents were displayed on the kitchen units and the office notice board. The night before the inspection a resident had been assisted to use a commode that had no bowl in place. This inevitable result from this carelessness left a strong odour in the residents bedroom. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 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 standard(s) 12,13,14,15 Residents are able to exercise their choice in how they wish to live. EVIDENCE: Residents spoken to stated that there are various activities offered within the home and that they can choose if they want to take part. The activities coordinator records which residents take part in activities. Residents said that families and friends visit the home and they can choose to see them in their bedroom if they want to. The menu’s seen showed that there was a variety and choice of food available throughout the day. One resident said that although staff liked to get them ready for bed at around 8.00oclock they could get ready at a time of their choice. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 12 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 standard(s) 16,18 The home has a satisfactory complaints system. Satisfactory systems are in place to ensure the protection of residents from abuse. EVIDENCE: Residents stated that if they wanted to complain they would talk to the manager and feel that they would be listened to. A number of staff training files, including their induction training, contained details of staff attending training in Protection of Vulnerable Adults. Accounts of residents’ monies were seen and systems for the safe keeping of money were satisfactory. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 13 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 standard(s) 19,20,23,24,25,26 There is a potential risk to residents as the building is not always secure. Resident’s bedrooms are comfortable and homely giving them a positive experience of living at the Hillings. EVIDENCE: After the last inspection of the Hillings a requirement was made that “arrangements must be put in place no later than the 31st July 2004 to ensure that no unauthorised person can enter the premises without first being seen by an appropriate member of staff”. On arrival at the home a member of staff opened the front door, let the inspector in and walked away without checking her identity. Bedrooms were pleasantly personalised with resident’s own items. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Relief staff are not being given the necessary training to ensure that residents are in safe hands at all times. The recruitment procedure was unsatisfactory for the protection of residents. One member of staff working on the day of inspection who was recruited from overseas was finding it very difficult to understand the residents and other staff needs and wishes. EVIDENCE: The relief manager had no recent training in the administration of medication, fire safety or moving and handling. All staff should be appropriately trained. Staff files seen contained application forms, references and criminal records bureau checks. One member of staff spoken to did not understand the inspectors’ questions. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36,37, 38 Resident’s views are taken into consideration in the running of the home. Staff are not receiving the one to one support with their manager to talk about any issues they have with their job or any training needs. This could lead to service users being placed at risk, as not all staff are up to date on their mandatory training. EVIDENCE: Minutes of residents meetings were seen. Residents spoken to said they could speak to care staff or the manager if they had a complaint. Records of resident’s money were found to be accurate. Staff are not having regular supervision with their line manager. Several members of staff have not received any supervisions in 2005. The manager stated that she had not had time as she had been training a new member of the management team. The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 1 3 x x 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 3 3 1 3 2 The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 17 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 OP7 Regulation 15 Requirement Each service user must have a written plan that is accurate and up to date and includes all information on how a service users health and welfare needs are to met. The care plan should be signed by service users or their representative to say they have read it. This was a requirement from the previous inspection. All staff resposible for admistering medication must receive training in the recording, handling, safekeeping, safe adminsitration and disposal of medicines. Arrangements must be put in place no later than the 30th June 2005 to ensure that no unauthorised person can enter without first being seen by an member of staff. (This was a requirement from the previous inspection). Systems must be put in place to ensure the home is free from offensive odours. All staff should receive mandatory training on a regular basis to include fire, moving and Timescale for action 1st August 2005 2. OP9 13(2) 1st August 2005 3. OP19 13(4) 30th June 2004 4. 5. OP26 OP27 16(2)(k) 18(1)(b & c) 30th June 2005 1st August 2005.
Page 18 The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 6. OP36 18(2) handling, health and safety, food hygiene, medication (for those resposible) and first aid. An action plan must be sent to the commission by no later than the 15th July 2005 stating how this will be achieved for each member of staff. Arrangements must be put in place for staff to receive formal supervision at least six times a year. 1st July and ongoing. 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. Refer to Standard Good Practice Recommendations The Hillings I53 I03 15140 THE HILLINGS V224839 130505 STAGE 4.doc Version 1.30 Page 19 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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