Inspection on 16/01/09 for The Hillings

This inspection was carried out on 16th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hillings 15/10/09

The Hillings 02/11/07

The Hillings 23/05/06

The Hillings 09/05/06

The Hillings 22/09/05

The Hillings 13/05/05

The Hillings 05/10/04

The Hillings 16/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 5JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Hilton     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 5JW 01480214020 01480475755 admin@thehillings.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Hillings Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 64 Number of places (if applicable): Under 65 Over 65 0 54 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 30 0 The Hillings is situated at the end of a cul-de-sac in a quiet residential area of Eaton Socon a few minutes walk from local shops and about two miles from the busy market town of St Neots. The Hillings is registered to provide accommodation and support for 64 people. The home offers single storey accommodation in five flats each comprising of single bedrooms, a lounge/dining room, kitchen, toilets and bathroom. 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, which is also used as an activity centre. There is a main kitchen, laundry, staff facilities and sluices. Details of the fees can be obtained from the home. The CSCI report is made available in the foyer of the home. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We the Commission for Social Care Inspection (CSCI) carried out a key unannounced inspection of The Hillings on Friday 16th January 2009 at 07:30 hours using the Commissions methodology described below. This report makes judgments about the service based on the evidence we have gathered. Staff, including night staff, people who live at the home, visitors and the manager were spoken to as part of this inspection. An Annual Quality Assurance Assessment (AQAA) was completed and returned to the Commission prior to this inspection. Surveys were sent to people who live in the home, their relatives and staff. 7 relative surveys, 6 staff surveys and 19 residents surveys were returned to the Commission Care Homes for Older People Page 6 of 26 before the inspection took place. Information from these can be seen in the body of the report. A number of other records were seen, together with two staff personnel files and the files of three people living in the home. A short observational tool for inspection (SOFI) was undertaken in one of the lounges for people with a diagnosis of dementia. This is a tool used to help us gain an insight into the care provided at the home when those receiving the care are unable to tell us that information. Observations are made every five minutes for two hours using the best outcomes for those being observed. Comments made from the observation are documented in the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided in a variety of ways so that people who are thinking about moving to the home can make a decision as to whether their needs can be met. Evidence: Details in the AQAA showed that people are given detailed information to help them decide if the home is right for them. The service user guide and statement of purpose are available in different formats (large print and audio). These were good at the last inspection and have not been inspected again. People are assessed before being admitted to the home to make sure their needs can be met. The reports supplied by the placing authorities are also used as part of this assessment. There was evidence of this in the files seen. Feedback from the resident surveys showed that some people had been to the home Care Homes for Older People Page 10 of 26 Evidence: on respite, others had family who had visited before they made a decision about moving to the home. Of the 19 surveys returned seven said they had contracts, eleven said they did not and one person did not answer. It was not clear if those who did not have contracts were funded by the local authority or self-funding. 13 people felt they had received enough information to decide if the home was right and six did not. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care staff have the information they need to care for people in the home. Evidence: Surveys returned by staff showed a variety of views on whether they received up to date information about the needs of the people they cared for. Staff spoken to during the inspection showed they did understand the needs of the people in the flats and they felt the information was correct at the time. Details provided by the manager in the AQAA showed that he understands the importance of person centred care and is ensuring this is moving forward in a variety of ways. There are new care plans being trialed (alongside the previous version) to see if they provide better information and are easier to complete and update. Those seen as part of this inspection showed that information is written with the person, and details how they want to be cared for in all areas of their lives. For example one area was how you can help me maintain personal hygiene; this involved shower once a week in the evening, use of a particular brand of soap and can clean own teeth. Care Homes for Older People Page 12 of 26 Evidence: Another was to maintain appearance and this included type of clothing, colours, type of perfume the person liked and make up. The information gave a picture of the person and their preferences. The things written in the plans must be legible to be of any use. There was one section that neither we nor the manager could read. All documents should be signed and dated to ensure staff know which is the most recent. There were several documents on the files seen that did not have this on. One person said in the survey that their relative had a number of health issues, which had gone unnoticed by staff and the GP and is now in hospital as the result of a fall. Another person whose file was being inspected had lost weight. The person was weighed on 3/11/08 and weighed 62.65 kgs and on 5/12/08 weighed 59.65 kgs a loss of 3kgs. There was no evidence on file of what had been done in relation to this loss, whether the GP, D/N or Dietician had been involved. This was discussed with the manager who said he would look into the situation. As a result of this assurance we will not make a requirement at this time. On speaking to a staff member in one of the dementia flats she said that one person who had had scabies had been forcibly creamed and bathed to treat the condition. The information was clarified by the manager that this had been done in consultation with the district nurse, family and constantly trying to reassure the person. The incident had been documented and was on file. Sixteen people living in the home felt they received the care and support they needed always or usually, however three felt they sometimes or never did. On speaking to people as part of the inspection they said they were very happy with the carers and that they worked hard, but some also felt their needs were time driven and task orientated. 17 people felt staff listened and acted on what they said but two felt they did not. The manager said that there are several audits carried out on a regular basis in medication, observation of practice, care plans, infection control and full home audits. A copy of the observational audit was seen and found to be detailed and contained advice on how to move practice forward. Keys to the medication room are now kept in the office. All staff who administer medication have provided their signatures to ensure the audit trail can be made. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities provided must enable and engage people so that they can feel included. Evidence: One of the staff surveys felt more activities would benefit the people living in the home as some of the more able lack stimulation and get bored. Relatives completing the surveys felt more interaction between staff and people living in the home could improve their quality of life. One was unsure if their relative was involved in any activity as they were unable to remember. We spoke to the new activities manager who is overseeing the co-ordinators in The Hillings and other homes owned by the same provider. She has extensive experience and explained the changes she is making. When these are made it is expected to make a significant difference to the way activities are provided, how they are recorded and how people are involved. She attended a relatives meeting held in the home and felt there was a positive response to her ideas. 15 people who completed the survey felt the home provided activities they could take part in but four did not. Care Homes for Older People Page 14 of 26 Evidence: During the observation in one of the lounges for people with dementia, we saw one person given a puzzle book but he had to wait 20mins to be given a pen that allowed him to complete it. Another person was given a scrap book of pictures but there was no engagement to interest them in it. When one person wanted to tell a member of staff something they were told Dont tell me now. Hang onto it and you can tell me later. The carer never went back him. Not all people with dementia can retain information and need to have staff who will listen to them. Later on the day of inspection several people were playing bingo in the activity room and appeared to be enjoying their cups of tea and biscuits. 17 people liked the meals at the home but one person only sometimes liked them and one person never liked them. There is always a choice at mealtimes and if anyone does not like what is on offer staff said other things can be provided. It was nice to see fresh fruit available and nibbles provided in the flats, especially for those with dementia whose appetites may not be as good as they were. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and can be confident the issues will be dealt with appropriately. Evidence: All surveys returned by relatives showed they knew how to make a complaint. 14 people who live in the home said they knew how to make a complaint and five said they did not. 18 people knew who to speak to if they were not happy. On speaking to people in the home during the inspection most knew who to talk to if they were not happy. Those with dementia may need more assistance to understand complaints although relatives and others are often their advocates. It would be good practice for information about advocates to be available and displayed in the home. Staff surveys showed that they knew what to do in the event of a complaint or allegation being made to them. Staff spoken to during the inspection understood they needed to tell a senior and knew what the types of abuse were. Some were less clear on whether resident on resident issues were abuse. This was discussed with the manager and he will ensure this is made part of the Safeguarding training (formerly called adult abuse or Protection of Vulnerable Adults). The manager has dealt appropriately with allegations of abuse made to him. There is one however (not dealt with directly by the manager), that although initially dealt with Care Homes for Older People Page 16 of 26 Evidence: according to the company policy and procedure should have been referred to the Police. There is also a question of the advice given by the Safeguarding team in Social Services but this is being dealt with separately. The manager acknowledged that a referral should have been made to the Police according to the company procedure, and is ensuring all staff who deal with safeguarding understand their responsibilities. The company Protection of Vulnerable Adults Safeguarding Protocol September 2007 states that As a matter of course allegations of criminal behavior should be reported to the Police. We have spoken to the Director of Quality within the organisation who said that the Safeguarding lead in Social Services had been out to the home and confirmed that the deputy manager had dealt with the issue as he had advised. As a result we have changed the judgement to good. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home and grounds are well maintained to provide a pleasant and safe place to live. Evidence: Information in the AQAA showed that the home is well maintained and comfortable for people to live in. Comments in some of the staff surveys were that the home is clean, comfortable and warm and that staff endeavor to maintain a high standard of cleanliness under difficult circumstances. People are encouraged to personalise their bedrooms and those seen during the inspection had a variety of personal belongings in them. The domestic team has been increased to provide increased frequency of cleaning in problematic areas. On the day of inspection the entrance into two flats (adjoining) had offensive smells which were there at the beginning and end of the inspection. In discussion with the manager it was evident that domestic staff tried to ensure the home smelled nice, the flooring in some bedrooms had been changed and specialists had looked at the problem. The issue according to flooring specialists is that where there is a continence problem the urine has soaked through flooring and into the concrete underneath and unless that is replaced the odours will remain. The manager is still looking for ways to Care Homes for Older People Page 18 of 26 Evidence: solve the problem and we will not make a requirement at this time. 16 people who live in the home who completed surveys said the home is fresh and clean, two said usually and one said never. Other areas of the home are bright and welcoming with fresh flowers in the flats and entrance hall. There is a maintenance schedule and decoration of bedrooms occurs as they become vacant. There are pleasant safe garden areas for people to use when the weather improves. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training to enable them to care for people in the home and meet their needs. Evidence: Information in the AQAA showed that at the time it was completed the home had 28 full time care staff, 10 part time and 15 other staff not providing care. Nine staff have NVQ Level 3 in Care and four are starting in January 2009. Nine staff have NVQ Level 2 in Care and eight are starting in January 2009. One person is completing NVQ Level 3 in Food Processing and two people are completing the course at Level 2. Staff surveys returned showed they did not start work until the appropriate checks had been completed. Details in the files seen during the inspection showed that gaps in employment had not been explored even though there was a specific area on the interview form to do this. The manager said he would ensure all gaps were investigated in future and would discuss with staff whose files we saw about any gaps. Staff said they had received an induction and further training that was appropriate to their role. Staff spoken to during the inspection confirmed they too were receiving training. Details on the training spreadsheet further verified these comments. Care Homes for Older People Page 20 of 26 Evidence: Staff surveys showed that they felt there were usually or sometimes enough staff on duty. There were comments that when a staff member goes sick just before their shift it is not always possible to get agency staff at short notice and so the shift has to manage. This occurred on the day of inspection when three staff called in sick. Off duty staff were asked to cover some of the shift, which they did, and so there was only one staff not covered. One person said that extra staff were needed in some of the flats. Other comments in the staff survey included the way that many staff go out of their way to ensure the needs of people in the home are met. Relatives were concerned at the level of staff where English is their second language which can make them difficult to understand but also raises concerns about how those staff understand people with dementia who may use inappropriate words or with anyone using colloquialisms e.g. I want to spend a penny. One staff member spoken to during the inspection was asked what he/she understood by that phrase and they thought it was about money. The manager was spoken to and he said staff attend English lessons but they are not specifically for care staff, just general language. It was discussed that it might be useful to have some general and much used phrases given to staff to help them meet the needs of people in the home. Another issue raised by some relatives was level of staffing for example when one person needs assistance, this can leave the rest of the flat with no staff. This was discussed with the manager and he said that all flats have a level of staff that allow one person to be on the floor at all times. People who live in the home commented in their surveys that there are not enough staff at night and that staff are often very busy and cannot always attend to their needs. The staff rota showed that staff are assigned to each flat and where there are adjoining flats staff are expected to assist the other flat when necessary. Staff numbers would allow this. Positive comments in the relatives survey included friendly, caring staff, permanent staff are very kind to the residents and kind and patient staff. In the surveys completed by those living in the home were that staff were kind and helpful. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in an open and transparent way with input from the staff and those living there to make it a plasant place to live. Evidence: Staff said they were given support by the manager often or sometimes. One person commented that he is always there to listen to my comments and concerns. It was clear on the day of inspection that the manager is available if needed and he tries to ensure a friendly and open way of working. Staff supervision is being completed and a list of furture dates was seen. Staff spoken to said they did get supervision, but felt they could talk to the senior staff and manager whenever they needed. Fire records were seen and staff have been involved in fire drills. Other fire checks such as emergency lighting have been completed as required. The money of some people living in the home was checked and found to be correct. Care Homes for Older People Page 22 of 26 Evidence: Food stored in the fridge in one of the units was not dated so it was not clear when it had been opened and put there. This was done before the end of the inspection. The manager said that the quality assurance monitoring for the home was completed by head office but he did not have a report from 2008 available to show us at the time of inspection. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 17 The safeguarding procedure must be followed; to include the police in investigations where necessary. This is to protect those who live at the home from abuse. 28/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!