Inspection on 02/11/07 for The Hillings

This inspection was carried out on 2nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

The Hillings 15/10/09

The Hillings 16/01/09

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

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ Lead Inspector Joanne Pawson Key Unannounced Inspection 2nd November 2007 11:00 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 The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hillings Address Grenville Way Eaton Socon Cambridgeshire PE19 8HZ 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) 01480 214020 01480 475755 The Hillings Limited Manager post vacant Care Home 64 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (54) of places The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th April 2007 Brief Description of the Service: 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 units 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 and is also used as an activity centre. There is a main kitchen, laundry, staff facilities and sluices. The current fees for privately funded resident’s range from £525 to £600 a week depending on the level of care provided and if the bedroom has an ensuite toilet. Funded residents’ fees range from £351 to £416. The home has recently registered 19 more beds in two newly built units. The CSCI report is made available in the foyer of the home. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out an inspection of The Hillings using the Commission for Social Care Inspection’s methodology. This report makes judgements about the service based on the evidence we have gathered. Our evidence also includes an inspection of the home which two inspectors, Joanne Pawson and Alison Hilton made on Friday 2nd November and Monday 5th November 2007. The acting manager was present through most of the inspection. A number of records were seen, together with staff personnel files and files of people living in the home. We spoke to staff and people in the home during the visits. On the first day of inspection there were 54 people in the home and one person was in hospital. One person was admitted that afternoon, increasing the number of residents to 55. What the service does well: What has improved since the last inspection? What they could do better: All people living in the home must have risk assessments completed and these must be updated regularly or when necessary. This will ensure that staff can support people and meet their needs. Care plans must be kept up to date and take into account changes in physical and mental health. For example weight records alone are insufficient. The home must be able to evidence what actions they are taking if someone has gained or lost significant weight. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 6 The record of medication and its administration must be completed, and include the number of tablets entering the home to ensure the well being of those living there. There must be an adequate stock of medication for each person using the service. This will safeguard the health of residents. Incidents relating to the welfare of those living in the home must be reported to the appropriate authorities. The environment must be improved so that there are no unpleasant odours. Complaints must be fully investigated. Staff must always be available in sufficient numbers to ensure the safety of those living there, and that there needs can be met. Staff must attend mandatory training so that they can meet the needs of the residents. Regular checks of the fire equipment must be made to ensure it is in working order. An immediate requirement was issues during the inspection. 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 summary of this inspection report can be made available in other formats on request. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6 Quality in this outcome area is adequate. Service users needs are assessed before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose but this inspection has found that not everything in the statement of purpose is happening. The statement of purpose states ‘our emphasis is on retaining the individuality of resident’s and as such a care plan is tailored specifically for their needs’. However not all residents had a care plan on the day of the inspection. All of the files for residents’ who lived in the home on a permanent basis had pre admission assessments in place. However not all of the residents files that were seen had basic information such as weight on admission or risk assessments that reflected the preadmission information. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 9 The relatives of some people living in the home said that they had visited before their relative moved in. One relative stated that they had not any information about the home before their relative had moved in. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Staff do not have the information they require to ensure they can meet the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The folders containing pre admission assessments and some care plans were being stored in plastic boxes which were not secure. There were also lots of documents such as old care plans, medication administration records and progress notes being stored on the top of filling cabinets in the office. Again these were not secure. One resident told us that he needed help with certain areas of his personal care but that he didn’t like to ask the staff for help, as they were always busy. The records for medication administration were poor. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 11 For one person living in the home there were the following issues:The audit of the records for the administration of medication showed that the number of signatures recorded did not reflect the number of tablets that were left. This would suggest that medication was being signed as given but were not actually given. There were 8 administration gaps on the MAR sheet between 27/10 and 4/11. Three other people living at the home had had medications run out (Chlorphenamine and Lactulose). One person had received her Metformin so late in the morning that the lunchtime dose could not safely be given. Staff said this was because there is often only two senior staff available to administer medication for the seven flats. Staff also said that this might mean that some people do not get medication with their meal (which may be required for certain medications). Senior staff were asked how two seniors would be available to sign for controlled drugs when the administration of drugs is completed for 7 units by those same staff. No one could give a clear answer. Care plans and risk assessments were poor and in some cases put people who live in the home at risk. The inconsistencies within the completion of records were marked. There were too many examples of poor care plans to list them all in this part of the report. For one person the detail on the initial assessment was good and others such as moving and handling and a falls risk assessment had been completed. However on the Braden pressure ulcer risk assessment she had a score of 10. The assessment states, “16 or less indicates the person is at high risk of pressure ulcers. A prevention plan must be put in place”. There was no further information or prevention plan on the file in relation to this issue. The care plan for this person had last been reviewed in August 2007. The person or their representative had not signed the plans. For another person there was little detail about their communication/social needs other than “speech impaired and comprehends but cannot speak”. A comment was made “likes to wander around the flat most of the time. Risk of falling down.” There were no further assessments about this issue. Another comment was around weight where someone had written, “Slightly changed on nutrition. She needs a little diet, seems getting heavy and bigger.” However the persons weight chart did not show an increase in weight. Since the last inspection (10/5/07) the incidents/accidents relating to one person were tracked. There had been 17 incidents but no risk or falls assessment had been completed and the falls assessor had not been The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 12 contacted. The acting manager could not give a reason why the falls assessor had not been contacted. For one person their weight on 8/8/07 was 58.10kgs and they were not weighed again until 3/11/07 when their weight had decreased to 49.2kgs. Although there were dietary and fluid intake records they were only completed from 13-17 October. There was no other information on file. The same person had a daily entry “X has been very verbal today (X’s sons name!). Complaining of back pain as well as left knee hurting 2x carers assisted with moving X from lounge chair to her bathroom.” There was no information about any medical intervention in relation to the pain. Another resident was weighed on admission in May and then not weighed again until August and again in November. The resident had lost 5kg in this time. Their dependency assessment had been completed in May but not again until October. The daily notes of one resident showed that she was regularly refusing food. There was no evidence that this was being monitored. The pre admission assessment showed that she was prone to urine infections. The GP visits form queried a urine infection on three different occasions but there was no evidence that this has been followed up. One relative stated that she had replied to a letter asking her if she would like to be involved in her fathers care plan and stated that she did. However she had not heard anything from the home since the letter and had never seen her fathers care plan. The home has run out of incontinence pads and net knickers for individuals and the staff have had to ‘borrow’ from others in the home. One relative spoken to said he was not aware of any care plan for his relative (who was on one of the units for people with dementia), but would ask to be part of the care planning process in future. Another relative was very happy with the care her father receives and was part of the care planning process. A relative completed the CSCI comment card and wrote ‘ He could be kept cleaner. I clean and trim his fingernails. Sometimes shave him as it hasn’t been done. His clothes he has on are not always clean.’ The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. There are a range of activities available for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative stated in a comment card that there is a friendly caring atmosphere in the home. Several relatives stated that they had to chase the home staff for updates on their relative rather than staff letting them know about any changes. There were details of monthly activities found in each unit such as on 6th November Coffee morning, 7th Holy Communion, 8th Chris Lewis entertainer, 14th Lunch trip to Jaffa Orchard Café, 15th Ken Dawson entertainer and 19th Fiona McLean singer. Each unit also has details of weekly activities such as this week Monday am entertainment (did not arrive), pm knitting and woolcraft; Tuesday am manicures, pm pamper day; Wednesday am Communion, pm art project; The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 14 Thursday am quizzes, pm games in flat F; Friday am red poppies, pm memory games. On talking to one of the activities co-ordinators it was evident she had experience and she said she had attended various training days. She said the home has its own transport but there is a limit to the number of wheelchair users who can be accommodated at any one time. Details of activities that people have taken part in are recorded on a sheet about the activity, there is nothing that is recorded on individual files at the moment. Two of the relatives’ surveys stated that they thought that suitable activities were not provided for residents with dementia. One resident told us that he had been encouraged by a carer to do a painting as he had not done for three years. The resident had completed the painting and seemed very proud of his achievement. One relative spoken to praised the activities co-ordinators for the variety of things they put on. She felt more trips out would benefit her relative, but was aware that the size of the home and number of staff available meant this was not easy, although she would be willing to pay extra for the opportunity. She said the newsletter the home produced contained information about events. The lunchtime meal was seen and looked appetising. There was a choice of minced cobbler, potatoes and vegetables or quiche, potatoes and beans. Dessert was angel delight, yoghurt, ice cream or cheese and biscuits. Those spoken to said they had enjoyed their meal. On one unit people asked why the spoons had not been put out for the meal and the staff member told them that it was because some people used them to eat their main course and not their dessert. Eventually she did put out the appropriate cutlery for the meal. On another unit one person had to wait until the only staff member was free to assist her to eat lunch in her room. Staff said cooked breakfasts are not offered. Staff said they felt more could be done for diabetics, as when the afternoon tea and cakes are served, all they get is fruit and occasionally diabetic jam tarts. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. The adult protection procedures have not been followed to ensure that service users are not placed at risk from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person living at the home had money go missing from her purse. The report made said that the family was asked if they wanted any further action taken and when they declined nothing else was done. The acting manager said that she had taken no further action about this incident. There had been four incidents that should have been reported under the Protection of Vulnerable Adults system, but the acting manager acknowledged that this had not been done. When asked why the incidents hadn’t been reported the acting manager replied ‘ the family were aware and were quite happy that it could happen’. The acting manager stated that she would check the POVA course content with their trainer as she as not sure if it covered abuse between residents. On 11/7/07 there were 2 incidents involving the same person. The first was at 14:10 when a member of staff was hit with a brush the residents had taken from the PAT dog handlers handbag. Then at 16:20 same person slapped another resident round the face (she had red mark on cheek, cold compress The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 16 applied). The two were separated and monitored. Believed to be an issue over a handbag. On 10/8/07 one person living at the home pushed another to the floor as she was walking past. Senior care notified. On 23/8/07 one person living at the home grabbed another by the arm as they were having an argument. No injuries and the two were separated. No further action was taken. Staff complained that there are a lot of falls and incidents in the home. This was checked for the period since the last inspection (10/05/07) for one person on one of the units caring for people with dementia and she was found to have had 17 falls/incidents recorded. There was no risk assessment completed as a result of these falls. There was only one comment to observe for bruising after one fall. At least one fall occurred when no staff were in the unit as they were administering medication elsewhere. One relatives stated in the comment card that they had not been told how to make a complaint and were not given any policies or documentation when her relative moved into the home. She also stated that that when she had complained the response had been ok but that she had to chase for an answer or for information – usually many times. Three complaints had been received and investigated by the home since the previous inspection. One complaint had been made after a period of respite care. We looked at the information that was investigated by the acting manager. However the reply to the complaint did not give all the relevant information. The complaint was about a lack of personal care and staff not noticing a wound on the resident’s leg. The resident’s file showed that for the last two days the resident was in the home there was no record of personal care. However the complainant was not told this. The records also showed that the resident had only had one bath in the two weeks of respite. The acting manager stated that if it was not recorded then the staff probably didn’t offer her more baths. The reply to the complaint also stated that the flat the resident stayed in had up to ten residents staying there so if it was full residents would not get as much personal care. This is not acceptable. Staffing levels must reflect the needs of the residents. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is poor. There is not sufficient domestic staff to ensure the home remains clean and free from offensive smells at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some areas of the home did not smell fresh or clean. One resident told us ‘it smells rotten in here – I get up early and open all the windows’. The rotas showed that on some weekends there has only been one domestic working for 3.5 hours each day covering the whole of the home. At weekends it is usual practice to have only two domestics working from 8-11.30. As one resident put it ‘ I think there should be more cover at weekends – we live here all the time’. The acting manager stated that it had been difficult to recruit to the domestic posts. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 18 Bedrooms seen in different units were full of personal belongings and photos. Most people said they had brought small items from home. A relative of a resident stated that she had reported a broken toilet seat and it took ten days to repair. This meant that the residents had to sit on the porcelain seat and that her mother kept thinking that she had broken the toilet seat everyday. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. Staff do not have the training they need to do their jobs safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were inspected. The staff files contained lots of loose paper and it was difficult to find the relevant information. The files contained all of the necessary recruitment documentation. Staff spoken to said morale in the home is at an all time low. People feel they are undertaking so much extra work that they are at breaking point and that this will affect those who live in the home if they end up going off sick. The sickness record was seen and most long-term sickness has been noted and the reason given. There are some staff who have days of absence and the acting manager was unable to tell us why they had been off sick as senior staff did not always ask the reason. Senior staff commented that it was not possible to fully engage with new staff and ensure good practice, as they were so busy. This meant that long serving staff were leaving and new staff left after a short time due to the pressure and lack of support. There are times when units are left without staff. Where a unit has one member of staff on duty they have to leave the unit to tell someone they are The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 20 going on a break and then have to take that break. We noted that there were no staff on one unit when the staff member went on her break. The breaks are up to half an hour long. The operations manager for the home stated that she would be changing the shifts so that units were not unstaffed. Staff commented that the home uses many agency staff and although the agency try and send the same staff it is unsettling for everyone. It was seen during the inspection that there are also times when the agency staff was the only person on the unit. This is not appropriate especially on the dementia care units. Senior staff administer medication. Please see comments on this in standard 7. Ancillary staff commented that they are finding it more difficult to keep all areas of the home clean since they lost some staff. In the past there has been 1 cleaner for each unit, now there are 4 to cover the homes 7 units. They said there are 2 cleaners at the weekend. They also said that because of the shortage of hours the job of bed making had passed to the carers on each unit. It is unclear how carers manage to complete this task if they are on the unit alone. The staff training files for three members of staff were inspected. The staff were due to receive training in fire safety in October 2007. This has been booked for December 2007. For one member of staff training also out of date was the protection of vulnerable adults and first aid. For the second member of staff their moving and handling training should have been renewed in July 2007 and the protection of vulnerable adults training should have been renewed in November 2006. For the third member of staff their moving and handling, protection of vulnerable adults and health and safety training should all have been renewed in September 2007. This is very worrying and could be placing the residents and staff members at risk. The acting manager was not sure why they had not been booked on refresher courses. There is a training notice board in the staff room and courses are advertised and staff are asked to sign up for them. The acting manager must ensure that all mandatory training is up to date. Staff comments about training were that it was given but often it was very short sessions and not in appropriate areas. For example moving and handling training was completed in the link room where there is plenty of space for hoists, not in the confined area of a bedroom. There was no practice with slider sheets on beds i.e. in real situations. Staff who had only been in post for a few months said they had completed an induction and this included the areas of mandatory training. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 21 The activities co-ordinator said she had had training and was due to complete updates in a variety of courses. She had not done any course on infection control or food hygiene. One staff member stated that even though she did not complete all of her induction she has to work on her own. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is poor. The safety of residents is being put at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been in post since March 2007. She has applied to the commission to become the registered manager and has attended an interview with the commission and is awaiting the outcome of her application. It is a great concern that there are so many areas that need improving in the home to ensure that the residents and staff are safe. Although tasks can be delegated to other members of staff it is the managers responsibility to ensure these tasks are completed. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 23 The home holds small amounts of money on behalf of residents. The records and the balances held for three residents were checked. Two of the three were correct however the third record did not match the balance held. There was also a ring in the safe belonging to a resident. However there was no record on the resident’s file that a ring had been deposited with the home for safekeeping. There is an area on the residents’ financial balance sheet to record items deposited. The fire records were inspected. The emergency lighting must be tested once a month. The records showed that they had not been tested since March then not again until July and not since then. The fire alarms must be tested weekly. They had only been. An immediate requirement was issued stating that the tests must be carried out within 24 hours. The operations manager stated that the home did not have a maintenance man at present and organised the maintenance man from another one of the providers’ homes to attend The Hillings the day after the inspection to carry out the necessary tests. We have requested that the local fire service carry out an inspection of the home. We asked to see the supervision files for three members of staff. The acting manager stated that she had not done any supervision for two of the them and the third person had received one supervision. Considering the high usage of agency staff and the low morale of the permanent members of staff it is very important that they feel that they are receiving the support they need from the management team. The owners of the home send out a quality assurance questionnaire once a year. This was last completed at the beginning of 2007. The homes quality assurance report stated ‘the results from this home were not as positive as expected. 57 of residents stating that their care plans had not been reviewed. However at the time of this survey new care plan documentation was about to be introduced, and in that process a review of all resident care plans would be conducted over a period of time along with a new policy of regular reviews for all residents’. But as this report has already stated this was not put in place. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 24 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 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 1 X 1 The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 13(4)(c) Requirement Timescale for action 10/12/07 2 OP7 3 OP8 4 OP9 All people living in the home must have risk assessments completed and these must be updated regularly or when necessary. This will ensure that staff can support people and meet their needs. 15 Care plans must be kept up to date and take into account changes in physical and mental health. For example weight records alone are insufficient. There must be evidence what actions are being taken if someone has gained or lost significant weight. Care plans must detail all the needs of residents and state how staff should meet these needs to ensure there is a consistent approach. 12 The health care needs of the (1)(a)&(b) residents must be investigated and the appropriate treatment and when needed specialist health care professionals involved to ensure the health and welfare of the residents. 17(a)(2)S The record of medication and its DS0000015140.V354484.R01.S.doc 10/12/07 01/12/07 01/12/07 Page 26 The Hillings Version 5.2 5 OP9 6 7 OP16 OP18 8 OP26 9 OP27 10 OP30 11 OP35 12 13 OP36 OP38 administration must be completed, and include the number of tablets entering the home to ensure the well being of those living there. 12 (1) The home must make sure there is an adequate stock of medication for each person using the service. This will safeguard the health of residents. 22(3) Complaints must be fully investigated and the full facts given to the complainant. 13 (6) Incidents relating to the welfare of those living in the home must be reported to the appropriate authorities. 16(2)(k) The home must be kept clean and free from offensive odours. This will give the residents a pleasant environment to live in. 18 (1)(a) Staff must always be available in sufficient numbers to ensure the safety of those living there, and that their needs can be met 18(1)(c)( All staff must complete 1) mandatory training to ensure they have the skills to meet the needs of the residents. 17(2)Sche There must be an accurate dule 4 (9) record of all monies and personal possessions held on behalf of residents. 18(2) There must be a system put in place to ensure that all staff receive regular supervision. 23(4)(c) The Fire alarms and emergency lighting must be tested regularly to ensure they work sufficiently. chedule 3(3)(i) 01/12/07 01/12/07 01/12/07 01/12/07 01/12/07 01/01/08 01/12/07 01/12/07 09/11/07 The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 27 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 OP31 Good Practice Recommendations The manager should complete the NVQ 4 in care and management (or equivalent) and a course in dementia care. The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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 © 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 The Hillings DS0000015140.V354484.R01.S.doc Version 5.2 Page 29 - 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. 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