CARE HOMES FOR OLDER PEOPLE
The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ Lead Inspector
Joanne Pawson Announced Inspection 22nd September 2005 10:00 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.V250722.R01.S.doc Version 5.0 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.V250722.R01.S.doc Version 5.0 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 Margaret Rose Fuggles Care Home 46 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (46) of places The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th May 2005 Brief Description of the Service: The Hillings is registered to provide accommodation and support for 46 people over 65 years of age (20 of whom may have dementia). The home offers single storey accommodation 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 town of St.Neots. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection for The Hillings for 2005/06. This unannounced inspection took place for eight hours and was carried out by one inspector between 10.00 and 18.00hrs. On the day of inspection ten residents were spoken to. Other methods used for the inspection included reading documentation, speaking to staff, speaking to the manager and a tour of the home. An additional complaints visit to the home was carried out in July 2005. The complainant stated that there were a number of staff in the home for whom English is not their first language and that could therefore be placing the residents at risk. The complaint was upheld for two members of care staff and an immediate requirement made that the registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the service users. What the service does well: What has improved since the last inspection?
The security of the building has improved so that visitors to the home cannot enter without being asked who they are. The majority of staff have received training in moving and handling and fire safety. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 6 The majority of staff are now receiving regular supervision sessions with their line manager to discuss their role and any training needed to meet the needs of the residents. 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 DS0000015140.V250722.R01.S.doc Version 5.0 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.V250722.R01.S.doc Version 5.0 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 the following standard(s): 3 Prospective service users needs are assessed before moving into the home. EVIDENCE: Three care plans were tracked and contained basic information about the needs of the residents. Several residents stated that they had first come to the home on respite and decided to move in permanently. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 Care plans contained the basic information needed for staff to meet the resident’s needs. Not all staff are aware of the information contained in care plans. This could lead to residents receiving an inconsistent service. EVIDENCE: Care plans tracked contained basic statements such as carer must inform the office if any signs of hypertension. The care plan could be expanded to include what the signs could be so that staff that are not familiar with the residents are aware of what to look for. The care plan for a service user who does not speak English stated that there are communication cards with pictures and words to help communicate with the resident. The two members of staff working with the resident on the day of the inspection were not aware of the cards. The manager stated that one of the members of staff had only being working in the home a short time so had possibly not been shown them yet. Residents stated that they are treated with dignity and respect. The medication administration records were inspected and found to be accurate.
The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents receive a healthy balanced diet. Resident’s families are not always informed of incidents within the home. EVIDENCE: Residents stated that they enjoy the food provided. Minutes from the residents meeting included residents asking for more choice other than sandwiches at teatime. The manager stated that hot snacks are also available at teatime but residents often chose sandwiches. A residents relatives spoken to on the day of the inspection stated that they had not received any notification of their relative having an accident and came to visit and found them with bruising to their face. The relatives found this very distressing. The manager stated that it was usual practice to inform relatives of any accidents but on this occasion the staff on duty had not done it at the time of the accident. One resident’s family had asked a member of the management team to arrange for a catholic priest to visit their relative. This had not yet been organised. The manager stated that she would arrange it. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Not all complaints are recorded in the complaints log. Complaints are investigated and action taken where necessary. EVIDENCE: There was only one complaint recorded in the complaints log. The complaint had been investigated, partially upheld and the necessary action taken by the home. Whilst talking to residents and relatives they stated that they had raised concerns/complaints during the last twelve months and they had been acted upon. All concerns/ complaints should be recorded so that any investigation and follow up action can also be recorded. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The Hillings provides the residents with a clean and safe place to live. EVIDENCE: All areas of the home were clean and hygienic. The residents stated that they are happy with their bedrooms and can personalise them with their own items. Some residents and relatives spoken to said they thought The Hillings could look more homely by having plants and flowers and magazines around for the residents to read. There is a ‘link room’ where residents can take part in different activities. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, 30 There are insufficient numbers of staff on shift to ensure all residents’ needs are met and safe at all times. The homes recruitment procedures do not protect the residents from possible abuse. EVIDENCE: The home is separated into five ‘flats’. Each flat has it’s own staff allocation each shift. There are three flats with 10 residents in each. Two of these flats have two carers allocated the other flat has only one carer allocated per shift. The remaining two flats have eight residents in and only one member of staff. The manager, staff, residents and relatives stated that at busy times during the shift e.g. residents getting up and going to bed, meal times and staff breaks can be unattended for a considerable amount of time. The accident records show that residents are usually found by staff rather than staff being present when the accident happens. This could possible be due to residents trying to do things for themselves when waiting for staff. During the night there are only three members of staff on duty. If a resident requires assistance two members of staff always go the resident’s room. This could lead to three flats having no staff member present for periods throughout the night. The staff rotas were inspected and it was found that five carers regularly work between 53 and 82 hours per week. The manager agreed that staff might not be working to the best of their abilities when working long shifts with minimal days off. The manager agreed to change the rota for the coming week and reduce the carers hours to ensure that no carers were working over 61 hours
The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 14 per week with a view to further decreasing staff hours when new staff are employed. Mandatory training has improved since the last inspection but there are still staff that require training in first aid and infection control. The majority of staff had not received training in first aid. The home had not received a POVA First or CRB check for a member of staff working on the day of the inspection. The carer had worked unsupervised the previous evening and assisted residents with bathing. The manager stated that the member of staff had been told not to carry out any personal care unsupervised. The manager stated that she was unaware that staff should not commence work before the receipt of a POVA first or CRB as an outside agency processed the CRB’s for homes staff. The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Not all procedures are being followed to protect the health, safety and welfare of the residents. EVIDENCE: The fire testing logs were inspected and it was found that fire alarms have not been tested every week during the last year. Only three out of eighteen members of staff tracked had completed first aid training. There should be a minimum of a qualified first aider on shift at all times. The manager sends out quality assurance questionnaire to residents and their families once a year. Residents meetings are held every three months. On the day of the inspection several relatives of the residents stated that they would be interested in attending a relatives meeting to discuss the home and share ideas to make improvements. The manager agreed to organise this. The frequency of staff supervision has improved since the last inspection.
The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 16 The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 18 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 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 complaints must be recorded. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and safety of service users. Care staff must not commence work before the receipt of a satisfactory POVA First check. Care staff should be supervised by a member of staff until the receipt of a satisfactory CRB check. All staff should receive mandatory training on a regular
DS0000015140.V250722.R01.S.doc Timescale for action 01/01/06 2 3 OP16 OP27 22 18(1)(a) 22/09/05 22/09/05 4 OP29 19(1)(b)(i ) 22/09/05 5 OP30 18(1)(C )(i) 01/12/05 The Hillings Version 5.0 Page 19 6 OP38 23(4)(C )(v) basis to include fire, moving and handling, health and safety, food hygiene, medication (for those resposible) and first aid. This was a requirement from the previous inspection. Fire alarms should be tested weekly. 22/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Hillings DS0000015140.V250722.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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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