Care Home: Hill House

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What the care home does well Hill House DS0000070482.V375431.R02.S.doc Version 5.2 People receive an assessment prior to being offered a place at the home. This ensures that the home is able to meet their needs. Care plans and risk assessments are kept under monthly review. Mrs Doveton told us that since purchasing the home, providing a safe environment has been their priority. People using the service are encouraged and supported to make decisions about the way they choose to live their lives. People told us that the food provided by the home is of a good standard. Mealtimes are relaxed and provide an opportunity for people to socialise if they choose to do so. Staff members told us that they were properly inducted, recruited, trained and supervised. Any complaints received by the home are taken seriously and acted upon. The management have clear plans on how they wish the home to be run in the future. The home is ensuring that the people living at the home and their representatives have the opportunity to share their views on the service provision. What has improved since the last inspection? At the previous inspection seven statutory requirements were made. All have already been addressed. The home has now appointed an activities co-ordinator on a part time basis. There is an activities programme on the notice board to encourage people to participate. Measures have been put into place to further improve infection control. A new washing machine and drier have been purchased. The washing machine has sluicing facilities and red alginate bags are used to transport soiled laundry. Anyone needing to enter the kitchen must wear a white overall. Many areas of the home have been fitted with new carpet and redecorated. The home now has a portable loop system to aid people with a hearing loss. A new head chef has been appointed. He ensures that he is available to meet with people living at the home daily. The arrangements for managing medication have improved. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Staff have received training in development and awareness. Training is offered on a monthly basis. Staff are receiving one to one formal supervision from the manager of the home, however it is recommended that she attends training in supervision skills. The manager has successfully attended a `fit person` interview with CQC to become the registered manager. Systems have been developed to ensure that residents` and their representatives can share their views with the management. Regular resident meetings are held. Within our surveys one staff member commented ` Hill House has improved over the last year and high standards are always met`. What the care home could do better: Although care plans provide general information on how a person`s needs should be met, they should also record in more detail the desired outcomes that people may have. Mrs Doveton told us that the manager is booked on a training day in September on person centred planning. When a person using the service has a specific care need there needs to be more clarity within the care plan. This may include people who may have a sensory loss or diabetes. There also needs to be a risk assessment in place to support the care plan. The home needs to develop a complaints log to ensure that any complaints received are addressed within the given timescales and monitor for possible trends. Although some work has been carried out to improve the environment, areas such as the laundry and kitchen are still in need of refurbishment. The owners of the home are fully aware of the need for environmental improvements and they are included within their plans for the future. We suggested that the new staff induction checklist is signed by the staff member when they feel that they are competent in each area. When the home uses agency staff, we recommend that they request written confirmation form the agency to confirm that all staff are suitably trained and that they have been checked against the POVA list.Hill HouseDS0000070482.V375431.R02.S.docVersion 5.2Care needs to be taken to ensure that fire drills are completed at least every three months. Environmental risk assessments need to be developed to ensure the health and safety of all residents and staff. Key inspection report CARE HOMES FOR OLDER PEOPLE Hill House Little Somerford Chippenham Wiltshire SN15 5BH Lead Inspector Pauline Lintern Unannounced Inspection 21st July 2009 10:00 DS0000070482.V375431.R02.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill House Address Little Somerford Chippenham Wiltshire SN15 5BH 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) 01666 822363 anitakeegan@yahoo.co.uk www.firlawn.co.uk Hill House (Malmesbury) Ltd Ms Anita Keegan Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 19. 3rd July 2008 Date of last inspection Brief Description of the Service: Hill House is registered to provide care for nineteen older people. The home is not registered to provide nursing care, therefore the community nursing team support people with any nursing needs. Mr and Mrs Doveton have recently purchased the home. They also manage a care home with nursing within the local area. The registered manager is Ms Anita Keegan. The home is a spacious country house located on the outskirts of Malmesbury. Bedrooms consist of one double and seventeen single rooms. Many of these have en-suite facilities. The rooms are located on the ground and first floor. A passenger lift is available to give easier accessibility. There is a library and a spacious dining room with an additional seating area. All areas are individual in style. A large garden is situated to the rear of the property with far reaching open views of the local countryside. Staffing levels are maintained at two carers on duty throughout the waking day. At night there is one waking night staff and a person provides sleeping in provision. Measures are being taken to have two waking night staff. In addition to the care staff, there are domestic staff, a cook, an activities organiser and a maintenance person. Fees for living at the home range between £464.70 and £605 per week. The fees are based on the room occupied and the dependency level of the person. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star . This means the people who use this service experience Good quality outcomes. This service was last inspected July 3rd 2008. The unannounced key inspection took place on 21/07/2009. The inspection took place between 10.00 am and 5.00 pm. The manager Ms Keegan was available throughout the day to assist us. Ms Keegan has been in post since May 2008 and has successfully become the registered manager of the home. The owners of the hone are Mr and Mrs Doveton. Mr and Mrs Doveton and Ms Keegan were available to receive feedback at the end of our visit. The pharmacy inspector visited to look at medication systems. The findings of this visit are detailed within this report. We met with people living at the home in private to obtain their views on the service. Two visiting relatives also shared their views with us. We took the opportunity to meet with two recently recruited members of staff to obtain their views and those of one longer serving staff member. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys; to be distributed by the home to people using the service and staff members, care managers, GPs and other health care professionals. Six staff members and three people using the service responded. The feedback received, is reported upon within this report. We sent Ms Keegan an Annual Quality Assurance Assessment (AQAA) to complete. This was the home’s own assessment of how well they are performing and it gave us information about their future plans. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, staff files, complaints and training records. We also looked at the measures in place for monitoring quality assurance. What the service does well: Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 6 People receive an assessment prior to being offered a place at the home. This ensures that the home is able to meet their needs. Care plans and risk assessments are kept under monthly review. Mrs Doveton told us that since purchasing the home, providing a safe environment has been their priority. People using the service are encouraged and supported to make decisions about the way they choose to live their lives. People told us that the food provided by the home is of a good standard. Mealtimes are relaxed and provide an opportunity for people to socialise if they choose to do so. Staff members told us that they were properly inducted, recruited, trained and supervised. Any complaints received by the home are taken seriously and acted upon. The management have clear plans on how they wish the home to be run in the future. The home is ensuring that the people living at the home and their representatives have the opportunity to share their views on the service provision. What has improved since the last inspection? At the previous inspection seven statutory requirements were made. All have already been addressed. The home has now appointed an activities co-ordinator on a part time basis. There is an activities programme on the notice board to encourage people to participate. Measures have been put into place to further improve infection control. A new washing machine and drier have been purchased. The washing machine has sluicing facilities and red alginate bags are used to transport soiled laundry. Anyone needing to enter the kitchen must wear a white overall. Many areas of the home have been fitted with new carpet and redecorated. The home now has a portable loop system to aid people with a hearing loss. A new head chef has been appointed. He ensures that he is available to meet with people living at the home daily. The arrangements for managing medication have improved. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 7 Staff have received training in development and awareness. Training is offered on a monthly basis. Staff are receiving one to one formal supervision from the manager of the home, however it is recommended that she attends training in supervision skills. The manager has successfully attended a fit person interview with CQC to become the registered manager. Systems have been developed to ensure that residents and their representatives can share their views with the management. Regular resident meetings are held. Within our surveys one staff member commented Hill House has improved over the last year and high standards are always met. What they could do better: Although care plans provide general information on how a persons needs should be met, they should also record in more detail the desired outcomes that people may have. Mrs Doveton told us that the manager is booked on a training day in September on person centred planning. When a person using the service has a specific care need there needs to be more clarity within the care plan. This may include people who may have a sensory loss or diabetes. There also needs to be a risk assessment in place to support the care plan. The home needs to develop a complaints log to ensure that any complaints received are addressed within the given timescales and monitor for possible trends. Although some work has been carried out to improve the environment, areas such as the laundry and kitchen are still in need of refurbishment. The owners of the home are fully aware of the need for environmental improvements and they are included within their plans for the future. We suggested that the new staff induction checklist is signed by the staff member when they feel that they are competent in each area. When the home uses agency staff, we recommend that they request written confirmation form the agency to confirm that all staff are suitably trained and that they have been checked against the POVA list. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 8 Care needs to be taken to ensure that fire drills are completed at least every three months. Environmental risk assessments need to be developed to ensure the health and safety of all residents and staff. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 9 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 Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prior to being offered a place at the home, people receive a full assessment of their needs. EVIDENCE: Prior to being offered a place at Hill House an assessment is completed to ensure that the home is able to meet the persons needs. All aspects of their life are considered such as health, medication, mobility, tissue viability, personal care and social needs. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 11 We looked at the assessment of the most recently admitted person. We also talked to the person to ask if they were happy with the process, which they confirmed that they were. They told us I visited this home and another one locally and I preferred this one. Another person commented my son lives locally and he knew the home so he brought me here. I have my own belongings around me and my son bought me a new bed. One person told us that initially they did not wish to go into residential care and they were very upset when they arrived. However, now they are settled and are very happy with their bedroom. They said that they enjoyed sitting outside when the weather allowed. Ms Keegan reported that one person from the home as been admitted to hospital and they are unsure whether they will be able to meet their needs when they are discharged. This may result in the person moving to a home more suitable to meet their needs. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the 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 plans are in place and kept under regular review. People told us that they have access to healthcare professionals as required. People are protected by the home’s procedures for the safe handling of medicines. People confirmed that they are treated with respect and their privacy is upheld. EVIDENCE: Most people we spoke to had knowledge of the contents of their care plan. We saw that care plans and risk assessments are reviewed monthly by Ms Keegan to ensure that any changes are recorded. Care plans generally reflect the persons assessed needs however, we asked Ms Keegan to ensure that they include more information on the desired outcomes for the person receiving a service. For example, what is important in Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 13 their life and what they hope to achieve from the service. This may include increased independence or social interaction with others. There needs to be more clarity in care plans to any specific needs an individual may have. This could include diabetes. Care plans need to detail who is responsible for certain tasks such as toenail care, blood tests etc. One persons file reminded staff to arrange for the chiropodist to visit when necessary and to ensure that the persons toe nails are kept short. It does not detail who is responsible for carrying out this task. There needs to be more information on aids and equipment available, how to communicate appropriately with someone with a vision and hearing loss and ensure that they do not become isolated. Discussion with one member of staff confirmed that they understood how important it was to spend time with a visually impaired person. Where there are specific needs we suggested that Ms Keegan completes a risk assessment to accompany the care plan. People we spoke to told us that they were very happy with the care being provided to them. One relative told us its brilliant here; you couldnt fault it in any shape or form. Anita (manager) will always let me know what is going on. Other comments received from people we spoke to include I am happy here, its what you make it and its lovely here, I cant see but they are so kind and take me for walks. Within our surveys one person told us the home provides excellent care for the residents and maintains high standards at all times. We asked people if they were happy with the amount of baths they had in a week. The majority said that they were happy. One person commented of course I would prefer more than one bath a week but I understand that there is a lot of people living here. Another person added I have a strip wash everyday so its fine. There continues to be no fixed hoist facility on the first floor, however there is currently no one needing a hoist who is located on the first floor. We asked people on the first floor if they were happy to take their baths on the ground floor. They all confirmed that they were happy to do so. We noted in the daily notes that one person had recently been refusing to take a bath. The manager confirmed that this had been discussed with the persons relative and the reasons for their decision would be respected. It was agreed that the person would in future have a strip wash unless they felt that they wished to take a bath again. We asked Ms Keegan to ensure that this decision and preferences be added to the persons care plan. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 14 At the previous inspection a good practice recommendation was made. This related to subjective terminology being used in daily notes. There has been an improvement in this area. Ms Keegan reported that staff had recently attended training in development and awareness and this had resulted in some improvement in record keeping. She confirmed that improving record keeping was an on going process. We noted that assessments have been completed for falls, tissue viability and manual handling. We saw that where people have been at risk they have been referred to the appropriate health care professional. People told us that if they are feeling unwell the GP is called. One person commented they get the doctor if I need one. Daily notes show that relevant health care professionals are accessed when needed. Each person now has a Malnutrition Universal Screening Tool (MUST) assessment completed within their care plan. Peoples weights are being monitored and recorded. CQC recently received an anonymous complaint alleging there was a high number of falls within the home. We discussed this with the manager, looked at assessments and accident forms. We concluded that there had been falls experienced by people, however all appropriate action had been taken and preventative measures put in place. Falls risk assessments are in place and kept under review. Ms Keegan told us that recently the Hearing and Vision team had assessed someones needs within the home. This included looking at tools and resources, which may be available to the person. We spoke to the person and they told us that they already have a speaking clock in their room. Within the AQAA it states that there are twice weekly music and movement sessions, which promotes exercise and staff training to promote health and personal care. Our Pharmacist Inspector looked at arrangements for the handling of medicines. Medicines are stored securely and there is appropriate storage space for the number of people currently accommodated. We discussed ways of increasing the storage for when more people are admitted. Medication administration records had been completed correctly and records of medicines received into and returned from the home were available. These had been audited by the manager. Records of creams and nutritional supplements are kept separately. A suitable homely remedy list had been agreed. Controlled drugs are recorded in the appropriate book; we saw some pages where lines had been left blank and some historic entries (before the time of the current owners) that were not accurate, although the current stock is correct. All staff Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 15 who administers medication are trained by the manager and pharmacist, staff told us of the training and how their competency was assessed. We saw records of visits by healthcare professionals and evidence of how their guidance had been put into practice by the home. We saw protocols to support staff when administering medication prescribed ‘as required’. People are supported to manage their own medication if they choose to do so. Staff prepare a risk assessment and keep the person under regular review. People we spoke to confirmed that they make choices and decisions about the way they live their lives. One person commented they accept my choices and visiting is good. Ms Keegan reported that she had arranged for a visiting clothes shop to come to the home. This enabled people to pick their own clothes and make their own purchases if they wished to do so. One member of staff told us I make sure I spend time chatting with people when I deliver personal care, so as they do not feel uncomfortable with it. X washes her face herself, I let people tell me what support they want. We observed staff members spending time with people and chatting. One person told us Anita never passes you without saying hello, another person said as people come and go they always say hi X. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are now more opportunities for people to participate in activities if they wish to do so. Links with the local community are encouraged and promoted. People told us they can choose their own daily routines. Friends and visitors are welcomed to the home. People told us that they enjoyed the food provided by the home and that their preferences are respected. EVIDENCE: Since the last inspection the home has recruited a part time activities organiser. Ms Keegan reported that many of the people living at Hill House prefer to remain in their bedrooms during the day. Meal times are generally when people meet up and chat over coffee and mints following their meal. Ms Keegan said that she is hoping that the increase in activities will encourage people to participate more. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 17 It was evident from speaking to people that many like to spend time in their rooms reading and watching television. One person commented I dont like to socialise too much. Another person added I dont worry about activities, I have my TV and I sit and chat with the lady next door, after my meal. The activities organiser works from 9.30 to 12.30 every day. We noted that there was a weekly activities programme on the notice board. Activities arranged included, board games, quiz, and keep fit, relaxation, poetry/stories, sing-along, gardening and arts and crafts. Ms Keegan told us that many people living at the home enjoy cooking. Photographs were available showing people making scones. At Christmas time some people made homemade mincemeat. There is now a residents computer in the library for internet and email access. Within our staff surveys we asked how the home could improve. One person commented more activities for the residents, Im sure residents would love to play Bingo. A recent success was the garden party held at Hill House. Mrs Doveton told us that many family members and friends attended the event. Some residents who are usually reluctant to leave their rooms enjoyed the afternoon, especially the afternoon tea and cakes also the Pimms, which was available. People were able to play croquet on the lawn. Entertainment was provided by local hand bell ringers and a local jazz band. Mrs Doveton reported that many children attended the event along with the Mayor. Ms Keegan had placed photographs of the event in an album, which was kept in the library so that everyone could recap on the day. We discussed the importance of gathering information from the residents and their families to ensure that peoples particular interests and social needs were being met. Mrs Doveton told us that she was hoping to arrange for a curator from the museum to bring in items from the past, which may be of interest to the people living at the home and aid their memory. We suggested that any activities are evaluated to see how successful or not they have been. Mrs Doveton told us that she was planning to talk to residents the following day, at the residents meeting to find out their views on recent activities and the garden party. People have access to the local community and have visited the Butterfly Farm and garden centres. During the day of our visit the hairdresser was visiting the home. This took place in the hallway. Ms Keegan explained that although it was not the idea location hairdressing had always taken place there as it provided plenty of space. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 18 Mrs Doveton told us that the home had recently become members of the National Association for Providers of Activities for older people. Ms Keegan will now be able to access information and resources from their web site. Mrs Doveton added that the home have their own website. Ms Keegan explained that the Church of England Vicar visits once a month. She explained that one person is unable to leave their room now due to ill health. As their religion is very important to them Ms Keegan has arranged, with their permission, to hold the service in their room, so that they can continue to be present. One person we spoke to told us the Jehovah Witnesses visit me for a chat; I do Bible studies with them. Within the AQAA it states we have introduced Memorial services following the death of a fellow resident so as a home we can celebrate and share memories of the individual. Relatives we spoke to told us that they are always made welcome at the home. People told us that they can have visitors when they choose and can spend time alone with them in their rooms or in communal areas if they prefer. We noted that many people had telephones in their rooms. One person told us I have the numbers in the memory so that I can easily access, whoever I want to call People we spoke to told us that they can get up and go to bed when they choose. One person said I can stay in bed all day if I choose to. One person told us that they prefer to take their meals in their own room rather than go the dining room. This was included in their care plan. A new head chef was appointed before Christmas and took up his duties the week before Christmas. He told us that he was really enjoying his work. He came to Hill House from College and has achieved National Vocational Qualification (NVQ) level 1, 2 and 3 in catering and hospitality. The chef told us that he speaks to all residents at the start of the day to see if they would like any variation to the days menu. He added that he now makes all cakes, biscuits and pastries sugar free that everyone can eat them. We noted that there were plenty of supplies of food available. This included plenty of fresh vegetables and fruit. The chef explained that many people prefer to have tinned fruit as it was easier for them to eat. One person we spoke to told us that they like to eat fish each day rather than meat. The chef showed us his fish freezer and said that he varies the options for this person. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 19 We asked to see the fridge freezer temperature records. The chef told us that he takes the temperatures daily; however there were no records available. We asked him to ensure that temperatures are recorded daily to ensure food is stored at the correct temperature. The manager now requests that anyone entering the kitchen is expected to put on a white overall to reduce the risk of food contamination We observed the main meal of the day during our visit. The atmosphere in the dining room was relaxed with soft music playing in the background. Ms Keegan told us that wine, sherry and port is available at lunch if people choose. The meal consisted of Pork tenderloin, stuffing, mashed potatoes, seasonal vegetables and gravy. Swiss roll and ice cream was the dessert of the day. Freshly ground coffee was also available. Each table had a menu on it. We observed staff members assisting people to the dining room and supporting them with their eating if required. One staff member was seen taking time to chat to one person, whilst they were at the dining table. They asked if they were enjoying their food. We noted that the chef also came to the dining room to obtain feedback on the meal and to exchange pleasantries with everyone. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 told us that they know how to make a complaint or raise a concern. People are protected from abuse, neglect and self harm EVIDENCE: People we spoke to confirmed that they knew the procedure for making a complaint. Comments we received included I would tell Anita as you can speak to her if you are not happy. People confirmed that Ms Keegan was always available if they needed to raise any issues. One person told us that three of their dresses had not been returned from the laundry. She confirmed that she had reported this to the manager. We discussed this with Ms Keegan, who confirmed that she would be looking into it, however often the missing clothes was found in the back of a wardrobe or drawer. The home does not currently have a complaints log, which details actions, timescales and outcomes. We asked Ms Keegan to introduce a log so that she can monitor for any trends or patterns that may affect the welfare of people living in the home. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 21 As mentioned previously within the report CQC has received two anonymous complaints regarding this service. We asked Ms Keegan to investigate both complaints and feedback to us with her findings. One area of the complaint was found to be substantiated and the member of staff involved has subsequently resigned from their post. All other allegations were found to be unsubstantiated. Staff members we spoke to told us that they knew the local protocols to follow if they suspected any form of abuse had taken place. Training records showed that staff receive safeguarding training. We noted that during the interview process, questions are asked relating to abuse awareness. Staff members are provided with information on the local protocols No Secrets in Swindon and Wiltshire. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owners have plans to further develop the home, which will enable them to offer a wider range of resources and facilities. Some areas of the existing building are in need of replacement and/or refurbishment. EVIDENCE: Hill House is a large spacious country house, which is in keeping with the local area. There are pleasant grounds with views of the countryside. Bedrooms are located on the ground and first floor. There is a small passenger lift, which gives level access. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 23 Ms Keegan and Mrs Doveton told us about their plans for the future of Hill house. A planning application has been prepared for submission. If granted, this will enhance the facilities and environment for the people using the service. Ms Keegan reported that the owners and she were aware that some areas of the home, such as the kitchen and the laundry are in need of updating and this will be addressed as the planned project progresses. This said, there have been many improvements made to the home since our last visit. New carpets have been fitted to many rooms and many rooms have been redecorated. Mrs Doveton reported that she plans to redecorate the hall way next. Everyone we spoke to told us that they were happy with their bedroom and the facilities available to them. One relative told us you will not find a better home than Hill house. Within our surveys we received the following comments, Hill house is a lovely care home with lovely residents and a really caring manager. The training is very good and we have some really good reliable staff. Hill house is very clean and well kept with beautiful grounds and the home its self is lovely with a good atmosphere between residents and some staff. The grounds of the home are beautiful Since the new ownership a new washing machine and drier have been installed in the laundry. Ms Keegan told us that the washing machine has a sluice facility as the home does not have a separate sluice available to them. Red alginate bags are used for transporting soiled laundry to the washing machine. We noted that on our arrival and throughout the day there were no unpleasant odours. All areas of the home were cleaned to a good standard. People told us that their bedrooms are regularly cleaned and hovered and the beds regularly changed. Staff members receive training in infection control. Antibacterial hand wash is available at all hand washing facilities. Protective clothing is available for staff. All toxic materials are securely locked away. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the 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 told us that there is enough staff on duty to meet their needs and keep them safe. Staff are properly recruited, inducted and trained. EVIDENCE: Ms Keegan told us that there is two care staff working on each shift. The senior care assistant works shifts and has one day per month in the office assisting the manager. Two waking staff is on duty throughout the night. Ms Keegan told us that they were currently experiencing above average levels of staff sickness. Ms Keegan explained that they do use agency staff in these instances. She added that they try to use the same agency staff to ensure that they have a good knowledge of the people using the service. There is an induction folder for agency staff informing them of policies and procedures. We suggested that Ms Keegan obtains written confirmation from any agency they use to confirm that carers have a current CRB and lists their qualifications. Keegan reported that full time staff were very helpful and often cover additional shifts when there is sickness or annual leave. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 25 Within our staff surveys one person told us that they felt the home should employ more reliable staff so that the home did not have to use agency staff. They also felt that there should be better discipline within the home. Concerns raised by this person were balanced by positive feedback from others. We asked staff and the residents we met if they felt there was sufficient staff to meet their needs. All confirmed that there was sufficient staff on duty. One staff member told us there is more than enough staff on duty, I am able to spend one to one time with people. We asked people if staff responded quickly when they pulled their call bell. Everyone said that they are attended to quickly. One person told us by the time you count to five they are with you. People spoke highly of the staff, telling us I have no complaints about the staff they are all very nice girls and I am very fond of Anita, most of the girls are very good. As part of the inspection process we sampled staff recruitment records and spoke to recently appointed staff. Records show that all required safeguarding checks are completed prior to being offered a position. References are sought and proof of identity. This ensures that only people suitable to work with vulnerable people are employed. During the day we were able to meet with the training officer. She explained the staff induction and showed us the work book staff complete during their probationary period. One new member of staff showed us her induction checklist, which was signed off when completed. We suggested to the manager that staff sign the checklist once completed to confirm that they have received instruction and felt competent to carry out their duties. Within our surveys, staff members confirmed that they receive training relevant to their role. One member of staff told us during the three months that she had worked at Hill House she has attended training in health and safety, infection control, abuse awareness, manual handling and medication. They told us that once they had completed their induction they felt comfortable to do everything. They added that they shadowed a more experienced member of staff during their induction, which was helpful. We noted from the training programme that during June 09 training took place in pressure area care, fire awareness, dementia and hearing and vision. A distance learning infectious control training has also taken place. Training in malnutrition, care and assisting with eating is planned for the end of July. We saw that regular staff meetings take place. Ms Keegan told us that she hoping that the meetings will become open forums, where staff feel able to fully contribute to the discussion. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36 and 38 People using the 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 and managed by a person fit to do so and in the best interests of the people living there. There are suitable arrangements in place to manage peoples money safely. Health and safety policies and procedures are in place to protect staff and the people living at the home, however the lack of environmental risk assessments and fire drills could place people at risk. EVIDENCE: Since taking over her position in May 2008, Ms Keegan has successfully completed her fit person interview with CQC to become the registered Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 27 manager. Ms Keegan is a Registered Nurse, who has commenced her Management and Leadership qualification. Since her role began Ms Keegan has attended many training courses. These included a 6 month course, when she attended Action Learning Set, which is run by Skills for Care. Every 2 months she attends the Learning Exchange Network in management skills. Earlier this year she attended a Care show in Bournemouth. It is evident from discussion that Ms Keegan wishes to develop her management skills and further develop Hill house into an environment which is open and offers staff and the people living there the opportunity to participate in decision making. People have spoken well of Ms Keegan reporting that the home manager is always available for advice and support; Anita is a lovely person, charming and Anita always asks how I am. We saw that satisfaction questionnaire were available for people to complete if they wished to do so. These surveys had also been given to people using the service, their representatives and staff members. Mrs Doveton explained that she would be collating and evaluating the comments and would then feed this back to the people using the service. Ms Doveton told us that people do have suggestion cards in their room, which enables them to share their views. Regular resident meetings are another forum where people can discuss all aspects of their care provision. One person told us I go to residents meetings, there is one tomorrow. Most people go. I have a say and I ask for minutes to be taken. Sometimes people ask me to speak for them. Mrs Doveton carried out monthly quality audits on the home. She spends time talking to people living at the home and staff members. This ensures that people have the opportunity to discuss any issues. A new safe has been purchased for holding residents personal money. Two staff sign all transactions and there is restricted access to the safe. There are receipts for all transactions made. We checked cash held against the balance sheets. Two out of three balanced. One showed a £2 shortage, however it appeared that the balance may not have been correctly calculated. Staff members told us that they receive regular supervision from Ms Keegan. We suggested that Ms Keegan attends training in delivering supervision. Records show that staff members sign the minutes of their supervision to confirm that they agree the contents. We looked at the arrangements for health and safety within the home. We noted that the home had a fire risk assessment in place dated 01/05/09. However we saw that no fire drills had taken place since January 2009. We asked Ms Keegan to ensure that these take place as soon as possible. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 28 All of the bedroom doors are fire doors, however not all are fitted with automatic closures as yet. One person told us that they were concerned that there door did not have an automatic closure. Ms Keegan was aware of their concern and had spent time reassuring the person that they were safe with the door that was fitted. We saw in the maintenance file that hot water temperatures are regularly checked and recorded to ensure that safe temperatures are not exceeded. Restrictors are fitted to windows and all radiators are guarded to protect people form hot surfaces. The home has recently had a visit from the Environmental officer. One recommendation was made which was to move the electric fly killer. Work on this was in progress. The chef told us that pest control had visited the home and were satisfied with the arrangements there. We asked Ms Keegan for the environmental risk assessments and she told us that they had not yet been completed. We asked her to action this as soon as possible. We looked at accident books and found that they had been completed properly and linked with care plans and daily notes. Where people had experienced falls we saw that they had been recorded appropriately in the accident book. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 29 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 N/A 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 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 X 2 Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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(1) Requirement You must ensure that where specific needs are identified such as diabetes a risk assessment is in place to accompany the care plan. You must ensure that a log is kept within the home, of any complaints and concerns raised, action taken, timescales and outcomes. This will enable the manager to identify any emerging trends or patterns. You must ensure that all temperature checks of fridge freezers and probing of hot food is recorded to ensure safe temperatures are maintained. You must ensure that all environmental risks are assessed and kept under review. You must ensure that fire drills are carried out regularly. DS0000070482.V375431.R02.S.doc Timescale for action 21/08/09 2. OP16 22 21/08/09 3. OP38 13(4) c 21/08/09 4. OP38 13(4) c 21/08/09 5. OP38 13(4) c 21/08/09 Hill House Version 5.2 Page 31 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. 2. 3. 4. 5. 6. 7. Refer to Standard OP7 OP7 OP7 OP9 OP9 OP19 OP36 Good Practice Recommendations All aspects of a persons care needs are detailed within their care plan. Information on desired outcomes should be gathered and recorded within the persons care plan. When people make decisions/changes regarding their personal care routines; this should be recorded within their care plan. Consideration should be given to the amount of secure medicine storage that may be required in the future. Staff should complete the controlled drugs records in line with current guidance and in a way that cannot lead to any misunderstandings. Plans to refurbish the kitchen and laundry should be actioned as soon as possible. Ms Keegan should attend training in supervision skills. Hill House DS0000070482.V375431.R02.S.doc Version 5.2 Page 32 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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