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Care Home: Hill House, Combe Raleigh

  • Hill House Combe Raleigh Honiton Devon EX14 4UQ
  • Tel: 0140446694
  • Fax: 0140446694

Hill House is a care home providing personal care to a maximum of 25 older people who may also have a physical disability. It is a large detached, extended property, standing in its own grounds in the village of Combe Raleigh, near the town of Honiton. Bedroom accommodation is on the ground and first floors. Each is designed for single occupancy with en-suite W.C. and wash hand basin. There is a vertical lift and a stair lift between floors, a large sitting room and a dining room on the ground floor and a library/lounge on the first floor. There is also a dedicated hairdressing room. Local G.P and community nursing services serve the home and there is regular structured support by volunteers. Information provided by the service indicate that current fees are between £ 508-£512 per week.

  • Latitude: 50.820999145508
    Longitude: -3.1979999542236
  • Manager: Mrs Lynn Marie Pulman
  • Price p/w: £510
  • UK
  • Total Capacity: 26
  • Type: Care home only
  • Provider: Abbeyfield East Devon Extra Care Society Limited
  • Ownership: Voluntary
  • Care Home ID: 8208
Residents Needs:
Old age, not falling within any other category, Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Hill House, Combe Raleigh.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hill House, Combe Raleigh Hill House, Combe Raleigh Combe Raleigh Honiton Devon EX14 4UQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Hill House, Combe Raleigh Hill House, Combe Raleigh Combe Raleigh Honiton Devon EX14 4UQ 0140446694 0140446694 EastDevExtraCare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Abbeyfield East Devon Extra Care Society Limited care home 25 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Hill House is a care home providing personal care to a maximum of 25 older people who may also have a physical disability. It is a large detached, extended property, standing in its own grounds in the village of Combe Raleigh, near the town of Honiton. Bedroom accommodation is on the ground and first floors. Each is designed for single occupancy with en-suite W.C. and wash hand basin. There is a vertical lift and a stair lift between floors, a large sitting room and a dining room on the ground floor and a library/lounge on the first floor. There is also a dedicated hairdressing room. Local G.P and community nursing services serve the home and there is regular structured Care Homes for Older People Page 4 of 33 Over 65 25 25 0 0 Brief description of the care home support by volunteers. Information provided by the service indicate that current fees are between £ 508-£512 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and took place on Monday 18th May 2009 over a period of 6 hours. The manager was present throughout the inspection. During the inspection plans of care for 3 people living at the home were looked at in detail. This helps us to understand the experiences of people using the service. A number of other people were met and spoke with during the course of the day. A considerable time was also spent observing the care and attention give by staff. Several staff were spoken with during the day, including care staff and the manager. Prior to the inspection questionnaires were sent to 10 people living at the home to obtain their views of the service provided none of which were returned prior to this report being completed. Care Homes for Older People Page 6 of 33 During the inspection we toured the premises and a sample number of records were inspected including care plans, medication records, staff recruitment files, record of complaints, fire safety records and a record of accidents. What the care home does well: People who are considering making Hill House their home, and their relatives/representatives, are given good information about the home before any decision to move in is made. A representative from the home will also carry out an assessment of individual health and social care needs before anyone is admitted to the home to ensure their needs can be met. People are also invited and encouraged to visit the home, meet others living there and staff before making a decision. People spoken to during the inspection talked about the process of choosing and moving into Hill House, and they all expressed complete satisfaction with the outcome. The home has drawn up care plans covering aspects of care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. Medications are stored safely and only experienced staff carry out the administration. Records of medicines administered have been generally well maintained. People expressed complete satisfaction in the way they are treated by the staff and confirmed that their privacy is respected at all times. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. People talked about how they are able to lead their lives just as they want, without unnecessary rules or restrictions. The home provides a good range of activities to suit peoples interests. Excellent arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. People praised the standard of meals provided. Those who have specific likes and dislikes talked about how the cook makes sure they have exactly what they want. The menus are balanced, varied and nutritious meals and suit individual dietary needs. The home has an excellent range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean, fresh safe and hygienic. The home employs sufficient staff to meet peoples needs. Staff are competent and deliver high quality care in a safe manner. There is an open and positive atmosphere throughout the home. Excellent quality assurance procedures are in place. Peoples financial interests are safeguarded. Excellent systems are in place to safeguard the health and safety of those living at the Care Homes for Older People Page 8 of 33 home and staff. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. Improvement in recording details relating to individuals health and social care needs prior to admission to the home will further ensure that people receive person centred care. Evidence: All prospective residents and / or their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make Hill House their home. During this inspection we looked at the admission records of three people, one of whom had recently been admitted to Hill House. We talked to them about how they Care Homes for Older People Page 11 of 33 Evidence: chose the home,about the information that was shared with them and about the discussions and agreements that were reached on the care they need. One person told us they were not able to visit the home themselves as they lived too far away, but their family, who live locally, had visited. They told us if it was good enough for them then it was good enough for me. We were told that information had been given to the persons family, and when they arrived at the home they were given a copy of the homes Statement of Purpose and Service User Guide., which they said they have looked through, find easy to read and understand and use as a reference book. The manager had contacted the persons doctor and requested, and been supplied with, details of the persons past and current medical condition. This information was comprehensive and included details of current medications and any allergies the person has. This information was included in the care file we looked at during this inspection. The manager wrote to the person to confirm that according to the information provided it was felt that their health and social care needs could be met at Hill House. On the day of admission to Hill House the manager had undertaken an assessment of the persons current health and social care needs. The assessment records showed that information had been gathered to form the basis of a plan of care. However, the information did not include details of individual strengths or how people may achieve positive outcomes that will maintain their independence and support them to lead their lives as they wish. This means that although care staff know what care a person needs they may not know how they wish to be looked after. Another plan had not been dated or signed by the person undertaking the assessment, did not reflect whether the person had been included in the assessment of their needs and another did not include details relating to a persons current medical needs. We discussed the assessment process with the manager who told us that the format was due to be reviewed to include more comprehensive, detailed and individualised information. This information would then form the basis of individual care plans,,which would Care Homes for Older People Page 12 of 33 Evidence: include details of what the person needed help with, how staff would provide this and reviews of any changes. Copies of comprehensive assessment and plans of care for people who are not privately funded and are admitted through care management are obtained. The home does not provide intermediate care. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning provides staff with the information they require to meet the needs of individuals in a safe and respectful manner, while promoting their dignity and independence. Further development of care planning will ensure that peoples health and social care needs will be met in a person centred manner. People living at the home are not always involved in the initial drawing up or reviews of their care plans. Evidence: Each person living at Hill House has an individual plan of how their health and social care needs will be met by staff. Detailed planning, recording and reviewing peoples care makes sure that staff are up to date with changes, people receive appropriate care to achieve positive outcomes and care given is person centred. Care planning at Hill House is made up from an assessment of a persons daily Care Homes for Older People Page 14 of 33 Evidence: activities, for example washing, dressing, mobility and continence. We looked at 3 care plans and saw that information recorded was not comprehensive. For example plans did not include details of what a person could actually do for themselves and chose to continue to do to retain their independence or what their aims or goals were. No details had been recorded of how people chose to have care delivered, their likes, dislikes or whether they had been involved in the initial drawing up or reviewing of the plans. We noted that one person had developed an infection but no details of how this should be managed had been recorded in a specific care plan. No plan had been compiled to enable staff to be aware of care required for a person who experiences difficulties associated with Parkinsons disease; the only information recorded was Has Parkinsons disease, and requires help on bad days. Information relating to peoples social care needs is also undertaken as part of the care planning process. Information recorded in those we looked at included enjoys reading and activities, has asked to look after the library as they used to be a librarian. However, the plan did not include information relating to how this could or would be achieved or maintained. We spoke to the person concerned who confirmed that they are involved in organizing the library and that the have a daily newspaper delivered to them. Another care plan stated that a person enjoyed listening to classical music,the radio, enjoyed gardening and used to like to sew and knit. However, there was no indication of how these needs would be met by staff at the home. Staff write daily reports for each person living at the home. We looked at the daily reports for 10 people and they consisted mainly of a record of personal care, continence and rooms being tidied rather than the care delivered and the way people lived their lives. For example appears fine, had a bath, sat in the library with no indication of whether the people involved had enjoyed the experience or what choices they had made. Some entries in the daily report were statements of what staff had done for the person. For example, put on the commode, put on the bed for bed rest, taken back to bedroom, put safely into bed. There was no indication as to whether the person had been consulted and had made any choices. The daily reports did not always include information relating to whether assessed needs were being met. For example, Seen by district nurse re [their] ears. There was no information about the reason for requesting a visit by the nurse or further information relating to this entry. [And no record of the visit on the multidisciplinary Care Homes for Older People Page 15 of 33 Evidence: notes kept in individual file]. We spoke to the person concerned who told us they had experienced deafness and needed to have their ears syringed. Plans of care are reviewed regularly; however there was no evidence that people are involved in this review of their care. Those people spoken to could not remember being involved in this but were confident that they are well cared for and their needs are met by the home. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling and nutrition. All people living at the home are weighed monthly to ensure that their nutritional needs are met. We saw a record that indicated that a person had lost at least 3 kilograms in 4 months and had not been weighed for 2 months. No care plan of how this persons nutritional need would be monitored had been drawn up. This means that this person may be at risk of their nutritional needs not being met. People benefit from regular opportunities to make their changing needs known. Staff confirmed this when they told us that people speak openly to staff and staff have good communication with all those living at the home and with members of management to whom they report any concerns. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. Medication is generally well managed at the home. Medicines are stored securely and records were generally accurate, up to date and indicated that medication is generally appropriately administered. All staff that handle medicines have received training in the safe handling of medication, which ensures that people living at the home are cared for by competent, well trained staff The ethos of the service is that people are encouraged and supported to look after their own medicines if they wish and are able to do so. Lockable facilities are provided in all rooms for the safekeeping of medicines. Several of the people currently living at Hill House are looking after their own medicines and told us how this increases their independence. However, we did not see any assessments in care plan files of peoples ability to safely manage their own Care Homes for Older People Page 16 of 33 Evidence: medicines. For example, were they aware why they were prescribed the medicine, what the effects of not taking it, or taking too much might be or whether they could read the labels or open the containers? People living at Hill House felt that their privacy was respected and we saw staff knocking on doors and waiting to be invited in before doing so and offering personal care in a discreet manner. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are offered choices in all aspects of daily living. Social activities are well managed and provide daily variation and interest for people living at Hillhouse. Meals are nutritious and balanced and provide individuals with choice and variety. Evidence: People living at Hill House told us they are offered choices in all aspects of how they live their daily life. They told told us they can get up, and go to bed when they choose and do whatever they choose to do during the day. We arrived at the home at 9.30 am; some people were sitting in a lounge, reading daily papers, which are delivered to the home. They told us they had chosen to get up when they had. Hill House no longer maintains its own transport but arrangements have been made to enable people to use local transport that acts like a taxi service. During this inspection one person went to Exeter shopping with a member of staff. A member of staff Care Homes for Older People Page 18 of 33 Evidence: arranged transport for another person to attend an appointment the following day.Other shopping trips were advertised on a notice board, going to Taunton, Exeter, Dorchester and Newton Abbot. A list of activities for the forthcoming week is displayed on notice boards in the entrance hall and the dining room. Activities provided included exercise to music sessions, karaoke, quiz, armchair darts, bingo, hoopla hoop and the times the hairdresser would be at the home.We were told that a member of staff plays the piano whenever they are on duty, which is always enjoyed by all. We were told that some of the newer ladies have requested some form of beauty therapy sessions for an activity. The manager is currently looking into arranging for someone coming to the home to do manicures only, but is also looking in to the possibility of providing massages/reflexly sessions. We saw an assortment of Cds, tapes of books, and music, and board games in the lounge. The home has a separate library. which has an excellent variety of books and magazines including some written using large print. Also displayed on notice boards are photographs taken during some of the outings that people living at Hill House have enjoyed. Some people told us how much they enjoy the countryside surrounding Hill House and how much they enjoy walking in, or sitting in, the garden. We asked staff how they prevent people who prefer to stay in their room from the risk of social isolation. We were told that staff visit them frequently, talk to them about daily events, their interests and tell them what activities are taking place so that they may change their minds. During this inspection we saw care staff visiting people who preferred to spend time in their rooms to make sure they were comfortable and did not need anything. All rooms have a nurse call system, which means that people can call for staff when they wish. Several people spoke about how their relatives/ visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel at home. We looked at the visitors book and it was clear that many people received visitors and they came at different times of the day. People moving into Hill House are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed Care Homes for Older People Page 19 of 33 Evidence: before admission. All of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. Most of the people spoken to during this inspection said that the food served was very good. People living at Hill House are offered menu choice forms that they can complete weekly in advance to enable the cook to order accordingly., The cook also visits each person at the beginning of the week to ask if the want to change anything and there is always enough of each choice spare for any changes on the day either by choice or due to illness. People can choose to have their meals in the pleasant dining room or in their rooms if they wish. The meal served during the day of this inspection was well presented, hot and nutritious. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people living at the home are protected. Evidence: The home has a detailed, clear and simple complaints procedure, which is prominently displayed on a notice board in the entrance hall. A suggestions box is also available in the entrance hall, and the dining room, so that people can make suggestions or complaints remaining anonymous if they prefer. People living at the home confirmed they would feel comfortable complaining if they had any issues. We were told that some comments were made in the dining room about the lack of fresh vegetable available. The people concerned were upset that a cook had been told about their comments and had come to the dining room to tell them the, very good reasons why alternative vegetables had been served. Although the people involved felt that they had simply been talking amongst themselves and had not wanted to speak to the cook they agreed that their comments had been taken seriously an that staff always wanted the to be happy. The home has developed a system to maintain records of all complaints received and Care Homes for Older People Page 21 of 33 Evidence: how they are managed. We were told that 4 complaints have been made to the home since the last inspection. We saw documentation that these had been dealt with and records of responses to the complainant including details of how the manager had looked into the issues, had been maintained. One complaint has been made to the Commission since the last inspection. and the manager was then asked to look into the issues raised. The manager followed the services complaints procedure and responded to the complainant. People living at the home that we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or senior carer. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored. There was nothing to suggest that people living at the home are anything other than well cared for. People spoken to told us that staff were very helpful, respectful and that nothing was ever too much trouble for them. The manager told us that all staff have received training in Adult Protection issues. A procedure for responding to abuse is available and staff were aware of this. Staff were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle-blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is excellent providing a comfortable, clean and safe environment for those living in, working at and visiting the home. Evidence: People spoken to during this inspection said they were very comfortable living at Hill House. During this inspection we walked around the building, visiting many bedrooms, the sittings rooms, dining room, library, hairdressing room, bathrooms, laundry and kitchen. The home well maintained with the lounge areas especially homely and very comfortably furnished. Bathrooms are well equipped and the home has a good provision of equipment to aid peoples independence, for example extra handles in toilets/bathrooms, seat raisers, personal call bells(pendants) to be worn to enable residents to be mobile but able to ring for assistance if feel they need help. If advice is needed on a particular problem the regalement team at Hinton Hospital, or relevant organisation is consulted. The dining room is very well presented. Tables are well set with cruets, fresh flowers, napkin rings and freshly laundered individual napkins. One person told us they were surprised when the napkins were taken to be laundered after each meal! Care Homes for Older People Page 23 of 33 Evidence: The library is a particularly restful room. Several people told us they enjoy the spectacular views from the windows and enjoy the peace it affords. People have the choice of communal areas both inside and outside the home, this means that people have a choice of place to sit quietly, meet with family and friends or to be actively engaged with other people living at the home. They also said how much enjoyment they get from the gardens, and surrounding countryside, at Hill House. Decoration, fitting and fixtures such as furniture, curtains, carpets,,pictures, lamps throughout the home are of a very high quality. Fresh flowers and plants are placed around the home and people also spoke of the pleasure these give. All bedrooms have en suite facilities and all bedroom doors being fitted with locks promote peoples privacy. Lockable facilities are also provided in each room for the storage of treasured possessions or medicines. At the time of this inspection the home was extremely clean and fresh and we were told by people living at the home that it was always like this. The homes laundry was clean and well organised. Staff described good infection control practice that ensures that people are protected from the risk of cross infection. One person told us that their laundry is taken away and returned the same day and it is always beautifully done. We were told that the service had recently been visited by an Environmental Health Officer who recommended the ceiling and ducting in the kitchen be replaced. We were told that this will be carried out during the refitment of the kitchen which is planned to take place in the next few weeks. [ We also discussed the arrangements for the provision of meals at the home during this process] Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running, of the home. Attention to ensuring the homes recruitment procedure is followed when new staff are recruited will further protect those living at Hillhouse. Evidence: At the time of this inspection the manager, senior carer, four carers, an administrator, domestic, a cook and a kitchen assistant were on duty. This level of care staff changed to a deputy manager or senior carer and three carers during the afternoon and two throughout the night. Throughout the day carers are responsible for undertaking laundry tasks and during the evenings one carer undertakes cooking duties, leaving two to undertake caring for people living at the home. We asked staff whether this level of staff was sufficient to meet peoples needs and were told that it usually was. We were also told that needs of individuals take priority and the carer undertaking cooking duties would leave the kitchen to assist people if needed, and sometimes an additional member of staff comes on duty at 5pm -9pm if needed. Care Homes for Older People Page 25 of 33 Evidence: Staff and those living at Hill House felt that there was usually enough staff on duty to meet their needs. Throughout this inspection we saw staff respond to peoples needs promptly in a kindly and respectful manner. The manager said that the home does use agency staff and are aware of the problems associated with this, people not knowing staff and staff not knowing them. The manager told us that only staff that are familiar with the home and people living there are provide by an agency. During this inspection we met an agency carer who has worked at the home for some time and knows those living there well. This means that people can feel safe and secure with familiar staff to care for them. Communication systems at Hill House ensure that all staff are kept up to date with the changing needs of people on a daily basis. All staff attend a handover session when they report for duty. During this inspection we sat in on both the morning and afternoon handover, during which some very relevant information was shared. One care had not been working at the home for several days and was updated on information going back to the last time they were on duty. We looked at the recruitment files for three recently employed staff. Two included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training, evidence of identity, police checks and references. However, one file was not up to date and the recruitment procedure had not been carried out when the person had been most recently recruited at the home. The person had been previously employed at the home, had resigned and returned to Hill House after a short period spent away from the service. No recruitment procedures had been carried out for this member of staff when they were re employed. We discussed this with the manager who told us that the member of staff had left Hill House for such a short time that it was not thought that the recruitment procedure needed to be repeated. The manager also told us that a member of staff who had been employed and then spent an extended period not working at the home because of personal circumstance, returned to work only after the recruitment procedure had been followed. This was because the manager was aware that in the period of time away from the home circumstances may have changed and the ethos of the home is to ensure that people living there are protected from harm. Care Homes for Older People Page 26 of 33 Evidence: Not ensuring that the homes robust recruitment procedure is carried out when any person is employed means that people living at the home may be potentially at risk because the recruitment procedure has not been followed. Newly employed staff all undertake a period of induction training. This introduces them to the homes policies and procedures, the layout of the home, health and safety issues and conditions of employment. They also undertake an induction course covering care specifically related to health and social care needs of the people they care for. Training is a priority at Hill House. Individual staff files include confirmation of all training undertaken and all planned. This means that all staff are kept up to date with current good practice. During the last 12 months staff have undertaken training in the management diabetes, continence, safe handling of medicines, first aid update, protection of vulnerable adults and infection control with updates planned for the following year. Information received prior to this inspection told us that 11 of the 23 permanently emplyed staff at the home have achieved a Nationally recognised qualification [NVQ] at level 2 or above. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. x Evidence: The registered provider of Hill House is Abbeyfield East Devon Extra Care Society Limited, a voluntary provider and the management structure includes an active management committee. Mrs Pulman was appointed as manager at Hill House in August 2007 and has over 20 years experience of working with older people in a care home setting. Mrs Pulman has worked at Hill House for 12 years, gradually taking on more responsibility working as a senior carer. When appointed as manager she spent one month working along side the previous registered manager being introduced to the role and responsibilities of the manager. The manager told us the service has a good management team who all work well and compliment each other. There is an administrator who deals with finances of staff and Care Homes for Older People Page 28 of 33 Evidence: residents, she is able to help residents with any problems, banks and cashes cheques for them when needed and have excellent back up from Executive.Committee. Regular residents meetings are held at the home, attended by the manager and a member of the committee and occasionally the cook attends to discuss any menu issues. A copy of the minutes is made available to staff to enable them to see where problems are occurring and to see the good comments shared. These meetings give the manager the opportunity to discuss problems staff may be having with serving meals etc. We were told that people living at the home often have some good ideas on how to improve services. Minutes are given to all residents and to the executive committee and are discussed at each committee meeting. As the result of some of these meetings the manager has bought some new higher chairs, some with pressure relieving cushions, which are being well used in the lounge and in some of the bedrooms for those having difficulty getting up. Also a fish tank has been moved back to the lounge as it was being missed when moved to hall during decoration of lounge. The home also undertakes annual Quality Assurance surveys when surveys are sent out to relatives for their views and also regular visiting professionals. Some people living at Hill House choose to have personal money dealt with by the home. This means that a float is kept so that day-to-day items such as toiletries, hairdressing, papers and magazines can be bought as people wish. We saw records and receipts kept by the home; these were accurate and up to date. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Only records of fee payments are kept on computer. Records are kept in lockable filing cabinets and those seen were up to date. Records required by regulation for the protection of people living at the home are maintained. Training records confirm that staff are up to date with manual handling, fire safety, safe handling of food, first aid and infection control. Records confirm that fire alarms and emergency lighting tests have been carried out regularly. An assessment of identified hazards and associated risks relating to the environment, including fire hazards, has been undertaken. Information received before this inspection indicated that all equipment is well maintained regularly, all of which contributes toward ensuring that Hill House is a safe place for people to live. Care Homes for Older People Page 29 of 33 Evidence: Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessments of individual needs, undertaken prior to confirmation that the service can meet all needs, should be further developed to include more comprehensive information. Individual care plans should include detailed information of individual needs and abilities, how they would be met, by whom and any changes that occur. People, or their representatives, should be included in the initial drawing up of their individual care plans and in regular reviewing of the plans. The homes recruitment procedure should be consistently followed when employing people to work at the home. 2 7 3 7 4 29 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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