Care Home: Hillbrow House

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What the care home does well In making a decision to move into Hillbrow House people are provided with clear and helpful information about the home to inform decision making. Visits to the service prior to moving in are encouraged and facilitated by the home`s management. Staff are caring and well trained. They are able to recognise bad practice and would feel confident that in raising issues to the management they would take action to improve things. Care planning is in the process of becoming more person centred so that people receive an individualised package of care and support. Appropriate action is taken to monitor people`s health in relation to requesting the involvement of community health care professionals in caring for people at the home. The views of people living at the home are sought as part of established internal quality assurance processes. This means that people are empowered to have a stake in the running of the home. The environment is pleasant and clean. Meals are appreciated and choice of menu is offered. People spoke highly of the managers at the home, their approachability and dedication to the service. One person said the best word to describe how they felt living at Hillbrow House was in being `content;` reflecting the homeliness and relaxed pace at the service. What has improved since the last inspection? At the last key inspection no requirements and three recommendations were made. The recommendations were in relation to choice, self-medicating and staff supervision records. The home has taken action on these recommendations and they are not repeated in this report. What the care home could do better: We have made legal requirements about staff recruitment practices and medication record keeping. This is because people have been put at risk of harm by poor staff recruitment processes. This has included poor management with regard to policy guidance within the home on staff recruitment and by poor practices in failing to establish that staff are suitable to work with vulnerable people prior to staff commencing employment at the home. We found that medication records have not been consistently correctly maintained giving rise to potential errors in administration and potential inability to monitor people`s symptom control. Also there is not currently an effective system for managerial delegation in the home to ensure that information requested by the Commission is responded to in a timely fashion. We have also made recommendations to promote good practice in this report. Social and personal histories should be developed to aid the person centred care planing process. The home`s policy on staff recruitment should be revised. It currently gives incorrect advice. All moving and handling equipment ought to regularly serviced for fitness for continued use. Finally, we recommend that accident records be audited formally to demonstrate that managers are carrying out a strategic overview of accident prevention in the home. Key inspection report Care homes for older people Name: Address: Hillbrow House Hillbrow 1 Park Road Crediton Devon EX17 3BS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Judith McGregor-Harper     Date: 1 0 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 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. 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Hillbrow House Hillbrow 1 Park Road Crediton Devon EX17 3BS 01363773055 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: hillbrow@shears.eclipse.co.uk Hillbrow Residential Care Home Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hillbrow House is based in an original two-storey 18th century building with a modern ground floor extension. It is situated in a residential area towards the outskirts of the town, and on a main bus route. GP surgeries and other services are reasonably close by, and the shops are within one mile. The older part of the building has one double bedroom on the ground floor and seven single bedrooms on the first. There is a shaft lift between floors. The older part of the building also contains one of the lounges and the dining room. The extension has fifteen single bedrooms and a lounge. The lounges and the dining room have been decorated to a high standard being both attractive and homely. On the ground floor there is a step down into the dining room with grab rails at either side. There is also a step between two parts of the corridor, which has been ramped. There is an attractive, Care Homes for Older People Page 4 of 31 Over 65 24 0 Brief description of the care home well-maintained and sheltered garden to the rear of the building with flowerbeds and pond. A patio area has been paved and a small fountain added. There is a paved area with seating to the side of the home. There is also a good-sized car park. Fees for the home are approximately 450 pounds per week. A copy of the latest CSCI inspection report was displayed in the entrance hall. Care Homes for Older People Page 5 of 31 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: one star adequate 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: The quality rating for this service is 1 star. This means that people who use this service experience ADEQUATE quality outcomes. This key inspection was unannounced and was a scheduled visit as part of our routine inspection programme. The homes last key inspection was in January 2007 and the home received a rating of excellent at the inspection visit. We have carried out two Annual Service Reviews since the 2007 key inspection. Annual service reviews were completed using information supplied to us by the home and surveys from people with an interest in the home on the 26th March 2008 and the 19th February 2009. In these reviews the information we received gave us no reasons for concern or to bring our planned inspection schedule forward. For our inspection on the 10th and 11th December 2009 we (the Commission) were at the home on two days spending a total of 9 hours at the home. We looked at key standards covering: choice of home; health and personal care; daily life and social activities; complaints and protection; environment; staffing; and management and Care Homes for Older People Page 6 of 31 administration. During the visit we spoke with or observed the majority of people who live at the home. We looked closely at the care, services and accommodation offered to 3 of the 23 people who were living at the home. This is called case tracking and helps us to make judgements about the standard of care and helps us to understand the experiences of people who live at the home. We looked at care and attention given by staff to people we case tracked and we looked at their assessment and care planning records. We spoke with visitors to the home, with duty staff and with the Registered Manager and the homes owner who is the Responsible Individual. We visited some of the bedrooms to briefly view accommodation of people we case tracked and we saw all communal areas of the home. Prior to the inspection the owner sent us the Annual Quality Assurance Assessment (AQAA). This is a service self-assessment document giving us information about the home, its management and information about the needs of people living there. The AQAA asks for evidence in relation to what the home does well and what they think they can improve upon. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: We have made legal requirements about staff recruitment practices and medication record keeping. This is because people have been put at risk of harm by poor staff recruitment processes. This has included poor management with regard to policy guidance within the home on staff recruitment and by poor practices in failing to establish that staff are suitable to work with vulnerable people prior to staff commencing employment at the home. We found that medication records have not been consistently correctly maintained giving rise to potential errors in administration and potential inability to monitor peoples symptom control. Also there is not currently an effective system for managerial delegation in the home to ensure that information requested by the Commission is responded to in a timely fashion. We have also made recommendations to promote good practice in this report. Social and personal histories should be developed to aid the person centred care planing process. The homes policy on staff recruitment should be revised. It currently gives incorrect advice. All moving and handling equipment ought to regularly serviced for fitness for continued use. Finally, we recommend that accident records be audited formally to demonstrate that managers are carrying out a strategic overview of accident prevention in the home. Care Homes for Older People Page 8 of 31 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. Care Homes for Older People Page 9 of 31 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 31 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 people with sufficient and clear information with which to make an informed choice as to whether they wish to move into the home. People are encouraged to visit Hillbrow House before they choose to move in and an assessment of the support they require ensures that the home can appropriately meet their care needs. Evidence: The home has recently revised its Statement of Purpose. The AQAA informed us that the Statement of Purpose is available in the alternative formats of large print or tape/MP3. The homes owner, Mr. Shears, has forwarded to the Commission revisions of the Statement of Purpose when they have been made, as is good practice. This then provides us with current information about service provision at the home. We viewed care records of 3 people who live at the home. This included the records of Care Homes for Older People Page 11 of 31 Evidence: one person who had recently moved into Hillbrow House. All of the records inspected had a completed assessment of current needs and there was an assessment of needs recorded with the newly admitted person, who had signed their plan of care. We spoke with this person who confirmed they had discussed their care support needs, likes and preferences with the manager. They also told us that they had visited to home before deciding to move in and had received literature about the facilities and management of the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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 has become more person centred and reflects peoples current support needs. This informs staff how to ensure consistent delivery of care. People are treated with dignity and respect, which contributes toward peoples sense of wellbeing at the home. Medication records are not always completed well. This means that mistakes could occur when administering medicines to people or peoples symptoms may not be controlled. Evidence: We looked in detail at the plans of care for 3 people currently living at the home. We also sat with the registered manager whilst she was updating some other peoples care plans and discussed with her how she receives information in order to revise plans of care and how care practices are monitored at Hillbrow House. We could see that the home is trying to make the plans of care for people more holistic and person centred. This had been identified as a focus area for improvement in the homes Care Homes for Older People Page 13 of 31 Evidence: AQAA. The home uses a number of assessment tools such as those to assess skin integrity, moving and handling needs and equipment, falls risk and environmental hazards to individuals. The registered manager is working to expand on the use of these assessment tools to inform an overall descriptive plan of care tailored to a persons individual circumstances. This reflects the ethos of person centred care planning and is recognised as current best practice. We saw that, for example, where a person had diabetes, that there was a useful and informative plan of how the person would maintain healthy living with diabetes. There was a healthy eating plan and instructive prompts for monitoring of foot care and normal blood sugar ranges for the person concerned were recorded. We saw that one persons care plan we looked at had a Mental Capacity Act assessment completed, but that the assessment did not record what decisions or action(s) the capacity assessment was completed in respect for. We discussed this with the homes management and of the need to ground any assessment of capacity in a context of capacity to reach a specific decision to do something, in order to make the assessment meaningful. Care plans were signed by the individual it concerned and people we spoke to in the home told us they were aware that they had a written plan of care. During the inspection over two days we observed staff delivering care and support to people. We also spoke to people about how staff treat them and we spoke with two visitors on how they viewed care given to their friends or relatives who live at Hillbrow House. We observed staff delivering support to people in a kindly and attentive manner. In particular we noticed good practices when staff assisted people to move from sitting to standing positions or in helping people to move about the building. People spoke to us in complimentary tones about the caring aptitudes and skills of the staff and managers. One visitor told us that recently when staff numbers were unavoidably low on one weekend day due to sickness that the standard of care and attention people received remained high due to good leadership and teamwork. People told us that staff respect their privacy and dignity. Currently there are no shared rooms in use at the home. At the last key inspection it was recommended that people be provided the provision to lock their room doors. We saw that it had been recorded that people had been asked if they wanted this facility and declined the offer. During the inspection we suggested to the homes owner that locks be fitted and people offered a key to decline if they so wish as to make the choice tangible. Care Homes for Older People Page 14 of 31 Evidence: We inspected how medicines are stored and managed at the home. We were informed by the registered manager that the home recently had an inspection by the dispensing pharmacy and no issues of concern were raised. The homes AQAA informed us that we believe we have robust Policies, Procedures and training regarding ordering, control and dispensing of medication.... The AQAA also identified an area in which to raise standards by improving the medication audit trail. We found that on this occasion that management auditing of Medication Administration Records (MAR) for the current month had failed to pick up on some poor completion of daily medication recording. We found that on the current MAR for 8 medicines that have a variable dose prescribed that the dose given was either not recorded or inconsistently recorded. This means that the therapeutic dose is then difficult to establish for the person. We also found that on 3 occasions where a prescribed medicine had been hand transcribed on the MAR that there was no record on the MAR of who had transcribed the medicines, nor was there a counter signatory to prevent transcription error. We did find however, that medicines were stored safely and that cold storage of medicines was monitored. Controlled drug records were inspected and were correct and peoples records indicated that they had been consulted to whether they wished to self-medicate or have the home manage the administration of their medicines. Care Homes for Older People Page 15 of 31 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. Links with visitors and the community are good, giving opportunity to support and enrich peoples lives at Hillbrow House. The home offers a suitable range of activities and entertainments to stimulate and occupy people. The meals at the home are well presented and nutritious offering both choice and variety. Evidence: In care plans inspected there was recorded evidence of peoples likes and dislikes and lifestyle preferences with regard to such as dietary preferences, faith practices, living wills and daily routines. During the inspection over two days we saw people moving freely about the home going to their individual rooms on request as they liked. We spoke to people about the daily routine at the home and people told us that there was flexibility within the staffing routines to accommodate peoples changing preferences. For example, one person was resting on their bed in the early afternoon. In conversation with them they told us that they had decided they wanted an afternoon rest and had asked staff to assist them to their room. Care Homes for Older People Page 16 of 31 Evidence: The home advertises social events and activities on its foyer notice board and also produces a regular in-house newsletter of events and chat about Hillbrow House. On display around the home were seasonal arts and crafts produced by people living there. We noted that on the AQAA an area that the management had identified as a focus for improvement was to make greater effort to ensure that activities reflect the abilities and interests of each Resident. In the 3 care plans looked at in detail we did not find a developed personal and social history section. We recommend that, where, possible, these be obtained as part of a person centred care planning process, as this information can aid the tailoring of activity sessions and outings to peoples past and current interests. We met 2 visitors during the inspection. Both told us they receive a warm welcome by the staff. One visitor was having lunch with their friend in the dining room. The homes AQAA informs us that free meals are provided to visitors invited by the Resident. The home has a comfortable and inviting dining room. Some people we spoke to said they choose to eat in their rooms whereas others use the dining room. People told us that a pre-meal aperitif is offered and that there is a choice of main meal dishes and dessert. We saw food and drink likes and dislikes recorded in care plans. Questions about meal quality are included in the homes in-house annual quality surveys, results of which are published and displayed in the home, with any accompanying plans to change and improve meal services at Hillbrow House as a consequence of survey results. The AQAA informs us that the kitchen was inspected by the Environmental Health in July 2008 and no major issues were identified. At the inspection kitchen staff confirmed that the kitchen was inspected by the Environmental Health in 2008 and that they had no immediate concerns. Care Homes for Older People Page 17 of 31 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 management uphold a cooperative attitude toward complaints resolution, which means that people feel empowered to raise constructive suggestions on how to improve the service they receive. Staff have good working knowledge on how to report concerns about peoples welfare. Evidence: The AQAA for the service provided us with statistical information on how many complaints the service has received in the last 12 months. The Commission has not received any complaints directly about Hillbrow House since the last key inspection visit . At our inspection we looked at the homes complaints file. We could see that there was a record of concerns, complaints or allegations, dates and times of action and outcomes to resolve the issues to the satisfaction of the person raising the problems. Compliments received were also displayed on the staff notice board in the managers office. We spoke to people privately about how confident they felt raising issues within the home. People expressed they would have no hesitation in reporting issues to the management and said they believed they would be taken seriously if they had concerns. People also told us they knew they could raise complaints directly to outside agencies. Care Homes for Older People Page 18 of 31 Evidence: We spoke with some duty staff regarding their understanding of what constitutes abuse and how they would report this. Staff told us they had received training on how to recognise and report suspicions of abuse and staff also knew that they could whistle blow if managers did not act on reported abuse. We saw that the current Devon alerters pathway guidance document for reporting suspicions of abuse was available in the homes policies and procedures file in the managers office. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at Hillbrow House is clean, comfortable and homely and meets the needs of people well. Evidence: We toured the building looking at communal areas and looked briefly in bedrooms we were invited to enter by the person residing within. The communal areas are homely, with a high standard of furnishing and dressing. People we spoke to told us that the owner works hard to provide an attractive and homely environment at Hillbrow House. Outside of the building there is level access to the home from the gardens, with seating provision in courtyard space. During the inspection people took the opportunity during winter sunshine to go out and enjoy some outside air. We saw in peoples care plans that the home environment had been risk assessed in relation to hazards that may pose a risk to the individual. This is good practice demonstrating that risk assessment is considered to how environmental adaptations may benefit individual circumstances rather than a generic approach to home adaptations. The home has some adaptations to assist moving and handling for staff and people living at the home. For example, there are 3 communal bathrooms, 2 with assisted baths and 1 with a walk-in shower, which also has facilities for the hairdresser. 5 Care Homes for Older People Page 20 of 31 Evidence: bedrooms are en-suite and the remaining rooms have wash hand basins. Additional assisted toilets are provided on each residential floor of the home. We saw that radiators were guarded to prevent heat transfer injuries and daily records of hot water outlet temperatures were maintained in bathrooms to monitor fail safe devices fitted to baths. The home was clean and free from offensive smells. We noticed one area on the underside of a fixed bath hoist that required deep cleaning and this was attended to satisfactorily during the inspection. We saw that staff put on appropriate gloves and aprons when preparing to attend to personal care tasks and we saw staff washing their hands after assisting people with personal care. The homes AQAA informed us that all care staff have seen the seven HPA [Health Protection Agency] films on Infection Control as part of their Infection Control training programme. Care Homes for Older People Page 21 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The deployment and numbers of staff available throughout the day and night are sufficient to meet the needs and current numbers of the people living at the home. Good training opportunities are provided for the staff team so that peoples health needs are met. Recruitment practices have put people at risk from the employment of staff potentially unsuitable to work with vulnerable people. Evidence: Daily staffing levels remain as that from the time of the last key inspection. 4 care staff are rostered for the morning shift, including a senior carer (07.30 - 13.45). 3 care staff work in the afternoon, including a senior carer (13.45 - 20.00) and there are 2 waking night staff. In addition to these staffing numbers the registered manager and owner provide managerial cover over 7 days a week and ancillary staff are rostered in sufficient numbers. We were advised by the management that they are considering creating an additional Activity Coordinator post to provide regular activity opportunities for people. We asked for a copy of the current staffing roster (28 days) to verify staffing levels, which was duly supplied for us. We spoke to people about how long they had to wait for staff assistance when requesting help and people told us that there was not a problem in staff responding Care Homes for Older People Page 22 of 31 Evidence: promptly to their requests. The homes AQAA, completed on the 4th December 2009, informed us that currently approximately 60 of our staff [are] trained to NVQ 2 or above. The home also has one internal NVQ assessor on the staff team. We inspected the recruitment files of 6 staff currently employed at Hillbrow House who were employed since the last key inspection. We found that in 3 of the 6 files inspected that staff had commenced employment at the home prior to checks being received confirming that the staff applicants name was not on a list of people considered unsuitable to work in a care home with vulnerable people. We also found that the ex-employer of a person dismissed from a care post had not been contacted as a referee to provide detail of the dismissal. There was a professional reference for this person but it did not provide detail of the disciplinary action in this matter and was solicited from a private address. The applicant was subsequently employed at Hillbrow House. We also found in 3 of the 6 staff files inspected that applicants had started duties in the home before references had been received, which would give detail of their suitability of working in a care setting. Such staff recruitment practices put people living at the home at potential risk of harm. We looked at staff training records and spoke to duty staff and managers about how staff training needs are identified and provided. We saw that the registered manager has been maintaining a useful monthly at a glance staff training matrix. This has enabled her to identify areas that staff require training or training updates. For example, training for staff in understanding the conditions of Parkinsons Disease and Multiple Sclerosis had recently been identified and sourced. The home public ally displays all staff training undertaken on a wall opposite the dining room. We could see that records had been updated within the last month. Staff told us there were good training opportunities provided at the home and that their individual training needs are discussed in supervision sessions with their manager. We asked some duty staff about how they cared for the people living in the home and staff had good knowledge of peoples current and changing needs. Care Homes for Older People Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the home is managed in such as way as to promote the health and welfare of people who live at Hillbrow. However, during this inspection we found that management practices in staff recruitment put people at risk. Evidence: The homes AQAA stated we believe that we provide a high quality service in which our Residents can feel safe, secure and fulfilled. We found several examples of good management practices during the inspection visit. People living at the home we spoke with, visitors and duty staff we interviewed spoke in praise of the approachability and dedication that the homes managers give in trying to provide a quality service at Hillbrow House. The registered manager holds the Registered Managers Award and was able to demonstrate both a detailed knowledge of the individual needs of people living at the home and a broad understanding of issues that affect promotion of the health of older people. Staff told us they felt supported and supervised in their work. We examined written supervision records of 4 staff. The records were maintained well and had been signed by both staff member and their supervisor. It was clear that the Care Homes for Older People Page 24 of 31 Evidence: process for arranging staff supervisions and follow-up of issues raised in supervision sessions was transparent and seemed to work well. There are developed formal quality assurance processes at the home. This includes in-house systems as well as external auditing in order to look for ways to improve quality at the home. For example, as a result of a recent assessment by external auditors the home has developed a comprehensive bed rail risk assessment and consent form as a result of feedback by the external assessors. The registered manager had also initiated a review and re-write of all care plans in order to encapsulate the person centred ethos toward care planning. It is a strength of this service that the management is able to take on board and act when suggestions for improvement are put to them. During the inspection we found that recruitment practices have been unsafe, putting people at risk. The homes safeguarding policy, which includes statements on staff recruitment, produced by an outside company, gives incorrect advice to when staff applicants can commence supervised work in the home. We found that staff did start work prior to necessary background checks being returned. In addition, letters were sent to staff applicants by the owner, Mr. Shears, stating that the practice of commencing employment whilst awaiting a clearance check against a list of names of people unsuitable to work with people living in care homes was in line with Hillbrow and CQC policy. We discussed this incorrect statement with Mr. Shears, referring to guidance published by the Commission on the safe recruitment of staff. Before leaving the home we asked to be supplied with a copy of the current staffing roster and asked Mr. Shears to provide us in writing, without delay, written reassurance that all staff on this roster have received a satisfactory Criminal Records Bureau check. If this was not the case we wanted to know how this would be managed in relation to the safety of the people living at the home. We received written confirmation from the home on this matter on the 18th February 2010. We asked if the home handles any monies on behalf of people. The registered manager informed us that people or their relatives manage their own personal allowances. We looked at some health and safety equipment records and risk assessments and toured the building looking at the state of repair of adaptations in the home. The fabric and structure of the home seemed to be in good order. We cross checked some servicing records against information given to us in the homes AQAA and we found that the information in the AQAA matched that held in the home. We noticed that hoist slings are not inspected as part of servicing contracts for patient hoists. This is recommended. From examining accident records we also noticed that one person had suffered a cluster of falls recently. We asked the registered manager if accident Care Homes for Older People Page 25 of 31 Evidence: records are audited regularly to look for trends or patterns in order to devise strategies in care plans for accident prevention. We were told that this takes place but it is an informal auditing process and is not written down. We recommend therefore that accident records be audited monthly and recorded. This will then demonstrate that the management is fulfilling its strategic role in accident prevention at the home. Care Homes for Older People Page 26 of 31 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 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Hand transcribed entries on a medication administration record must be signed and counter witnessed. This is prevent hand transcribing errors. 26/02/2010 2 9 13 Variable doses for prescribed 26/02/2010 medicines must be recorded on the medication administration record. This enables the therapeutic dose to be established. 3 29 19 Staff cannot start working until the provider has received confirmation that staff applicants names are not included on a list of people unsuitable to work with vulnerable people. This is to protect people from the risk of harm. 29/01/2010 4 29 19 Staff must not commence work at the home until two 29/01/2010 Care Homes for Older People Page 28 of 31 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 written references have been received. One reference should be from the last employer and include detail of why the person left their employment. This is ensure the suitability of the applicant to work in a care environment. 5 33 19 Letters sent out to staff applicants must give correct advice on safe recruitment that reflects current best practice guidance. This is to protect people by ensuring only staff fit to work in the home are employed. 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 29/01/2010 1 12 We recommend that personal and social histories be obtained as part of the person centred care planning process. This information can aid the tailoring of activity sessions and outings to peoples past and current interests. The homes safeguarding policy should be amended to reflect the legal position regarding background checks on staff applicants. Accident records should be monitored for trends and 2 33 3 38 Care Homes for Older People Page 29 of 31 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 patterns and actions recorded as part of a managerial accident prevention strategy. 4 38 All moving and handling equipment, including hoist slings, should be regularly inspected. Care Homes for Older People Page 30 of 31 Helpline: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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