Care Home: Hillcrest Residential Home

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What the care home does well Hillcrest completes an assessment of need before residents move in and therefore is able to be confident they can meet peoples needs. Information is available about the home and contracts are in place. Surveys completed by residents told us that contracts were in place and that that their was enough information provided about the home. People can expect a good standard of health and personal care at this home. The home is good at bringing people back to a good level of health if they have been admitted with concerns about their wellbeing. Medication is safely managed and privacy and dignity is respected. Residents speak highly of their care and support they receive. One resident told us; `total care is excellent` another resident told us `the staff are very kind to me`. We spent time observing staff and residents together and saw the interaction was friendly, respecting choices and that staff were quick to respond to requests. Staff were seen to aid residents with personal care ensuring privacy and dignity. The overall atmosphere was very relaxed and unhurried. What has improved since the last inspection? Since our last visit to the home a number of environmental improvements had taken place. Decoration of the home is ongoing with the dining room and toilets being decorated. In addition a new wooden decking area has been developed with direct access from the living room. There is also a block paved area accessing the garden. Residents spoke of having time outside during the summer months that they enjoyed. This demonstrates that the home is subject to regular maintenance and updating. In relation to assuring quality within the home the manager had feedback from a number of people who used the service. They were asked their experience of catering, personal care, daily living at Hillcrest, the premises and management. The results were available for us to examine and overall these were positive. On our last visit to the home there had been a visit from the fire and rescue service and they had written to the home with work required to ensure the safety of residents. The manager was able to confirm that the physical work on exits and fire detection had been completed and on this visit the fire risk assessment had been reviewed. We looked at the fire extinguishers and they had been serviced. Weekly fire alarm tests had been completed and staff had training on fire drills. The recording of this had changed as this was done on an individual basis now. Staff also complete a fire safety check each shift to ensure the ongoing fire safety of residents. What the care home could do better: This report does not contain any requirements, but during feedback and discussions with the manager future developments for the service were discussed. The manager has yet to complete her registered managers award as due to circumstances beyond her control. The manager has given an undertaking to enrol upon an appropriate course and become suitably qualified. The manager agreed to develop information about each resident on their ability to evacuate the building should the need arise. Key inspection report Care homes for older people Name: Address: Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB     The quality rating for this care home is:   two star good 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: Claire Hutton     Date: 1 6 1 0 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 26 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 26 Information about the care home Name of care home: Address: Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB 01284760774 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Christopher J and Mrs Magda Hope care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named individual as notified to the Commission on 23/11/06 in the category of Physical Disability. Condition to expire on 07/01/09. Date of last inspection Brief description of the care home Hillcrest Residential Home is a privately run care home based in a Victorian property that has been extended and adapted to provide residential care since 1997. The home is located in a quiet residential area of Bury St. Edmunds. It is close to a small shop that is accessible to some residents. Hillcrest provides two single bedrooms and one double bedroom on the ground floor along with nine single bedrooms on the first floor. Access to the first floor is by stair lift. There is a step between the lift and the bedrooms, which may prove difficult for service users with mobility difficulties. One of the bedrooms benefits from the provision of en-suite facilities. There are two communal assisted bathrooms and five assisted Care Homes for Older People Page 4 of 26 Over 65 13 0 0 1 2 0 1 0 2 0 0 8 Brief description of the care home toilets within the home. Residents have access to a lounge that overlooks the pleasant garden with seating provided. There is also a separate dining room on the ground floor. Fees at this home range from £362 to £498 per week but do not include the cost of newspapers, hairdressing, toiletries, chiropody and transport. Care Homes for Older People Page 5 of 26 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 was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced over 2 weekday mornings, which lasted 5 hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from 14 Have Your Say surveys. The Annual Quality Assurance Assessment (AQAA), issued by the Care Quality Commission (CQC) was returned completed by the manager. This self-assessment gives providers the opportunity to inform CQC about their service and how well they are performing. We (CQC) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and Care Homes for Older People Page 6 of 26 safety. Time was spent talking with people who live in the home and 4 members of staff. The manager of the home was available on the second day of this inspection and fully contributed to the inspection process. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: This report does not contain any requirements, but during feedback and discussions with the manager future developments for the service were discussed. The manager has yet to complete her registered managers award as due to circumstances beyond her control. The manager has given an undertaking to enrol upon an appropriate course and become suitably qualified. The manager agreed to develop information about each resident on their ability to evacuate the building should the need arise. Care Homes for Older People Page 8 of 26 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 26 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 26 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. Hillcrest completes an assessment of need before residents move in and therefore is able to be confident they can meet peoples needs. Information is available about the home and contracts are in place. Evidence: There is information available about this service as this was confirmed in the selfassessment provided by the home and 5 residents told us they had enough information and written information about the homes terms and condition (contract). However we would recommend that information about the service is displayed at the home along with the last inspection report. We examined records for several residents and found that an assessment of need had been completed before they had moved into the home and therefore the service is confident that they can meet peoples needs. Care Homes for Older People Page 11 of 26 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. People can expect a good standard of health and personal care at this home. Medication is safely managed and privacy and dignity is respected. Evidence: We looked at 3 current care plans for people of differing dependency levels and found a good plan of care in place that gave information to staff on how best to support the individuals. Plans also included risk assessments for personal safety, nutrition and falls prevention. Two staff spoken with said the plans were good and it was useful that everyone was involved in these plans. There was evidence that these were reviewed regularly. Four surveys from residents said that they always received the care and support they needed two residents said they usually did. One resident told us; total care is excellent another resident told us the staff are very kind to me. One new resident who had a nutritional assessment had also had the community dietitian to visit them. There was good evidence to show that the individuals weight was monitored and strategies followed to ensure their nutritional well being whilst following guidelines around their diabetes. This individual had also had also had eye Care Homes for Older People Page 12 of 26 Evidence: screening specifically for diabetes. A community psychiatric nurse had visited and their medication reviewed by the GP and reduced since being at the home. We therefore have good evidence to show that the health of individuals who move into this home is thoroughly assessed and action taken to maintain and in some cases improve their health and well being. The six surveys returned from residents said that they always received the medical support they needed. We also received positive feedback from two health professionals and they said caring team. I think they do well and A very nice home. The staff are always very helpful and have all the information I require when I visit. We spent time observing staff and residents together and saw the interaction was friendly, respecting choices and that staff were quick to respond to requests. Staff were seen to aid residents with personal care ensuring privacy and dignity. The overall atmosphere was very relaxed and unhurried. In relation to medication at the home we saw the lunch time medication being given out. This was completed well as staff were pleasant, chatting but observant that medication was taken and then records completed. The records completed were good and showed that residents received their prescribed medication and if residents chose not to have their medication then this was noted appropriately on the forms. We also checked the controlled drugs stock and records and these were well maintained. Storage is set to improve as a new drugs trolley had been purchased. Medication kept in a fridge was secure and at the correct temperature. Staff spoken to confirmed they had received training in how to administer medication. Care Homes for Older People Page 13 of 26 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. Hillcrest provides individual activities and social contact for residents. The residents are provided with a wholesome and appealing balanced diet to keep them well and healthy. Evidence: We spent time in the main lounge observing the routine of the home and talking to residents. Residents participated in a game of bingo during our visit. There was evidence of regular visits from the mobile library and this included DVDs being borrowed to show on the homes large TV in the lounge area. There were individual activities going on with people reading the newspaper and playing dominos. A staff member spoke about the seasonal arts and crafts that they organise using beads, wool and cross stitch. A resident showed us their recent handiwork in making a glasses case. Preparations were under way for lunch with the dining tables being set out nicely with table clothes, condiments and drinks. Residents spoken with said the food at the home was always good with plenty of choice if you did not like what was on offer. One meal we saw was pork chops, with potato and vegetables and bananas and custard for pudding. Another meal seen and enjoyed was roast chicken. Care Homes for Older People Page 14 of 26 Evidence: Most people chose to have lunch at the small dining tables. During the meal mellow music was put on and the residents ate their meal to Cliff Richards. One resident chose to eat their meal in their room. Their lunch was served on an individual tray and the meal was covered to keep it warm. A plate guard was used and the resident was encouraged to eat the meal for themselves, but with staff assistance. Close attention was paid by staff to requests made by the residents. After lunch one resident got themselves ready to go out into Bury town centre. Another resident prepared themselves for their visitors. The visitor book showed us that the home receives many relatives and differing times of the day. Care Homes for Older People Page 15 of 26 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. People who use this service can be confident that concerns, complaints and safeguarding will be taken seriously and acted upon. Evidence: With regard managing complaints the self-assessment told us that all residents and relatives are issued with a copy of the complaints procedure and have the advantage of being able to raise any concerns directly with the owner/manager. The owner manager is at the home most days and is in day to day control of the home and is approachable should their be any concerns needing to be raised. The complaints procedure was clearly displayed upon the wall for anyone to access. In the last 12 moths the home has received 2 complaints. We were able to view the log where these were recorded and found that these had been looked into and responded to. All six surveys from residents said they were aware and knew how to make a complaint should they need to. With regard to safeguarding adults the home has a copy of the local policy and procedure for reporting possible abuse of vulnerable people. The manager confirmed that staff had received training as part of their induction and some staff had attended a specific training course. We spoke to staff and they confirmed that they had read the homes policy and procedures and were aware of different types of abuse. Staff were also clear that they had a duty to alert any suspicions and knew the process for doing Care Homes for Older People Page 16 of 26 Evidence: this. This service has had no safeguarding issues in the last 12 months. The self-assessment completed by the manager told us that staff at the home were attending training on the Mental Capacity Act in order that they are up to date with developments in care. Care Homes for Older People Page 17 of 26 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. Hillcrest provides a comfortable environment that is safe, clean and homely. Evidence: The home was nice and warm in all areas visited. This may be as a result of a new gas boiler recently being installed. The surveys returned from five residents said that the home was always fresh and clean. On our last visit to the home the exterior of the home had recently been painted and the main entrance, stairs and landing had also been recently decorated. On this visit we noted that the dining room and toilets had been decorated. In addition a new wooden decking area has been developed with direct access from the living room. There is also a block paved area accessing the garden. Residents spoke of having time outside during the summer months that they enjoyed. This demonstrates that the home is subject to regular maintenance and updating. There is a specific small building for laundry that is well equipped. Hillcrest provides two single bedrooms and one double bedroom on the ground floor along with nine single bedrooms on the first floor. Access to the first floor is by stair lift. There is a step between the lift and the bedrooms, which may prove difficult for service users with mobility difficulties. One of the bedrooms benefits from the provision of en-suite facilities. There are two communal assisted bathrooms and five assisted toilets within the home. Residents have access to a lounge that overlooks the pleasant garden with Care Homes for Older People Page 18 of 26 Evidence: seating provided. There is also a separate dining room on the ground floor. In terms of aids and adaptations the home has a stair lift in place. We saw a resident use this and they required and received support to use it. We saw other people use this independently. There was a hoist available and we saw this had been serviced. In the lounge some residents were sat upon inflated cushions to prevent any pressure areas. A new bath upstairs had also been installed. Care Homes for Older People Page 19 of 26 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. Hillcrest has sufficient staff that are generally well recruited and trained. Evidence: We examined the roster for the previous 2 weeks and found that consistently there were 2 staff on duty during the day and at night there was a waking night staff and a staff member sleeping in case of an emergency. All surveys completed by the residents said that staff were available when they needed them. Staff spoken with said that staffing levels at the home were OK. Also the six surveys received from staff reflected this view. The self-assessment told us that the home had a stable senior staff team in place and that there were regular team meetings and hand overs from one shift to the next which were supervised by the manager. The feedback from staff was very positive about working at Hillcrest and there was good team support with moral positive and a good sense of direction focused on residents and their needs. With regard to staff training the manager told us that 75 of staff had NVQ 2 and above. The self-assessment told us that eight staff had training in the use of chemicals and infection control. We spoke to a staff member about what would they do if they discovered a fire. the staff member had a clear knowledge of what to do and this corresponded with the home procedures clearly displayed within the home. Records examined showed that staff had a good base line training in matters such as manual handling, basic food hygiene, 1st aid and medication. Care Homes for Older People Page 20 of 26 Evidence: We looked at the recruitment records for 3 staff and found that all required checks had been undertaken according to regulation. Care Homes for Older People Page 21 of 26 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. The management of this home is satisfactory with the health and safety being maintained to protect residents and residents views are sought to inform the running of the home. Evidence: The manager of this home has many years experience in looking after older people. She originally trained as a nurse. The manager has yet to complete her registered managers award as due to circumstances the 2 different courses she had enrolled on were not able to be completed. The manager has given an undertaking to enrol upon an appropriate course and become suitably qualified. Staff spoken with thought well of the manager and one person said shes easy to talk to. Staff also confirmed they received supervision. In relation to assuring quality within the home the manager had feedback from a number of people who used the service. They were asked their experience of catering, personal care, daily living at Hillcrest, the premises and management. The results Care Homes for Older People Page 22 of 26 Evidence: were available for us to examine and overall these were positive. The home does not take control of financial matters for residents, but they do hold small amounts of cash for people. We looked at the storage and records for this and found that these were satisfactorily maintained with receipts kept. We looked at health and safety matters. The self-assessment told us that all required policies and procedures were in place and that all equipment was appropriately maintained. We sampled a number of these records e.g the stair lift and found them in place. We also found hot water temperatures from baths to be within safe limits and a landlords gas safety certificate had recently been issued. On our last visit to the home there had been a visit from the fire and rescue service and they had written to the home with work required to ensure the safety of residents. The manager was able to confirm that the physical work on exits and fire detection had been completed and on this visit the fire risk assessment had been reviewed. We looked at the fire extinguishers and they had been serviced. Weekly fire alarm tests had been completed and staff had training on fire drills. The recording of this had changed as this was done on an individual basis now. Staff also complete a fire safety check each shift to ensure the ongoing fire safety of residents. The manager agreed to develop information about each resident on their ability to evacuate the building should the need arise. Care Homes for Older People Page 23 of 26 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 24 of 26 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 Care Homes for Older People Page 25 of 26 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. 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