Care Home: Hillcrest (Stourbridge)

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What the care home does well People who live in the home receive support from a team of staff who know their needs and personal preferences. They are encouraged and assisted to maintain contact with family and friends. Regular consultation takes place with the individual and their health care specialists to ensure their physical and emotional care needs are being appropriately met. The home actively encourages people to participate in the running of the home should as carrying out tasks involved in planning, shopping and preparation of meals. Good systems are in place for people to express their views and these are appropriately acted upon by the home. Staff are familiar with the home`s processes for ensuring people are kept safe. What has improved since the last inspection? The home has revised its care plans for people who live at the home. Suitable provision is made to support people to make their own decisions. Where a person lacks capacity to make informed decisions, appropriate processes have been put on place to identify what is the best course of action. Improved systems for supporting staff to carry out their duties have been implemented. The training programme has been updated. This includes more client-centred training to enable staff to increase their knowledge and develop their skills to become more competent and confident in meeting people`s needs. What the care home could do better: The home has made some progress in implementing its re-decoration and refurbishment programme. This programme and outstanding remedial work should be completed in a timely fashion. Improved systems have been put in place to ensure the health, safety and welfare of people living in the home is more fully promoted and protected. A formal system for regularly reviewing care plans has yet to be implemented. Each person should be provided with a written contract that includes details of the service the home will provide, the fees for the service and information about what is not covered in the fees. Staffing levels should be regularly reviewed to ensure they are sufficient to meet the changing needs of people who live in the home. The manager must continue to ensure a member of staff, trained in administering medication, is on duty at all times. The quality assurance system needs to be developed further in order for people to be fully confident their views form part of the home`s assessment of its own performance. The home has made good progress since out last visit. A senior representative of the company and the manager should discuss current allocation of her time to ensure it is suitable to enable her to continue to develop the service. An application to registration a manager for the home should be provided to our regional registration team. CARE HOME ADULTS 18-65 Hillcrest (Stourbridge) 40 Perrins Lane Wollescote Stourbridge West Midlands DY9 8XP Lead Inspector Linda Elsaleh Unannounced Inspection 3rd and 8 September 2008 2:30 th Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest (Stourbridge) Address 40 Perrins Lane Wollescote Stourbridge West Midlands DY9 8XP 01384 823050 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Select Health Care (2006) Limited Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) The maximum number of service users to be accommodated is 7. 2. Date of last inspection 21st January 2008 Brief Description of the Service: Hillcrest is a traditional house, which has been converted to provide accommodation for 7 younger adults with learning disabilities. The home is situated in a quiet residential area in Wollescote and blends well into surrounding properties. All rooms are single and one room has an en-suite facility. There is a small parking area at the front of the building. There is a patio area on the ground floor and a garden area on the lower ground floor to the rear of the property. Bedrooms are situated in the lower area and first floor of the house. There is no lift access for service users. There are lounge and dining room facilities on the ground floor. The home currently has limited bathing and toilet facilities. The home provides care for people with a range of learning disabilities who may also have challenging behaviour. A statement of purpose and service user guide is available to inform residents of their entitlements. Information regarding fee levels is not currently included in the published statement of purpose and service user guide. There are additional charges for residents, which include hairdressing, chiropody, toiletries and holidays. The home should be contacted for information about the fees charged for this service. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This unannounced inspection was carried out over two days in September 2008. The purpose was to assess the home’s performance against the key standards in the National Minimum Standards for Care Homes for Adults and report on the progress made to address previous requirements. The findings are based on the information received by us, the Commission for Social Care Inspection (CSCI), examination of relevant records and documents kept at the home and discussions with the manager, staff on duty and people who live in the home. The atmosphere within the home was relaxed and friendly. People living in the home and staff told us they were pleased with the work being undertaken to improve the environment. At the time of this visit one person’s bedroom was in the process of being re-decorated. The requirements made at the previous inspection have been met. What the service does well: What has improved since the last inspection? The home has revised its care plans for people who live at the home. Suitable provision is made to support people to make their own decisions. Where a person lacks capacity to make informed decisions, appropriate processes have been put on place to identify what is the best course of action. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 6 Improved systems for supporting staff to carry out their duties have been implemented. The training programme has been updated. This includes more client-centred training to enable staff to increase their knowledge and develop their skills to become more competent and confident in meeting people’s needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 5 Quality in this outcome area is adequate. A Statement of Purpose and Service User Guide is available and provides information about the service the home provides which enables people to make informed choices about where to live. People will benefit from the work being undertaken to improve on these formats. The home has a policy for assessing the needs of people before they come to live at the home. However, we are unable to comment on how effective this process has been carried out, as there have been no new admissions to the home during the last twelve months. People do not have a written contract or statement of terms and conditions with the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose and Service User Guide. In the information provided to us by the home acknowledges these could be produced in more suitable formats to make it easier for people who live in the home to Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 9 understand. Plans have been made for the manager and deputy to attend training in making information accessible to people with learning disabilities later this month. At the time of this visit there were three people living at the home. There have been no new admissions since the last inspection. The information provided by the home states they have a referral and admission policy that was reviewed in April 2008. The manager told us she intended to revisit this to ensure the process ensure it includes consideration to the compatibility of any new person with the existing people living at the home before a placement is offered. The manager told us work has commenced with the local authority for people currently living at the home to have their needs re-assessed. The files of people we looked at show meetings are taking place with a representative from the local authority, health care specialists and other significant professionals. Staff reported good working relationships have been established with professionals, however the re-assessment process is taking longer than expected. Contracts for individuals living at the home have not been updated since before the company took over this service. This remains an outstanding recommendation. The manager told us she has been unable to obtain a copy of the funding agreement from the local authority. This needs to be obtained to ensure these and individual contracts between the home and individuals clearly state/agree on what services are covered/not covered by the fees. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. Individual care plans are produced by the home. However, a formal system for the regular review of these plans needs to be implemented so the individual and/or their representative can be assured changing needs and personal goals are reflected in the plans. People who live at the home are supported to make choices and informed decisions about their lives. Where a person lacks capacity to make informed decisions this is discussed in their best interests in a multi-disciplinary meeting. Risk assessments are produced to support people to lead independent lifestyles, as far as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 11 We looked at the care plans for the people who are living at the home. As previously stated, re-assessments of people’s needs are being carried out by the local authority. In the meantime the home has been working on developing individual care plans, based on their knowledge of people living in the home, and this is being shared with the local authority. The plans provide staff with details of how people are to be supported with different aspects of their daily living, for example personal and health care, communication and lifestyles and choices. Since our last visit training in working with people with autism has been provided to ensure the needs of a person living at the home is understood and are being met appropriately. The manager told us a system has yet to be introduced to ensure care plans are reviewed with the individual, their relative/representative and other significant people at least twice each year. The home has sought the advice from and made referrals to the speech and language therapists in order to work with individuals to produce personcentred Communication Passports. The passports inform the reader about the person’s preferred form of communication, daily routines, likes and dislikes and how they respond to different situations. This provides with another method of expressing how they wish to be supported. Each person is allocated a key worker. The manager and staff informed us the people living at the home are supported to make their own decisions, wherever possible, however their decision-making ability is limited. The records of one person we looked at shows regular multi-disciplinary ‘best interest’ meetings are held to discuss concerns about her/his capacity to make informed decisions, for example treatment for her/his health care needs. Other records show people are encouraged to make day-to-day decisions and choices such as which member of staff they would like to support them with their personal care, the clothes they want to wear, activities they participate in and the meals they like to eat. Records show consultation also takes place with people living at the home about the day-to-day running of the service. These include minutes of meetings with key workers and surveys they have responded to. The manager says she has yet to look at involving people who live in the home in the process for recruiting staff. Staff said they do occasionally try to encourage people to participate in ‘house’ meetings. However, these have not been very successful and individual consultations continue to be the more productive method of obtaining their views. We saw people being consulted about how they wish to spend their time and during the afternoon they all went out with staff to buy food from a supermarket. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 12 Individual risk assessments are produced from the care plans to cover any issues that may have the potential for harm. For example, one person has risk assessments about how they are to be safely supported in the community and during the night-time hours. These are reviewed each month. The risk assessment for the night-time hours have been amended to reflect the changes in the person’s behaviour. Risk assessments have also been carried out to cover areas such as medication and general health care needs. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. People living in the home are provided with support for their personal development. However, staffing levels should be reviewed to enable more opportunities to be provided to enable people to part take in community-based activities on a more regular basis. Staff support people, wherever possible, to maintain links with family and friends. People are offered a choice of meals that meets their personal preferences and dietary needs. They are able to participate in the preparation of their meal and are provided with a suitable environment to enjoy mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 14 We were told that people choose how they wish to spend their day. Staff we spoke to told us they had been providing support for one person to attend a local college by accompanying her/him during sessions. The manager told us the person was very disappointed when the college ended their sessions and they are looking for suitable courses at different colleges. Another person enjoys attending a local day centre twice a week. The other person who lives at the home does not wish to attend college or a day centre, preferring to spend time in the community with staff. The manager and staff told us two people need to be supported by two staff when in the community and one needs this level of support at other times. This means the majority of activities are planned in advance to ensure sufficient staff are on duty. This reduces the opportunities for unplanned/spontaneous activities to take place. The manager is discussing this with the local authority, who fund these placements, as part of the reassessment process. We were told the manager attended a one-day training course in ways of accessing activities with the home’s activity co-ordinator. The manager said it focussed more on activities for people with dementia, but never the less they felt some aspects of the programme was useful to them in developing the activities they provide for the people they care for. A pictorial activity board in displayed in the kitchen. One person showed us, using the picture board, which activity s/he participated in the previous day. Another person spent part of the day with a member of staff tidying and cleaning her/his room. The third person spent most of her/his time in the lounge. We were told people enjoy watching television. The lounge is spacious, but sparsely furnished and poorly equipped. However, it is due to be re-furnished and provided with new entertainment equipment in the near future. This will provide people living in the home with a more comfortable and stimulating environment. We were told that last year all people living at the home went on holiday together. However, due to the diverse needs and different interests this arrangement proved unsuitable. This year arrangements have been made for each person to spend a week away with staff on their own later in September and October. One person told us they have regular contact with a relative and another enjoys regular visits to home of a family member. The staff told us they support people to maintain contact with family and friends and, where applicable, keep relatives informed about progress. The home has a policy for contact with/visits by family and friends and this was last reviewed in April. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 15 Information provided by the home tells us 80 of the staff team have attended training in basic food hygiene. The records kept by the home show arrangements are being made of other staff to attend this training. During this visit people who live at the home were seen to be actively involved in menu planning, shopping and preparation of the evening meal. We observed good interaction between the staff and people living in the home. The home has a picture board menu planning system. This helps people to decide what they would like to eat. One person used the menu board to show us what shopping had been brought, their favourite meal and the meal they had chosen to eat that night. People are encouraged to consider healthy options when choosing their meals. There is evidence that the home has consulted with people’s doctors where there are any concerns regarding their dietary needs. Records are kept of all main meals taken. However, it is also recommended that supper/snacks are also recorded. This will enable effective monitoring to take place where any dietary or health issues are identified. Meals are provided in a well-equipped kitchen. Most people chose to take their meal in the dining room, however, dining furniture is also provided in the kitchen and people may dine here, if they wish. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. People living at the home receive personal support in the way they require and prefer. The home consults regularly with their health care specialists to ensure the person’s physical and emotional health care needs are met. Suitable systems are in place for the safekeeping of medication managed by the home behalf of the people who live in the home. Immediate action has been taken to ensure a member of staff trained in the administering of medication is on duty at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans show how people are to be supported with their personal care. The staff team consists of male and female staff. This shows any preferences, such as support being provided by a person of the same gender, can be accommodated. The manager told us there are strategies in place to Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 17 discourage one person becoming too dependent on a particular member of staff. We were told that due to disturbed sleeping patterns regular checks on people are carried out through the night. One person’s records shows in the past s/he has chosen to sleep in a chair in the lounge, but is now spending more time in her/his bed. Limited information was available about the need for checks to be carried out on other people. The manager is advised to discuss the need for frequent night-time checks to be discussed in the person’s meetings, with a multi-disciplinary team as part of the re-assessment of their needs, to ensure their right to privacy is protected. There are records of regular visits from community health care professionals such as dentist, optician and chiropodist. Records are kept of these appointments, meetings and outcomes. People are given the option to receive these services in the home or are supported by staff to access them in the community. Where people do not want a specific treatment, there is evidence that the home is working with the relevant professionals to look at other suitable arrangements for meeting their health care needs. The home manages medication for all people living at the home. We looked at the practices to see how medication is managed. The home has a medication policy that was reviewed in February 2008. Medication is stored in a safe and secure location. It is administered by staff who are trained and the records show update training is arranged. Information provided by the home show us they deal appropriately with any errors that occur. This is verified by the records kept and through discussions with staff. Two people are prescribed “as required” medication to help calm them at times when they become agitated and display behaviour that challenges the service. Protocols for administering this medication has been produced. However, these need to be reviewed to ensure staff are provided with clear information about the strategies to be used prior to considering administering this medication. Staff need to record fully their observations and discussions held with senior staff. This will ensure a consistent approach is taken, enable effective monitoring of the situation and the use of “as required” medication to take place. We looked at the rota and found that on certain shifts there was no trained member of staff to deal with medication. The manager advised us that on these occasions she or the deputy would return to the home to administer medication. However, this is an unsatisfactory arrangement and does not address the administering of medication prescribed on an “as required” basis. Given this concern we issued an immediate requirement for suitably trained staff to be on duty at all times. We received evidence from the home to demonstrate action had been taken to address this within the timescale we set. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 18 The home has a system for handing over responsibility of medication from one staff member to another. The manager carries out regular audits of medication in the home. The prescribing healthcare specialists also carry out regular reviews of each person’s medication. The records show one person’s medication was last reviewed in June this year. Another person’s review took place in August during her/his admission to hospital for this purpose. The home notified us about this event at the time. The home has a general homely remedies protocol. The manager is advised to consult with the GP for each individual for guidance on which homely remedies can be safely administered and produce individual protocols for staff to refer to. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People who live at the home feel the home listens to their views and acts on these. There are suitable procedures and systems in place to protect people from abuse and self-harm. They are supported by staff that been trained in adult abuse awareness and safeguarding issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure. This is produced in a suitable format for the people who live here. Copies were seen in various locations throughout the home. Since the last key inspection, there has been one complaint. We looked at the record kept by the home. This showed this was dealt with appropriately. We have not received any complaints about this service. One person used the staff photo board to show us who s/he would speak to if they were unhappy or had any concerns about the service. The home has an adult protection policy relating to adult protection. Information provided by the home tells us this was last reviewed in April this year. The policy is available to staff together with the local authority’s policy and procedure for dealing with safeguarding issues. The staff we spoke to knew how to report incidents and felt confident that any reports would be Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 20 listened to and acted upon. The majority of staff had received training in safeguarding. There have been no safeguarding referrals and we have not been made aware of any concerns. Training is provided in managing challenging behaviour. This involves the use of distraction and deflection techniques. A ‘no restraint’ policy is in operation at this home. Staff told us how displays of challenging behaviour are managed and records seen on the files we looked at concur with the examples given by staff. The home works closely with other professions to identify suitable strategies for managing and reducing incidents of challenging behaviour. Personal allowances are managed by the home on people’s behalf. We checked a random sample of records and found them to be in order. Receipts are obtained for all transactions and countersigned by two staff members. The manager and area manager regularly audit random samples of these records to make sure they are being well-maintained. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. The home is in the process of completing its programme of re-decoration and refurbishment in order to provide people with a more homely and comfortable environment in which to live. There are improved systems in place to ensure the home is kept clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a number of rooms have been re-decorated. However, some remedial work identified during our last visit has yet to be addressed, such as ensuring the floor in laundry is made impermeable, the extractor fan in the toilet is repaired and the lower ground floor bathroom is refurbished. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 22 People who live at the home are consulted about colours and furnishings for their bedrooms. One person invited us into their room. S/he opened the door using her/his own key. The room is pleasantly decorated and has lots of personal possessions on display such as posters, soft toys and family photos. A lockable facility is provided. This was open and the person told us s/he did not have a key for this. This was discussed with the manager who said there was no reason why this person should not be provided with a key to her/his locker. We were told one person has not been provided with a key to their bedroom because s/he is not aware of its use. A record should be kept on a person’s file of any reason why keys to their bedroom door and/or cabinet have not been issued. This is to ensure their right to dignity and privacy is respected. One person has moved into a spare bedroom while her/his room is being redecorated and refurbished. S/he is looking forward to returning to this room once the work is completed. The manager has identified a date for re-decorating and refurbishing the lounge. The date set has been identified to cause the least disruption for the people who live there. We were also advised that consideration is being given to the choosing of suitable and durable furnishings and entertainment equipment. The home does not employ any ancillary staff. The staff team have been provided with a more comprehensive schedule to ensure all aspects of the home are cleaned within suitable timescales. It identifies tasks that must be completed each day, week, month or periodically throughout the year. Staff described how they carry out these duties according to the schedule and the home’s policies and procedures. The records show regular monitoring takes place to ensure cleaning tasks and minor repairs have been appropriately completed. Notices are displayed in some rooms giving instructions to staff. These should be removed and an alternative method for promoting staff should be devised because these notices impact on providing a homely atmosphere for people to live in. The staff team are provided with training in infection control and use of hazardous substances around the home. Protective clothing, such as gloves and aprons, are issued for use by staff when undertaking cooking duties, domestic tasks and supporting people with their personal care. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is good. People who live at the home benefit from the care provided by a competent and trained staff team. However, staffing levels need to be regularly reviewed to ensure the needs of people living at the home are fully met at all times. The home follows suitable procedures for the recruitment of staff to ensure the well-being of people who live here are fully protected. There are improved systems in place to support staff carry out their duties. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing compliment consists of a manager, deputy, senior assistants, care assistants and handy person. The team is made up of female and male staff. They come from different age groups and backgrounds and bring with them different life experiences. They are familiar with people’s needs, routines, likes and dislikes. The home has reduced its reliance on bank staff. This means people benefit from having their needs met by a consistent team of staff. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 24 Information provided by the home tell us all staff hold, or are undertaking, the National Vocation Qualification (NVQ) Level 2. The deputy and two senior staff are currently doing the Registered Manager’s Award (RMA). Staff confirmed that they are provided with opportunities to obtain a recognised qualification. The manager has acknowledged that staffing levels do not support a personcentred approach to meeting the current individual needs of people who live at the home. As a result of this a re-assessment of the needs of people by the local authority was requested with a view ultimately to increasing the staffing provision. Staffing levels in the home should be regularly reviewed to ensure they are able to meet the changing needs of the people who live here. The rotas we looked at do not allocate time for the handover of information between staff during shift changes. The home relies on the goodwill of staff arriving early for their shift. Formal arrangements should be arranged for shift handovers. A record also needs to be kept of all hours worked by staff, for example, when taking people to appointments or ‘on call’ staff returning to provide additional support. We looked at the recruitment practice carried out for the most recently employed member of staff. There is a completed application form, photograph, references, contract, interview records and criminal record bureau checks on her/his file. The manager is advised to ensure a written record is kept of its verification of references. The staff member was provided with a formalised induction programme that included a basic introduction to the house, awareness of policies and procedures and her role. S/he told us “I was provided with a suitable in-house induction. This enabled me to get to know the clients, their routines and the routines of the home.” S/he also said the manager had asked for her/his feedback on this process as she was planning to review the induction process in the near future. The home has developed a training and development plan. Since the last key inspection the majority of staff have undertaken a range of training to help them understand the needs of people who live in the home and provide suitable support. For example they have attended training in the role of the key worker, safeguarding, autism awareness, mental capacity, first aid, infection control and health and safety. Individual staff members have a personal training log where their attendance at training is recorded. There have been improvements in the level of supervision sessions provided for staff and annual appraisals have been carried out. One staff member said “the manager is available for advice and guidance at all times and a regular planned programme for supervision and ‘on floor’ supervision is provided”. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is adequate. People know the manager and her team run the home to meet their best interests and have benefited from the improvements that have been made. The quality assurance system is in a basic stage. It needs to be improved upon for people to be more confident their views underpin all self-monitoring, review and development by the home. There are improved procedures and monitoring systems to promote and protect the health, safety and welfare of the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 26 The manager has been in post for approximately 12 months. We have been advised that she is in the process of making a formal application to us to be registered. To date this has not been received and should be given a priority by the organisation. Throughout the inspection the manager was able to give us a clear indication of how she would like to see the service improve. The manager has a clear understanding of where the shortfalls are within the service and now needs to demonstrate to us how these are being addressed with the company. We were told that the manager operates an open door policy. The staff we spoke to confirmed this is so. The manager told us her contract specifies she is required to provide 24 hours per week direct care to people who live in the home and 16 hours per week is allocated to managerial duties. The manager and senior representatives within the company need to review this to ensure the progress that has been made continues and can be sustained once more people come to live at the home. There has been limited progress in the improvements on the quality assurance system since the last inspection. For example, the home needs to undertaken more work in strengthening its process for analysing the information it gathers. It also needs to produce a system for feeding back results from the surveys completed and the home’s findings on its own performance. A development plan for the service should be produced and made available to all interested parties. The home receives regular visits and audits from key members of staff within the organisation who produce written reports on their findings. The daily records and care plans are stored in the kitchen. This enables staff to access and update information on a daily basis. However, these files and records were not stored in a lockable facility. The manager rectified this immediately and said she would give consideration to identifying a more suitable location for storing these. There are a range of policies and procedures in place to support the safe working practices within the home. For example, regular fire safety checks and environmental risk assessments are carried out. Records show the environmental assessments were last reviewed in May this year. The Health & Safety file contains evidence that arrangements have been made for all staff to participate in the carrying out of fire drills with people who live in the home. This meets the recommendation made at the previous inspection. Regular checks are also includes room and water temperatures to ensure these are maintained at a comfortable and safe level. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 27 The manager is able to demonstrate good knowledge in respect of her health and safety responsibilities, such as monitoring accidents and incidents and identifying strategies, where possible, to reduce the risk of these re-occurring. She is advised to ensure arrangements are made for her to periodically update her knowledge and attending a recognised health and safety course for managers. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 2 X 2 X 2 2 X Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement Detailed plans and records must be kept for the administering of “as required” medication to ensure people receive a consistent approach from staff at all times. Timescale for action 17/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 YA6 Good Practice Recommendations Written contracts should be provided for each person that includes clear information about what is/is not covered byt the fees. Care plans should be reviewed at least twice a year with the person living at the home, their relative/representative and other significant people to ensure their needs continue to be met. Sufficient staffing levels should be provided to enable people to participate in unplanned/spontaneous activities. Records kept of meals taken should include snacks/suppers to ensure affective monitoring can take place where any dietary concerns are raised. DS0000069595.V371290.R01.S.doc Version 5.2 Page 30 3. 4. YA13 YA17 Hillcrest (Stourbridge) 5. 6. YA18 YA20 7. YA24 8. YA24 9. 10. 11. 12. 13. 14. 15. YA30 YA33 YA33 YA37 YA37 YA37 YA39 The need to check individuals through the night should be discussed as part of the re-assessment of her/his needs to ensure their right to privacy is maintained. The administering of homely remedies should be discussed with the individual’s GP and a written protocol produced to identify which homely remedies can be safely administered to the individual. The programme for the re-decoration and refurbishment of the home should continue to be carried in a timely manner to ensure people who live here are provided with a comfortable and well-equipped home. All people living at the home should be offered keys to their own rooms and lockable facilities. A record should be kept of any decision taken on their behalf not to offer them a key and the reasons for this to demonstrate their right to dignity and privacy is being observed. Instructions for staff that are on display around the home should be removed in order for a more homely atmosphere to be maintained for the people who live here. Staffing levels in the home should be regularly reviewed to ensure they are suitable to meet people’s needs. Time should be allocated on the rota for formal handovers to take place with staff during change of shifts. An application for the registration of the manager should be forwarded to CSCI’s regional registration team. The allocation of the manager’s hours needs to be reviewed to ensure she is able to meet her managerial responsibilities. An accurate record should be kept of all the hours worked by staff outside their rota-ed times to enable appropriate tracking to be carried out of how care is provided. A more comprehensive quality assurance system should be implemented and include a process for feeding back outcomes of surveys, the home’s findings on its own performance and provide all interested parties with a copy of its plans for the future development of the home. Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillcrest (Stourbridge) DS0000069595.V371290.R01.S.doc Version 5.2 Page 32 - 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. 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