Care Home: Hillcrest - Vernon

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hillcrest - Vernon 10 Maltravers Drive Littlehampton West Sussex BN17 5EY zero star poor service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Hillcrest - Vernon 10 Maltravers Drive Littlehampton West Sussex BN17 5EY 01903716619 01903731023 vernon@hillcrestcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hillcrest Care Ltd care home 14 Number of places (if applicable): Under 65 Over 65 14 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) The maximum number of service users to be accommodated is 14. Date of last inspection A bit about the care home Hillcrest - Vernon is a care home registered to accommodate up to fourteen Service Users with learning disabilities. The Registered Provider is Hillcrest Care Ltd and the Registered Manager is Mr. Gerard Santos. Additional charges are made for personal items, such as; clothing and toiletries with Service Users meeting the cost of some activities and complimentary treatments. The home is a detached property, situated in a small quiet residential street, just outside Littlehamptons town centre. There is easy access to all community facilities, including local rail and bus stations. Accommodation is provided over two floors. On the ground floor there is a comfortable living room with a large television, a sensory room, art/quiet room, dining room, kitchen and three bathrooms and one shower room. Eight bedrooms are located on the ground floor for those people who require ground floor facilities. Patio doors lead from the lounge into a goodsized multi-functional garden. Fees currently charged are 837-1347 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This inspection took place on December 3rd 2008. Prior to the visit all files held by the Commission were reviewed and all complaints and safeguarding issues were considered. There is an ongoing safeguarding investigation with which the organisation have fully cooperated. Staff disciplinary proceedings have been ongoing. The home had sent us their Annual Quality Assurance Assessment earlier this year when we asked for it and all documents requires on the day were made available. The registered manager facilitated the inspection, he has since that time resigned. What the care home does well Eight out of twelve people who use the service go to day centres, college or work shops. People who use the service have an annual holiday What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sheila Gawley 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 023 8082 1300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . People using this service experience good outcomes in this area because needs are fully assessed prior to admission and all have a contract and terms and conditions. Evidence: As a result of a recent safeguarding adults investigation with which the home have fully cooperated, there have not been any admissions to the home since the last inspection. There was evidence in care plans inspected of assessment prior to admission, including the care management plan from Social and Caring Services. This included information on accommodation, support, family contact, continence, specific condition related needs, behaviour and academic skill. Contracts for people who use the service were seen and these coved all aspects of the agreement such as room to be occupied, fees and personal support and services provided. All people who use the service receive information about the home in the Service User Guide Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 using this service experience good outcomes in this area because their assessed needs and personal goals are reflected in their individual plans, and they are consulted and can make decisions about their lives. Evidence: Each person who uses the service has an individual plan of care, nearly all people who use the service have been reviewed recently as part of the recent safeguarding adults investigation and care plans have been updated. The opinions of family have been sought by social services and all but one expressed satisfaction with the home. Risk assessment is in place and people who use the service are allowed to take risks. The way the people wish to have their needs met is recorded in the care plans. Those able to take care of personal needs are allowed to do so. Risks associated with needs or behaviours are documented, as are management strategies. People who use the service access facilities in the local community. There is a key worker system in place to facilitate this. Evidence: Three people who use the service were case tracked on this visit and care plans and medicine administration charts were inspected. These were all up to date. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People using this service experience adequate outcomes in this area because they are able to take part in age, peer and culturally appropriate activities and are part of the community but not all staff treat people who use the service with respect in the areas of having a lock on bedroom door and assistance with food. Evidence: People who use the service are facilitated to attend day centres to take part in activities and learn practical life skills. They also attend local Colleges, certificates of achievement were seen in bedrooms. All have an annual holiday. Staff take people out for walks, and shopping. There is an activities coordinator who works on a one to one basis and who organises trips out, she was spoken to and was in the process of booking a Christmas pantomime. Activities were seen recorded in peoples plans. One showed horse riding and dates attended. Walks out were recorded Evidence: and also the persons whereabouts and activity in the home such as music or television in the lounge or sitting in bedroom. Staff did interact with people who use the service in the sitting and dining rooms but one person who uses the service received less interaction than others. His needs are complex and whether he is in the correct category was discussed with the registered manager. During the staff handover a lot of staff were milling about but not interacting with the people who use the service during that time. Family and friends are welcome in the home and people who use the service are taken to visit their family. Staff knock before entering bedrooms. The preferred form of address for people is recorded in care plans. There is a sensory room, which was not used at all on the day, staff spoken to stated that it is rarely used, and that it could be better equipped. It has a computer, some lights, a trampoline and some board games. Bedrooms have a lock and people who use the service are risk assessed for use. One person who uses the service would like a key but due to wheelchair use he cannot reach the lock. This was discussed with the registered manager at the last inspection who stated that this would be addressed. This issue has not been resolved as yet. The kitchen is domestic in style. There is a varied menu in place and people who use the service are consulted on this. The main meal is served in the evening as people are out during the day. People enjoyed the meal of roast chicken served. People were assisted as required but one member of staff was observed wiping the table with a tea towel and then wiping the face of a person with the same cloth. This was brought to the attention of the registered manager. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using this service experience adequate outcomes in this area because their needs may not be met on all occasions. Evidence: Daily routines and personal care needed is clearly recorded. All but one of the people who use the service have had a review of care and ongoing and changing needs are recorded. the changing continence needs of one person were recorded and staff were observed meeting the needs as recorded. We were informed in the recent safeguarding process that personal care needs were not met and that a person was seen moved from the bathroom without being properly covered. A DVD recorded in the summer by the behaviour team showed staff ignoring needs and not communicating in a meaningful way with people who use the service. Staff disciplinary procedures have been ongoing since September as a result of that evidence and are now complete. Staff were observed managing care appropriately on this occasion. Three people were case tracked on this visit and care plans and medicine administration charts were inspected. All were up to date. Evidence: Medicines are appropriately received, stored, administered and recorded and policies and procedures are in place. Medicine administration charts inspected were to date. A new controlled drugs cupboard has been purchased which meets the requirement of the last inspection. The home is supported in the management of medicines by a local pharmacy. The drug fridge temperatures are recorded. There are not any people who self medicate at this time. People who use the service are facilitated to attend appointments with health professionals, a chiropodist visits the home six weekly. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using this service experience poor outcomes in this area because their needs have not always been met and this has put them at risk. Evidence: There has not been an open culture in dealing with complaints and poor practice in the home. Staff did not enable people who use the service address issues via the homes complaints procedures as their AQAA states they would. There is a whistle blowing policy in place but staff have ignored bad practice and not used it. There have been disciplinary procedures in progress since September, with regard to nine staff as a result of the poor care practices observed and filmed by the behaviour team in the summer and these are now complete. Two staff had been suspended and they resigned. One had been referred to the Protection of Vulnerable Adults (POVA) list and the other will be. The registered manager had handed in his resignation in October last year and has also left since the inspection. He to is to be referred to POVA. The DVD highlighted poor practice, which was putting people who use the service at risk of harm. The safeguarding investigation has substantiated abuse in relation to one individual and also substantiated institutional abuse. Ten out of fifteen staff had attended safeguarding training at the time of inspection and they have received guidance from the positive behaviour support team. They have been visited by a support worker from that team and the team manager and a social services manager intend to go into the home and provide further training for staff including training on Evidence: the whistle blowing policy. That guidance and training will have to be embedded in practice. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 using this service experience good outcomes in this area because they live in a safe and clean environment Evidence: The home was inspected and was found to be clean and free from offensive odours. Bedrooms were comfortable and were furnished to individual taste. There are not any en suite bathrooms or toilets. They contained the necessary adaptations required by the people who use the service such as track hoists or adjustable beds. Maintenance is ongoing. The dining room had been decorated. Flooring in the corridors has been replaced and there are plans to do the stairway and landing. The sitting is comfortably furnished and is domestic in style, there are plans to replace the furniture. Suitable bathing and shower facilities are available and these were clean and hygienic. There are suitable laundry facilities available. . The window restrictor one the upstairs bathroom was broken, this was brought to the attention of the manager. The home is meeting the requirement of a health and safety inspection by completing some work to the driveway. Evidence: 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using this service experience poor outcomes in this area because staff have been unable to challenge poor practice. Evidence: Practices observed by the learning disability behaviour team did not show that staff respected people who use the service, care needs went unmet such as changing people promptly when required. One person was constantly directed back out of the dining room and made to stand in the corridor. This has resulted in disciplinary proceedings against nine staff and training and guidance from the positive behaviour team has been given. The registered manager who had handed in his notice in October last has left since the inspection. The home is being supported by the manager from another home in the organisation. The interaction of staff with people who use the service was improved on this occasion but the individual who was seen to be directed out into the corridor did not receive as much interaction as others. The organisation has cooperated fully with the safeguarding investigation and has put in senior staff from another home to monitor care and to provide positive role models for staff. They cooperated with all reviews and have been involved with social services in contacting families to seek their opinion on care. Recruitment files inspected contained all the documents required. Evidence: There is a training programme in place and training certificates were seen in staff files. Ten out of fifteen staff have had recent safeguarding training. Induction is in place and induction files were seen. The need for training to be embedded into practice was discussed with the registered manager. He stated that four carers had left the home and that as a result of this the atmosphere had improved and that staff now felt able to discuss problems or poor practices. Staff spoken to confirmed this and stated that the home had an improved atmosphere, increased activities and improved paperwork. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using this service experience poor outcomes in this area because there are health and safety policies and procedures but poor care practices do not protect people from abuse. Evidence: As stated above since the day of the inspection the registered manager has left. The organisation has informed us of their interim management arrangements for the home. A new manager has been appointed and is expected to start in February when he had worked his notice for his current employer. Quality assurance systems are in place. The home supplied us with their AQAA when asked for it earlier this year. The organisation does an audit of accidents and their health and safety adviser collates the results. The operations manager completes regulation 26 visits. There is a monthly medication audit. The health and safety of people who use the service are not fully protected. There are policies and procedures in place but training did not lead to staff meeting care needs Evidence: with respect and dignity or fully protecting the people who use the service. There are contracts in place for utilities, hoists and vehicles. Water temperatures are tested. Documentation is in place for hazard analysis but this had not been carried out foe three months. There have, however, been shortfalls in the management of the home. Poor care practices were not identified and rectified leading to allegations of abuse and a safeguarding adults investigation, which substantiated abuse. Staff were not enabled and encouraged to challenge poor practice. These issues do not evidence that the home is run well and in the best interests of the people living there. The need to enable people who use the service to make complaints, to safeguard them from abuse and to enable staff to develop personal and professional relationships with them will be requirements of this inspection. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 22 22 The registered person must listen and act on the concerns of people who use the service. 31/01/2009 To encourage discussion on and reporting of shortfalls in care 2 23 13 The registered person must ensure, by training that people who use the service do not suffer harm or abuse or be put at risk of harm or abuse 31/01/2009 To ensure that people are cared for safely 3 32 12 The registered person must 31/01/2009 encourage and assist staff to maintain good personal and professional relationships with people who use the service To help staff develop the characteristics that would make them more approachable, interested, motivated and committed 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 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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