Care Home: Hilldales

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What the care home does well What has improved since the last inspection? CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Hilldales Hilldales 11 - 13 Oxford Park Ilfracombe Devon EX34 9JS Lead Inspector Jo Walsh Unannounced Inspection 09:00 28 August 2008 th Hilldales DS0000064816.V368050.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 Hilldales DS0000064816.V368050.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 Older People and 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. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilldales Address Hilldales 11 - 13 Oxford Park Ilfracombe Devon EX34 9JS 01271 865893 01271 879357 lesleyhilldales@hotmail.com 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) Dr Htay Kywe Mrs Thida Oo Ms Lesley Jean Mason Care Home 56 Category(ies) of Past or present alcohol dependence (56), Past or registration, with number present alcohol dependence over 65 years of of places age (56), Mental disorder, excluding learning disability or dementia (56), Mental Disorder, excluding learning disability or dementia - over 65 years of age (56) Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The adjoining corridor to be completed by December 2005. Date of last inspection 7th September 2006 Brief Description of the Service: Hilldales is a care home providing services for 56 men and women experiencing past or present alcohol dependence and/or mental health problems. The home provides accommodation and support for residents within a mixed age category. The home consists of two large detached terrace houses, which have been connected by an adjoining corridor. Previously registered as two separate homes, Hilldales and Northview, the home is now registered as one under the name of Hilldales. Hilldales is an older style property, which is situated within easy access of Ilfracombe community resources. Accommodation is single occupancy and there are several communal areas around the home, including a pool table and library area. There is no lift at this home so residents need to be fairly mobile. Wheelchair users can be accommodated on the ground floors and assisted baths are available. The home has a mini bus and offers transport to residents for hospital appointments and other trips. The average cost of care ranges between £260.00 and £700.00 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, certain activities and outings, and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents. Hilldales DS0000064816.V368050.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 3 stars. This means the people who use this service experience excellent quality outcomes. This inspection took place during a weekday in August and looked at all the key standards and focussed on listening to the views of the people who live at the home. We did this by using surveys prior to the inspection taking place, and by the use of an expert by experience. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are now using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The expert helped to speak to people about their experiences of living at the home as well as making some general observations. His comments are included throughout this report. The registered manager was available throughout the inspection and ensured access to key documents such as plans of care, staff records in relation to training, supervision and recruitment, and records in relation to administration of medications. Time was also spent talking to staff and observing care practice during different times of the day. Some staff were also asked to complete surveys that gives us information about how well supported and trained staff are to enable them to do their job. Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA), which gives us information about how the home maintains a safe environment, what training has been completed and tells us how they are reviewing their services to improve the care and support provided. This information helps to inform the inspection process. What the service does well: Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 6 Hilldales provides people with a clean, warm, safe and homely environment. The provider ensures that the building and redecoration is kept to a high standard and the cleaning staff are commended for their efforts in keeping the place clean. People who live at Hilldales said • It’s like a hotel only better. • It is always clean and tidy • I feel this is my home not a home. The staff team are experienced and have a good understanding of individuals’ needs and wishes. They were seen to provide support in a caring and respectful way and work hard to ensure that people are able to make choices about how and where they spend their time. People who live at Hilldales who were spoken to or returned surveys said that their needs were well met by the home. Comments included • I see this as my home, my room is decent and staff treat us well • This place got chosen for me but I am quite happy here, staff treat me well. • I am always well looked after. One of the conditions of my stay here is that I don’t drink alcohol, apart from that I can mostly do anything • I choose when I get up, what I wear and what I eat. • I am very capable of making my own choices and staff let me do that. All ten surveys returned ticked ‘always’ to the question do staff treat you well?’’ The home provides a really good range and choice of meals throughout the day, with flexibility for people to choose when and where they eat their food. People said • The food is excellent, I have put on weight since being here • You can’t get better • I always enjoy the meals here, if you don’t like what’s on the menu the kitchen will make you up something else as long as you tell them. The registered manager is experienced and qualified and ensures that the home is run in the best interests of the people who live there, with good systems in place to make sure their views are listened to and acted upon. What has improved since the last inspection? The staff team ensure that planned activities are offered most days, including trips out and about to places of local interest as well as shopping trips and activities in house. People spoken to said Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 7 • • I like to keep busy and enjoy doing painting You should come when we have karaoke, it’s really good. A fly screen has been fitted to the kitchen door to ensure that good standards of health and hygiene are maintained. The home has recently received 5 stars from the Environmental Health Department. 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. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 (Adults) and 3, 6 (Older People) Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: The pre admission assessment information was looked for two of the newer people living at the home and discussed these with the staff on duty during the inspection. The home ensures that they get the assessment and care plan information from the funding authority and also a health care assessment from any health care professionals involved with an individual. This enables the home to develop a plan of care based on assessed needs. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 10 Staff confirmed that the assessment information was made available to them and specific needs were highlighted and discussed so the staff team had information to be able to plan for a new person coming to the home. One person living at the home said they remembered someone from Hilldales coming to see them at Hospital before they moved in. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 (Adults) and 7,14,33 (Older People) Quality in this outcome is good This judgement has been made using available evidence including a visit to this service. Individuals’ care is well planned so that staff has good information to ensure that personal, health and social needs are met in a way that allows people to have choice and control in their lives. EVIDENCE: Plans of care were looked at for three individuals who live at Hilldales. The plans are written clearly and give good information about the individuals’ personal, health care and social needs. Where possible plans also record Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 12 personal histories and preferred routines, likes and dislikes. Plans of care are well organised so that information can be easily looked for, for example health care. Equality and diversity needs such as religion are included where possible as part of the plan of care. Some plans have clearly been completed with the involvement of the individual who signs to say they agree with the plan. Some newer plans had not yet been agreed with the individual but the registered manager confirmed that where possible they involve the individual and their key worker in the development and review of their care plan. Any risks have been clearly identified and risk assessments and behaviour plans form part of the plan of care. The home have also identified where a restriction has been placed on an individual such as allocation of monies or cigarettes. The plan of care states why these restrictions have been put in place, and this is reviewed on a six monthly basis. Some individuals said that staff monitored their money and gave them an allocation of cigarettes each day and indicated they understood why these restrictions were in place and why they had been implemented. Some individuals would be unaware due to their mental capacity that such restrictions have been implemented. The home need to ensure that they comply with requirements in the Mental Capacity Act 2005 for they’re to be ongoing assessment of an individuals capacity. The manger said they have had some training in this. People who live at Hilldales who were spoken to or returned surveys said that their needs were well met by the home. Comments included • I see this as my home, my room is decent and staff treat us well • This place got chosen for me but I am quite happy here, staff treat me well. • I am always well looked after. One of the conditions of my stay here is that I don’t drink alcohol, apart from that I can mostly do anything • I choose when I get up, what I wear and what I eat. • I am very capable of making my own choices and staff let me do that. All ten surveys returned ticked ‘always’ to the question do staff treat you well?’’ Staff spoken to and those who returned surveys said that plans of care gave them a good understanding of individuals needs, and that they kept daily records and had handovers before and at the end of each shift, so that important information about the changing needs of individuals is passed on to all team members. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 (Adults) 10,12,13,15 (Older people) Quality in this outcome is excellent This judgement has been made using available evidence including a visit to this service. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 14 Hilldales offers individuals a range of opportunities to engage in social and leisure activities that promote social engagement and which provides stimulation, variety and interest, and some opportunities to develop independent living skills. EVIDENCE: The expert by experience spent time talking to individuals living at Hilldales about their experiences in relation to the key standards around lifestyle outcomes. He also spent time observing some care practice and having lunch with people who live at the home. His report is as follows‘’The general feeling amongst the residents I spoke to was one of contentment with their lifestyle and care. Residents have opportunities for personal development. Some residents had jobs such as washing up and cleaning for which they received extra monies. If they wish to do their own laundry they were able or staff would do it for them 24 hours per day. They have access to only one computer (although no Internet access – which could be an option, even if supervised). There is also a library, which is designated a quiet area, with a good selection of books. There are daily shopping outings with staff, or residents are able to go out on their own after a risk assessment. Residents have daily afternoon activities. On the day of the visit the activity was art and crafts which both the residents and staff engaged with. There are a number of leisure activities on offer. Every day different activities are available including bowls, art and crafts, karaoke etc., which residents engage in freely and enjoy. There is a pool room with a pool table and dart board which residents can use at any time. There are also regular barbeques held in the grounds. Residents were able to have visits from family and friends daily at any time before 9.30pm. Visitors are allowed in residents’ rooms or communal areas. Residents can also take visitors on town visits. Residents’ religious needs are also catered for – they can visit the local place of worship. If necessary a member of staff will accompany them. The residents can also benefit (weather permitting) from days out, including to the Eden Project and coastal walks. There are wheelchairs available for less able residents. House meetings are held weekly so that residents and staff can voice any issues or feedback any good points about the home and/or their care. It is the residents’ choice to attend the meeting or not. Social workers visit regularly. The visits can be held in the residents’ rooms or in communal areas. If a resident does not want the visit to be held in their room privacy may be difficult. One resident stated that he ‘had to sit in my social worker’s car’. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 15 The food offered is of good standard. One resident stated, ‘It may be a small kitchen but they make amazing meals’. Different tastes are catered for and religious and vegetarian options are available. Food can be eaten in the dining area or in the residents’ rooms and there are no rigid times, although hot meals can only be kept for so long on a hot plate. There are two communal rooms both with excellent televisions, and a computer in one. Smoking is permitted in both these rooms and I feel that one could be made a non-smoking area. One resident suggested that residents with alcohol issues and those with mental health issues should be housed in separate sides of the house as their ‘needs are different and they are at different stages’. However I feel that is not feasible due to the split not being equal. If residents were attempting to address their alcohol use they were not asked to leave if they lapsed which I think a good policy. In these cases town visits were escorted by staff and monies stopped/curtailed. Although there was substitute prescribing in place I saw no evidence of structured group or one to one work to address alcohol issues – although this type of intervention may be provided. There is no set time on how long residents can stay. I spoke to one resident who had been there 13 years. Another stated that he ‘was here 10 years ago and things have changed for the better’. Asked how long he was staying, he replied ‘as long as possible’. Overall my impression of Hilldales was good. I pointed out one health and safety issue (access to main electrical fuse) which was rectified before I left the home.’’ People who live at Hilldales who returned surveys spoke highly about the food and meals provided. The kitchen staff confirmed that they try to ensure that all tastes are catered for. A cooked breakfast is offered every day as well as two meals, supper and snacks available throughout the day. There is drinks serving area so that people can help themselves throughout the day to hot and cold drinks. Menu plans are discussed with people at the residents meeting and times of meals have some degree of flexibility. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 (Adults) 8,9,10 (Older people) Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. People who live at Hilldales can be confident that their personal and health care needs will be fully met. EVIDENCE: Individuals who live at the home who were spoken to and those who returned surveys said that staff treated them well. All ten surveys ticked always to do staff treat you well. All bedrooms have locks fitted to ensure privacy and individuals confirmed that staff always knocked on the door before entering the bedroom. Staff were observed to address individuals in a respectful manner, referring to people by their preferred name and spending time chatting and joking with people. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 17 Plans of care detail individuals’ personal and health care needs so that staff has a clear picture of how to assist individuals with these needs. One person said ‘’ my health is 100 better since moving here, the staff make sure I have my medication and if I need to see my doctor they arrange for me to go to the health centre.’’ The health care section clearly shows what follow up has been implemented to ensure individuals health care needs are met. Routines are flexible to suit individuals preferences and ensure assistance with personal care is given at a time that where possible suits the individual. The medication system, records and storage facilities were checked and discussed with the senior carer. One person currently self medicates and this has clearly been risk assessed and reviewed on a regular basis. Records of administering medications appeared well maintained and up to date. Where hand written entries had been made on these records they were double signed. Most medications were stored securely, with the exception of on persons PRN (as needed) medication, which was kept in a box in the office area. This is not always secure and the home were advised to ensure this medication be stored in the controlled drugs cabinet, which they immediately did. They have also been advised that Diazepam should be treated as a controlled drug and administration of it be recorded in a controlled drugs book, which is bound and has numbered pages. This ensures that the pages cannot be tampered with and safeguards staff and individuals living at the home. Again the home agreed to do this and contacted the pharmacist to see if they could get them a controlled drugs record book. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 (Adults) 16-18, 35 (Older People) Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Individuals’ views are listened to and acted upon. EVIDENCE: People spoken to and those who returned surveys said that they knew how to make a complaint and that they were confident that any concerns would be acted upon. One complaint has been sent to CSCI since the last inspection. This was forwarded to the registered provider and we are satisfied that the issue has been investigated appropriately. The home keeps a detailed log of all issues and complaints they receive and have regular meetings with people who live at the home to ensure they have a say on how the home is run. The system for how the home handles individuals’ personal monies was checked for four individuals and found to be accurate and robust, with a good audit trail, which safeguards people. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 19 Staff have received training in the protection of vulnerable adults and those who were on duty were aware of what they should do if they suspected abuse of any sort. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30(Adults) 19,26 (Older People) Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. Hilldales provides people with a clean homely and well-maintained environment. EVIDENCE: People who live at Hilldales who were spoken to and those who returned surveys expressed a high level of satisfaction with the environment. It is clear that the registered providers have a programme of routine maintenance and Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 21 renewal of the fabric and decoration of the building. All areas are well furnished and decorated. The home is kept cleaned to a high standard and the domestic team are commended for the level of commitment to keeping the home fresh and cleaned to such a good standard. Most people who completed surveys commented this on and they clearly appreciated having a clean and well-maintained home. The expert by experience gave good feedback about the environment and was impressed with the overall standard of accommodation provided. He did comment ‘’ There are two communal rooms both with excellent televisions, and a computer in one. Smoking is permitted in both these rooms and I feel that one could be made a non-smoking area.’’ This is something the home should consider, perhaps raise this during a residents meeting. The expert also pointed out one health and safety issue, access to an electrical fuse. The management team said they would rectify this immediately and asked the maintenance team to put a lock on the boxing that covered this fuse. The home has policies and procedures for the prevention of infection control and gloves and aprons are available. A fly screen has been fitted to the kitchen doorway as recommended from the previous inspection. The environmental health department has awarded the homes’ kitchen with five stars, which is the highest level to achieve for cleanliness and good measures for ensuring health and safety. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 (Adults) 27,28,29,30 (Older people) Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Staff are reasonably well trained and supported to do their job, but would benefit from some more specialist training to help better understand the needs of people who live at the home. EVIDENCE: Three staff files were checked and relevant references and checks were all obtained prior to the person being employed. The registered manager stated that all new staff has an induction programme and also all staff receive regular one to one supervision. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 23 The registered manager said she had made sure that all staff had up to date training in all areas relating to health and safety and was also currently looking into some training in stress management as they have recognised that staff support people with complex needs and that this can be a very stressful environment. It was also agreed that staff would benefit from ongoing and updated training in techniques for dealing with aggressive behaviour and alcohol and mental health training. The registered manager said that this training has been completed by long standing staff, but not newer staff and they would look at getting this in place. Staff who returned surveys said they were well supported to do their job and most said they had good opportunities to do training. Everyone is offered the opportunity to do NVQ (National Vocational Training) in care. The AQAA states ‘’ Hilldales employs a well trained staff team who are competent and qualified and have become knowledgeable about the specific needs of the service users at the home. 80 of our care staff have gained an NVQ2 in care, 35 of our staff are trained to NVQ3 standards. All NVQ3 staff have completed a mental health unit from North Devon College.’’ Staff member comments included • I have been trained in all areas covering the care field. I also have updates regularly and any new laws and legislations that have been put in place. • I have supervision regularly to discuss any worries or concerns I may have. I am also aware that I can approach the manager regarding any issue. • Training covers all areas we need and any new training that becomes available we attend. Staff said they felt valued and worked as part of a team. Low staff turnover would indicate that staff are supported to do their job effectively. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 (Adults) and 31,33,35 & 38 (Older People) Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of the people who live there. EVIDENCE: Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 25 The registered manager is qualified and experienced to run the home. She has a good understanding of the needs of the people who live at the home and clearly works hard to ensure that the home is run in a way that is inclusive and gives individuals a say in everyday decisions. Ways this is done is by regular community meetings, staff meetings and supervision sessions and being available for people to talk to. The home also uses surveys to gain views on the quality of support and care, from the people who live there and from health care and social services professionals who place individuals and visit the service. Staff have training in all areas of health and safety to ensure they can do their job safely and competently. Policies and procedures are in place for all safe working practices and the home provided information prior to the inspection to show the maintain the environment and all equipment, so these were not directly checked during this inspection. The AQAA states ‘’ Following a certificated “Skills for Care Induction Training” that is conducted by an internal trainer staff continue to receive ongoing training that includes Adult Protection, First Aid, Infection Control and basic food hygiene. Staff also undertake mental health training, Health and Safety training, Medication Management, moving and handling, Challenging behaviour training, Fire Safety, Diabetes training, Non Abusive Psychological and Physical Intervention training, Epilepsy awareness, COSSH training, Alcohol and mental health training, and fitting incontinence products. Gas and electrical appliances are regularly serviced. Staff has recently completed Challenging Behaviour training and de-escalation techniques. The manager deals with the risk assessments, care plans and supervision of staff. The manager ensures that fire drills, fire alarm testing and water checks are carried out on a regular basis. Fire alarm tests are carried out weekly. Emergency lights are checked monthly. The home has a health and safety policy and members of staff are made aware of health and safety issues through supervision, meetings and training sessions. The manager ensures that Health and safety checks are carried out on the environment monthly. We have regular visits from Environmental Health Officers and Health and Safety Officers. All policies have been reviewed and are next due for a review in 2008. A safe electrical wiring certificate was issued on the 10/02/2006. An asbestos survey has been carried out and we have minimal amounts of asbestos present. Hilldales has a clear management structure and lines of responsibility and accountability.’’ Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 26 The management team are always willing to act on any requirements or recommendations that CSCI identify. During this inspection several issues identified had been dealt with before the end of the inspection day. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 27 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. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 3 3 X 4 X 5 X 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 4 38 X 39 X 40 3 41 X 42 3 43 X 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hilldales Score 3 X 2 3 DS0000064816.V368050.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA33 Good Practice Recommendations Newer staff should have ongoing training in specialist areas such as mental health, alcohol issues and dealing with aggressive behaviours to ensure they have the skills needed to deal with the needs of the people who live at Hilldales. All controlled medications should be recorded in a controlled medications record book, i.e. bound with numbered pages. 2 YA20 Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Hilldales DS0000064816.V368050.R01.S.doc Version 5.2 Page 30 - 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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