Care Home: Hillside Farm Care Home

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What the care home does well External professionals told us that the staff always managed people`s health and personal care well and referred people quickly for any health problems. We received surveys back from relatives of people living in the home and they said things like, "It is a small home and all resident`s get very personal attention, we are very happy with the standard of care my relative receives", "People are treated with respect and as individuals" and "My relative has obtained medical treatment very quickly when they have needed it". People living in the home told us that their relatives were always made welcome. One person living in the home told us, "My visitors are always offered a drink and they always say what a nice place Hillside is". What has improved since the last inspection? The manager continues to work well with the Commission and has responded in a positive way to any shortfalls identified at this inspection. People continue to be happy in the home and we have received many positive comments about the care delivered. A new cottage has been built to accomodate staff and the manager continues to make improvements to the home`s already excellent furnishings and fittings. What the care home could do better: Further work needs to be done on the risk assessments within peoples care plans to ensure potential risks are well managed. The record keeping around staff files needs to improve with records being maintained with regard to training and recruitment. The manager must assess staff complement in relation to the changing needs of people living in the home. Key inspection report Care homes for older people Name: Address: Hillside Farm Care Home Bunny Hill, Loughborough Road Bunny Nottingham NG11 6QQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 2 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Hillside Farm Care Home Bunny Hill, Loughborough Road Bunny Nottingham NG11 6QQ 01509852900 F/P01509852900 hillsidefarmresthome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rita Karen Linley care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of people who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code OP to service users of the following gender:-either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Hillside Farm Residential Home offers accommodation for up to 8 people who are over 65 years of age. The building is located just off the main road through to Nottingham from Loughborough. There is ample parking space to the front of the premises. The owner/manager resides in a house connected to the residential home. The building is surrounded by countryside. The range of fees are £560 - £665 per week. 0 Over 65 8 Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commisssion is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was July 19th 2006. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the agency, which took place over a period of six hours. The Registered Manager assisted us during the site visit to the home and made us very welcome. Care Homes for Older People Page 5 of 27 We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager, although the information within it was quite brief. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had 20 completed surveys back and they were many positive comments from people and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing two people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, one member of staff and three people who use the service to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the evvironment and facilities of the home to form an opinion about the health and safety of people who use at the service. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that are admitted to the home have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs and know how to care for them. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that the home has assessments in accordance with current regulations and the manager monitors the process and requirements. We examined the care files of two people living in the home and they both contained a full needs assessment that had been completed by the manager prior to them being admitted to the home. Where required, a copy of the social work assessment of the persons care needs had also been obtained. We received surveys back from people living in the home and they told us that they Care Homes for Older People Page 9 of 27 Evidence: had received enough information to help them to decide if this was the right home for them before deciding to move in and they also said that they had received a contract. We received surveys back from four health professionals who visit the home and they told us that the home always had assessment arrangements in place that ensured accurate information was gathered and the right service was planned for people. The home does not offer intermediate care and so standard six is not applicable. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are happy with the care they receive and they experience good quality outomes. However, some shortfalls in risk assessments could leave risks unmanaged in some areas of care. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that an assessment carried out prior to admission will help to formulate a care plan for any person being admitted to the home. However, one person who had been recently admitted to the home had information in the assessment relating to them needing a liquidised diet due to the risk of choking. Observations on the day demonstrated that this specialist diet was not being followed. The manager told us that they felt this person was able to eat food that was not liquidised but this risk had not been re-assessed by the appropriate health professional and the care plan did not tell staff how to manage this risk. The care plans contained some risk assessments appropriate for the persons needs Care Homes for Older People Page 11 of 27 Evidence: and information on how staff should manage the risk, although the information was quite brief. However an area of risk around behaviour had been identified for one of the people we case tracked and there was not any recorded documentation telling staff how to manage this risk. Discussions with staff demonstrated that they had good understanding of peoples individual care needs and all the information we have received prior to the inspection told us that people were happy with the care they were receiving and external professionals told us that the staff always managed peoples health and personal care well and referred people quickly for any health problems. Therefore the outcomes for the people being case tracked had not been affected by the lack of risk assessment. However it is important that information within care records is accurate and reflects the risks and support needs of each person. This will ensure that any new members of staff will have accurate information regarding each individual and will ensure needs are met appropriately. We received surveys back from relatives of people living in the home and they said things like, It is a small home and all residents get very personal attention, we are very happy with the standard of care my relative receives, People are treated with respect and as individuals and My relative has obtained medical treatment very quickly when they have needed it. We identified some shortfalls in the storage of the medication and this was discussed with the manager on the day of the inspection. The manager responded appropriately to improve the storage. Staff who administer medication to people living in the home have received appropriate training. However we observed a member of staff administering medication and they were not following the appropriate procedures. The manager also responded to this and has booked the staff on further training on the safe administration of medication. People living in the home and people who visit the home told us that the staff respected peoples privacy and dignity. Care Homes for Older People Page 12 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet with individual preferences being met. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that she listens to all involved with hillside to ensure people exercise their choices. She also said that people living in the home often visit the local country park and the woods in the grounds. We received six surveys back from people living in the home and they said that the home always or usually provided activities for them to take part in. The home does not have a structured activity schedule but discussions with staff and people living in the home demonstrated that activities are individualised. We received information from health professionals and relatives of people living in the home and they told us that the home supports people to live the way they choose. One relative told us, When we visit, everyone looks well cared for and stimulated Care Homes for Older People Page 13 of 27 Evidence: They also said, I receive regular e mails about how my relative is doing in between my visits. People living in the home told us that their relatives were always made welcome. One person living in the home told us, My visitors are always offered a drink and they always say what a nice place Hillside is. Although staff are preparing food in the home, there was no evidence that they have completed food hygiene training, despite this being a requirement being made for this at the last inspection. People living in the home are offered a choice of meal and they told us that good quality food was provided and that they are able to have drinks or snacks as they wish. Care Homes for Older People Page 14 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home know how to make a complaint and staff know how to respond to this. Staff know how to safeguard people living in the home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that the home has a clear and accessible procedure and that this is on display in the home and we saw evidence of this on the day of the inspection. The Commission has not received any complaints about this service since the last inspection and the manager told us that the home has not received any complaints in the last twelve months. Staff working in the home told us that they knew how to respond to complaints and people living in the home and told us that they knew how to make a complaint and they knew who to speak to if they were not happy. On the day of the inspection the home did not have the current local safeguarding procedures in place. However the home has not had cause to make any referrals. One member of staff spoken with did not seem to understand procedures relating to safeguarding vulnerable adults and there was no certificated evidence that they had attended safeguarding training. We discussed this with the manager ont he day of the inspection and she put the safeguarding procedures in place on the day of the inspection and booked training in Care Homes for Older People Page 15 of 27 Evidence: safeguarding vulnerable adults for herself and the rest of the staff for later in the year. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good housekeeping procedures provide people with clean, pleasant and homely surroundings in which to live. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that the home offers a peaceful countryside environment with a country park nearby. She also stated that the general running of the home is of a high standard and extra equipment has been purchased to assist the handyman to maintain the home. On the day of the inspection we found the home to be spotlessly clean, hygienic and maintained to a high standard. Bedrooms viewed were decorated and furnished to an excellent standard and were highly personalised. The dining area is pleasant and gives way to a large terrace overlooking open countryside. We received surveys back from six people living in the home and they all said that the home was always fresh and clean. One relative told us, The home is always very clean and nicely appointed. Another said, The home is always very clean and bright. The manager told us that staff are provided with gloves and aprons for any personal Care Homes for Older People Page 17 of 27 Evidence: care and staff are trained in infection control procedures. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has staff recruitment procedures in place and staff are supported to access training in some areas appropriate to the work they perform. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that the staff live on site at a newly built mews cottage producing staff coverage at all times and that the manager works very closely with the team which provides a happy atmosphere. The staff are being supported to access training, although records of staff training and certificates of achievement did not provide sufficient evidence of safeguarding training and there was no evidence of staff being trained in safe food hygiene practices. Staff confirmed that they have regular meetings with the manager regarding supervision of their practice. One relative told us, The staff are very friendly. Another said, The staff are very friendly and caring and my relative is looked after very well by them. One person living in the home told us, I see this as my own home. The staff help me to find things when I lose them and they keep the place nice and clean. When we asked members of staff what the home does well, we had comments like, Provide a happy Care Homes for Older People Page 19 of 27 Evidence: environment, very welcoming to all, We all care and We provide good care to all and everyone is happy here. We received information from staff that told us that they felt there was enough staff on duty to meet the needs of the people living in the home. However, the home does not have a wakeful member of staff on during the night and one of the people living in the home is identified as being at risk of falling. The manager told us that the sleeping member of staff gets up and checks on people living in the home every two hours. We discussed the issue of not having a wakeful member of staff at night with the manager and suggested that this person should have a review to make sure this risk can be managed during the night with the current staffing level. We viewed the files of two members of staff working in the home and they held most of the required documentation. There were some gaps in the recruitment records but we received information from the manager and staff working in the home that the required checks had taken place before they commenced working in the home. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there. However there has been some slippage of record keeping since the last inspection. Evidence: The Annual Quality Assurance Assessment (AQAA) that we asked the manager to complete was quite brief and did not tell us all of the information we needed to know. However, on the day of the inspection, the manager was very helpful and gave us all the information we needed to carry out the inspection. We gave feedback to the manager at the end of the inspection and she responded in a very positive way and began making improvments to identified shortfalls before we even asked her to. The manager told us in the AQAA that all of the homes health and safety systems, such as fire detection and alarms had been serviced this year and we saw evidence that staff have received training in health and safety, fire and safe moving and Care Homes for Older People Page 21 of 27 Evidence: handling. The manager holds the required qualification and she lives adjacent to the home and is available on site 24hrs a day except when on holiday. She is committed to spending time in the body of the home with the people living and working there. This however has led to some slippage in record keeping that should be completed by the manager. We received many positive comments about the manager and the home. One relative told us, We are very happy we chose this home. Another said, The staff and owners treat people with respect. They ensure everyone has individual attention and that their needs are met. One health professional who visits the service told us, There is a good level of individual attention in a homely environment. One member of staff told us, The manager is so kind and nice. We saw the homes comments book and this contained many pages of positive comments. The home sends out surveys at least annually to people living in the home and their relatives and she told us that she actions any issues immediately, although there is no written record of this. One person living in the home told us that the manager goes around to each individual living in the home every day and asks if they have any problems. They said She keeps a good eye on us and if anything is different she spots it right away. The home does not manage the personal finances of the people living in the home. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Where a risk is identified in a persons care plan, surrounding nutrition, pressure areas, behaviour, falls and other specialist needs, a plan of how staff should manage this risk must be recorded. This will ensure people are safeguarded from risk. 01/09/2009 2 9 13 The home must have in 11/01/2010 place a metal storage facility for controlled drugs, which meets the requirements of the misuse of drugs regulations 1973. This will ensure controlled medicines are stored correctly. 3 9 13 A competency assessment 01/09/2009 must be completed on all staff that administer medication. This should be reviewed regularly and action taken when medicines Page 24 of 27 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action are not administered using current best practice. To ensure staff are administering medicines safetly and correctly. 4 9 13 The temperature of the area where medication is stored must be taken each day. This will ensure medication is not being stored above the recommended temperature. 5 27 18 The manager must assess staff complement in relation to the changing needs of people living in the home. This will ensure there is always sufficient staff on duty to meet the needs of the people living in the home. 6 29 19 Where a POVA first check is made for staff commencing work prior to a criminal records check, a record of that check must be kept. This will provide evidence that the required checks have been made. 01/09/2009 01/09/2009 01/09/2009 Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 30 18 Staff that are involved in food preparation must be trained in safe food hygiene practices. 01/10/2009 This will ensure staff know what procedures to follow when preparing food. 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 1 7 Risk assessments and the care plan showing staff how to manage each risk could be built on to provide more information. Copies of certificates of training that staff have attended should be retained in individual staff files. 2 30 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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