Care Home: Hilltop House

What the care home does well Provides a good standard of care for residents. Provides a safe and homely environment for residents. Supports and encourages residents to lead an independent life according to their needs and strengths and to fulfil their potential as far as possible. Residents benefit from a committed and competent staff team that ensures continuity of care. What has improved since the last inspection? The upstairs bathroom has been refitted and now includes a shower for the benefit of residents. The garden pond has been removed and now provides a lawn area where residents can sit and relax. New fire doors and additional smoke alarms have been fitted following recommendations by the Fire Officer. What the care home could do better: To remove the metal gate previously used to block access to the kitchen. This is in order to uphold residents right of access and ensure their liberty is not deprived. Encourage some residents to go out more and pursue their interests. Provide staff with awareness of the wider structures that are in place to safeguard vulnerable adults. Key inspection report Care homes for adults (18-65 years) Name: Address: Hilltop House 30 Hilltop Road Twyford Berkshire RG10 9BN     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: Sally Newman     Date: 0 4 1 1 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 Adults (18-65 years) 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 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 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 Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Hilltop House 30 Hilltop Road Twyford Berkshire RG10 9BN 01189340053 01189340659 janet@hilltophouse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Janet Clarke care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 8 The registered person may provide the following category 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 category: Mental disorder, excluding learning disability or dementia (DE) Date of last inspection Brief description of the care home Hilltop House is a care home for 8 people with mental health needs. It is registered for adults over 18 years of age and is able to accommodate both genders. It does not provide nursing care or provide care for people detained under the Mental Health Act 1983. The house is staffed throughout the 24-hour period, with the night staff sleeping in. The house is owned and managed by Mrs Janet Clarke. The house is within a quiet residential area of Twyford. It is close to local shops and a bus stop is directly outside the property. Twyford has a train station, which is about 15 minutes walk from the Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 8 0 2 1 2 2 0 0 8 Brief description of the care home house. The fees in respect of this service are currently £690 to £845 per week. Care Homes for Adults (18-65 years) Page 5 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a routine unannounced inspection conducted over the course of three days and included a visit to the service of just under five hours duration. Time was spent in discussion with the manager and two members of staff were spoken to in private. Observations of activities within the home were conducted and four residents were spoken to briefly. Communal areas were seen and a range of documentation was examined. Information provided by the service prior to the visit has been used in the evaluation of outcomes for the residents. No requirements have been made as a result of this inspection. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the aspirations of various religious, cultural and racial needs. Care Homes for Adults (18-65 years) Page 6 of 27 No complaints have been received by the Commission about this service since the last inspection on 2.12.08. Care Homes for Adults (18-65 years) Page 7 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 Adults (18-65 years) Page 8 of 27 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 Care Homes for Adults (18-65 years) Page 9 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, 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. Service users are only admitted following a full assessment of their needs, with their full involvement and that of their representatives. Evidence: Evidence was provided from discussion with the manager and from documentation seen for the latest person admitted. A full range of information is obtained from all those professionals involved with an individuals care. The person is always visited either by the owner or the manager to commence documentation internal to the service and to get to know the prospective service user. The individual is then invited to visit the home together with relatives if appropriate to decide if the home is right for them. Care Homes for Adults (18-65 years) Page 10 of 27 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. Service users can be confident that their assessed and changing needs are reflected in their plans of care. They are supported to make decisions about their lives and to take risks as part of an independent lifestyle. Evidence: Evidence was obtained from information provided by the service prior to the visit, from discussion with staff, the manager and service users and from a range of related documentation seen on the day of the visit. There are comprehensive plans of care in place for each service user. It was noted that an established care plan system had been introduced called spandex. The intention was to rationalise recording of information a ensure access to important detail was effective. Currently two additional files are maintained for each service user where more detailed information is kept. This has the potential to create some confusion for staff where important information is missed. Detailed care plan information is headed by a description of the individual service user by their diagnosis. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: The manager agreed that this had the effect of labelling individuals and ran the risk of assumptions about individuals being made by staff. It is recommended that plans of care are reviewed to ensure that two separate systems are not in operation side by side and that information is recorded is such a way as to preserve the individuality of each service user. It was evident from talking to service users and staff that they are supported to make decisions for themselves and a range of examples were provided on the day where individual service users had decided for themselves what to eat, who to see and what to do. Risk assessments were seen. A general format is used that is then tailored to the individual. The system for recording risk assessments is separate to the Spandex system and the manager undertook to investigate whether there was documentation available that would avoid the use of multiple recording tools. Care Homes for Adults (18-65 years) Page 12 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who use the service are supported to make choices about their lifestyle and are encouraged to develop their lifeskills. Social, educational, cultural and recreational activities are varied and offer individual choice and meet aspirations and expectations. Evidence: Throughout the course of the visit residents were coming and going to a range of preplanned activities. One resident left on organised transport to attend a day centre and another told me about his regular shopping and lunch trip with a Community Support Worker. Others attend a local church regularly, there are shopping trips and meals out on a frequent basis. One resident has recently starting attending a singing group, which he throughly enjoys. The manager advised that she had dispensed with the homes vehicle, which was a Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: people carrier because residents preferred to go out alone rather than in groups and this provided a significant cost saving. However, the home does have access to another vehicle and is directly on a bus route. Daily routines are flexible and mealtimes are adjusted according to the planned activities undertaken by individuals. There was fresh food in evidence and staff spoken to confirmed that the majority of meals are prepared from scratch with fresh ingredients. It was noted that the food probing record was not completely up to date. It was evident from records seen that the weighing of individual residents is undertaken to ensure healthy weights are maintained. Care Homes for Adults (18-65 years) Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are met. The arrangements for medication are robust and protect residents. Evidence: The health and personal care needs of residents are clearly documented in the individual plans of care. The range of health care professionals called upon to assist with meeting individual needs was provided within information made available by the service prior to the visit and included a wide range of health care professionals. The service benefits from regular visits and support from local psychiatrists and community psychiatric nurses and enjoys a positive relationship with the local surgery. This information was in evidence within two plans of care seen. The plans detailed individual needs and recorded health care contacts. The medication storage arrangements were seen and the lunchtime administration of medication was observed. Two staff now sign for all medication administered. All staff receive in-house training on medication and documentation seen contained photographs of residents together with information about the medication prescribed. The manager confirmed that the home enjoys a supportive relationship with the local Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: pharmacy and the pharmacist is always on hand to discuss queries. The manager undertook to investigate whether the annual inspection of the medication arrangements could be recommenced as part of a pharmacy contract. Care Homes for Adults (18-65 years) Page 16 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their views and concerns will be listened to and acted upon and they are protected from abuse and neglect. Evidence: Information provided by the service prior to the visit confirmed that no complaints had been made about the service since the last inspection. The Commission has received no complaints or concerns about this service. The manager confirmed that residents are encouraged and supported to air their views both on an individual basis and within regular meetings. There is a robust complaints procedure that is made known to the representatives of residents. The manager confirmed that all staff had received instruction in the safeguarding of adults and this was confirmed by the two staff spoken to in private who demonstrated a sound understanding of the principles of safeguarding and the potential for abuse. It was clear from discussion with staff that there was little understanding of the social services responsibilities with regard to safeguarding of adults and the manager undertook to include this as a topic during staff meetings. The manager confirmed that she had made enquires with regard to attending safeguarding training organised by the social services department and a date will be fixed. The inter-agency policy on safeguarding adults was available in the home and the manager was clear about the action that needed to be taken should an allegation or Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: suspicion of abuse come to her attention. Care Homes for Adults (18-65 years) Page 18 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, 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. Residents benefit from a well maintained and homely environment that is kept in a clean and hygienic condition. Evidence: The communal areas were seen and were found to be tidy and reasonably clean. The manager confirmed that there is a rolling programme of refurbishment and replacement of furniture. Information provided by the service prior to the visit stated that the upstairs bathroom had been upgraded and a shower had been installed. Since a Fire Officers visit new fire doors had been fitted and additional smoke alarms had been installed. It was also confirmed that the garden pond had been replaced by a lawn area for the benefit of residents and facilitated greater use of the garden. It was noted that the Fire Officer had not objected to a metal gate that had been used to limit access to the kitchen for health and safety reasons in respect of one resident who now no longer lived in the home. The manager stated that the gate was no longer used and in consideration of the potential to deprive residents of their liberty she confirmed that the gate would be removed when the owner returned from holiday. Laundry facilities were seen and were considered to be adequate to meet the needs of the current service users. The manager confirmed that the principles for the control of Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: substances hazardous to health are adhered to and are supported by comprehensive policies, documentation and staff training. Care Homes for Adults (18-65 years) Page 20 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, 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the support of well trained and competent staff and are protected by the services policies on recruitment. Evidence: Information provided by the service indicated that all staff are subject to a robust recruitment programme that complies with the regulations. This was confirmed by the manager who also stated that no current staff were subject to disciplinary procedures or had a criminal conviction. All prospective staff must complete an application form and are subject to written references and formal interview. The application form now asks for a full employment history. The manager confirmed that all prospective staff have a POVA 1st check undertaken prior to a full Criminal Records Bureau check. All new staff have an induction programme and this was confirmed by those two staff spoken with. A new staff training package had been purchased and was proving to be successful. This covered a wide range of core training needs and involved staff in individual study followed by an examination that was assessed by the training organisation. In addition, all staff have now attended external training in basic mental health. All but three staff currently hold National Vocational Qualifications. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: One to one supervision takes place approximately 2 monthly and this was confirmed by the two staff spoken to. Staff confirmed that the staff team work well together, are supportive of each other and communicate and share the needs of service users efficiently. Staff meetings are held regularly. It was reported that staff hand-overs ensured that important information was passed on. Care Homes for Adults (18-65 years) Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home where their views are taken into account. They are protected by the homes policies and procedures for health and safety. Evidence: The manager acknowledged the considerable delay in submitting an application for registration but confirmed that the application was now ready and would be sent without delay. Information provided by the service confirmed that she held an NVQ 4 and a Registered Managers Award. Staff spoken to described her as supportive and approachable. It was apparent from discussion that the owner of the service was gradually reducing the time spent in the home. This was resulting in increased administration and paperwork for the manager to undertake. It is considered that the appointment of a deputy manager may need to be implemented in order to allow effective delegation of some management tasks. The manager confirmed that a quality assurance exercise had been undertaken with residents within the last two months. This had resulted in three completed questionnaires being received. Overall these contained positive responses. The Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: manager will consider widening this exercise to include all stakeholders with an interest in the home including Psychiatrists, Community Psychiatric Nurses and General Practitioners. Information provided by the service and the manager confirmed that there are robust health and safety systems operating in the home. All staff have received health and safety training. Due to the level of work this area entails it was acknowledged within information provided before the visit that improvements could be made in relation to the completion of necessary documentation. The manager confirmed that the services of an outside company had been purchased to ensure that all health and safety legislation is adhered to and that the service ensures that they are aware of any updates in employment law. The manager confirmed that all recommendations made following a Fire Officer visit in December 2008 had been addressed. One staff member spoken to confirmed that a full evacuation fire drill had been undertaken recently. Care Homes for Adults (18-65 years) Page 24 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 Adults (18-65 years) Page 25 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 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 6 Undertake a review of the care plans to ensure that appropriate information is efficiently and effectively recorded. Care Homes for Adults (18-65 years) 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. 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