Care Home: Hilltop Manor

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What the care home does well People`s needs are fully assessed before they are offered a place in the home to ensure staff can meet their individual needs. People receive care in a way that respects their privacy and dignity and individuality. "People who live in the home are supported to live the life they wish. The staff take the lead from the persons wishes and endeavour to allow them to live this way as long as no one else is affected". "The staff are well motivated, confident, well trained, but at the same time respectful and compassionate to the individuals in the home. There is a real feeling of a "Home".Activities being provided are individually tailored to stimulate people and meet their preferred social needs. The complaints procedure in place ensures any concerns raised are investigated and dealt with thoroughly. Staff know each person well and are skilful at dealing with any agitation or upset, to ensure peoples health and safety is protected. Management continually monitor the service and ensure that any shortfalls are acted upon making the home a pleasant place to live. What has improved since the last inspection? There were no requirements or recommendations made at the last key inspection. What the care home could do better: Accurate information must be recorded about medications taken and the reason why medication is not given; to ensure people`s health is not adversely affected. Advice should be sought from the local authority if situations occur which could may be required to be handled as a safeguarding issue. High dusting, replacement of one bath and floor covering in the laundry will enhance the facilities available to people and ensure infection control is maintained. CARE HOMES FOR OLDER PEOPLE Hilltop Manor 15 Finkle Hill Sherburn In Elmet Leeds North Yorkshire LS25 6EB Lead Inspector Denise Rouse Key Unannounced Inspection 28 February 2008 09:45 X10015.doc Version 1.40 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 Hilltop Manor DS0000007652.V349007.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. 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. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilltop Manor Address 15 Finkle Hill Sherburn In Elmet Leeds North Yorkshire LS25 6EB 01977 683898 01977 685567 hilltopcare@aol.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) Mrs Alison Jayne Green Mr Allen Williams, Mrs Claire Louise Buckle Mrs Alison Jayne Green Care Home 35 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to include up tp 35 (OP) and up to 35 (DE (E)) up to a maximum of 35 Service Users. 14/11/06 Date of last inspection Brief Description of the Service: Hilltop Manor is registered to provide residential personal and social care for up to 35 people over 65 years of age who suffer from dementia. The property is a two-storey building which has been extended and adapted for its present use. There are two passenger lifts providing access between the two floors and a pleasant secure garden at the rear of the property. The home is located in the village of Sherburn-in-Elmet, and is close to local services and amenities. The registered providers are Mrs Alison Green, Mr Allan Williams and Mrs Claire Buckle. The registered manager is Mrs Alison Green. The weekly fees on the day of the site visit ranged from £359.50 to £420.00. People have access to the service user guide and inspection report, situated in reception. This allows people to consider if the home can offer the services they are looking for. Hilltop Manor DS0000007652.V349007.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 2 star. This means the people who use this service experience good quality outcomes. The accumulated evidence used in this report has included: • A review of the information held on the home’s file since its last key inspection. • Information submitted by the registered provider in the Annual Quality Assurance Assessment. • Surveys received from one person living at the home, three relatives, two health care professionals and one member of staff. • An unannounced visit to the home by one inspector and an expert by experience, which lasted six hours and included a full tour of the premises. • Evidence was gained by direct observation during the site visit. Also by speaking with people living at the home and their visitors, the manager, proprietor, deputy manager and staff. Inspection of records, including care profiles, medication administration records, staff files and some of the home’s policies and procedures. • What the service does well: People’s needs are fully assessed before they are offered a place in the home to ensure staff can meet their individual needs. People receive care in a way that respects their privacy and dignity and individuality. “People who live in the home are supported to live the life they wish. The staff take the lead from the persons wishes and endeavour to allow them to live this way as long as no one else is affected”. “The staff are well motivated, confident, well trained, but at the same time respectful and compassionate to the individuals in the home. There is a real feeling of a “Home”. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 6 Activities being provided are individually tailored to stimulate people and meet their preferred social needs. The complaints procedure in place ensures any concerns raised are investigated and dealt with thoroughly. Staff know each person well and are skilful at dealing with any agitation or upset, to ensure peoples health and safety is protected. Management continually monitor the service and ensure that any shortfalls are acted upon making the home a pleasant place to live. What has improved since the last inspection? 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. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (6 not applicable) People who use this service experience good quality outcomes in this area People are assessed and have information available to them and their representatives, about what the home has to offer, so they can make an informed choice. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Experienced staff undertake a full assessment of people’s individual needs which includes their state of mind, concentration and memory, risk of falls and health care needs and social preferences. Information is gained from the individual, where possible, or their relative or chosen representative and from discharging hospitals and care management. If people’s needs cannot be met they are not offered a place in the home. Prospective residents are invited to spend time at the home, with their family to see if it is the right place for them. Staff spend time with them, to answer Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 9 their questions. Written information is available in the service user guide and statement of purpose to tell people what services the home can offer them. Surveys received indicated that people were happy with the information they received, which helped them make a decision that the home was the right place for them. Intermediate care is not undertaken. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 People who use this service experience good quality outcomes in this area People’s individual care needs are met and their privacy and dignity is respected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People have their individual health care needs recorded and these needs are reviewed monthly or as the persons needs change to ensure that the care they are receiving is right for them. Risk assessments are in place and kept up to date and reviewed to ensure individuals health and safety is protected, this includes monitoring individual’s risk in relation to falls and wandering. People are treated with a great deal of individuality, dignity and respect by very attentive and patient staff. People are encouraged and supported to live the life they choose and can get up and go to bed when they like, they follow their own chosen routines, wherever possible. People are helped to talk about their memories. Staff assist Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 11 people who appeared to feel frightened, lost or agitated in a sensitive and individual manner. Health care professionals and the local general practitioner visit the home as required. Escorts are provided for people to attend hospital appointments, the dentists and opticians if a domiciliary service is not available. Special equipment is available in the home to ensure that people’s special health care needs are met. Information about advocacy services is available to ensure individual’s rights are respected. Interpreters are used for residents whose first language is not English at case reviews, to help gain their views. Medication systems were inspected. One person had been prescribed medication on one day of the week only. This was not signed for as being given on two out of three weeks on the medication administration record (MAR). The balance of tablets left in the box indicated that these tablets had not been given as prescribed. Also one person had not taken a tablet on two occasions, the reason for this not being taken was not recorded. These shortfalls must be addressed to ensure people are receiving their medication as prescribed or information is recorded as to why medication has been refused. Surveys received were positive about health and personal care. One relative stated “ My relative was taken into hospital recently, we were kept fully informed at all times. I was also asked to give permission for them to have a flu jab, this never happened at the previous home”. Another relative stated, “ I believe that at all times there is consideration of each individual’s needs”. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 People who use this service experience good quality outcomes in this area People’s social and dietary needs are met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Activities are tailored to suit individuals needs, these include one to one pampering sessions such as manicures. Group activities also occur, such as making beanbags for use by the local junior school pupils who visit the home and help create community awareness. Entertainers visit the home. Local clergy provide a religious service monthly. A local hairdresser attends to people’s hair and visits the home regularly. The home is quiet and various lounges have different stimuli, one lounge has a television without sound, another with sound, one with“ Oldie worlde” music and another lounge area offers peace and quiet. People living in the home have plenty of choice and the atmosphere is one of calm, which helps to soothe people. The wide variety of communal areas avoids clashes between people who have different social preferences. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 13 The activities’ programme is displayed and has pictures on it to help explain the activities available. It catches the eye of the residents and their relatives. A range of activities equipment is available to ensure that individual’s preferences are catered for. National celebrations are recognised such as Christmas and Easter and an Easter Bonnet making activity is being undertaken. The home provides an activities co-ordinator. Each person’s social likes and dislikes are recorded. Care staff undertake activities with peoples preferences in mind. A record of the activity undertaken is kept to ensure people have regular social interaction. Social interaction is maintained as well as links with the wider community. Visiting is open and people are able to go out with their family and friends if they wish. There is trust between residents and staff, People said “the staff are lovely” and “They will do anything I want”. Staff knew each individual person well and did not patronise them or were over familiar, they were friendly and treated them as equals. People can choose to eat in two dining areas or in their bedroom. Dining areas are well presented with cloths and napkins and cutlery is placed on the table at the time the meal is served. The menu is displayed on a board in the dining room and there is a choice of food available at teatime. People who required assistance eat in a small dining area assisted by patient staff in an unhurried manner. People at the home preferred this arrangement. People are asked politely if they require assistance, and second helpings are offered along with sauces and gravy. Meals served looked appetising with use of different textures and colour to stimulate people’s appetite. Staff asked people “ May I take your plate if you have finished please and said “ Excuse me” before asking people if they would like seconds. People spoken with said they enjoyed their meal and staff ensured that people received a nutritious diet. make people feel People felt valued and important at mealtime and their special dietary needs were catered for. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 People who use this service experience good quality outcomes in this area People can be assured complaints would be dealt with appropriately and they are protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints policy displayed in reception. There have been no complaints received since the last inspection. Surveys received indicated that people feel happy to talk about any concerns they might have with the manager or staff within the home, and that issues raised would be investigated and dealt with. Staff receive training about how to safeguard people in their care. Staff knew what action they must take if abuse occurred. However one person living at the home had displayed some behaviour due to their confusion. Management had considered this and had not discussed this with the local authority as a possible safeguarding issue, because they felt they could still meet the person’s needs. The local authority was contacted at the time of the site visit, about this issue. Help and guidance is to be sought on any issues which may occur in the future, to ensure people continue to be protected from abuse. All necessary pre employment checks are carried out to ensure that people are protected from staff that may not be suitable to work in the care industry. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 26 People who use this service experience good quality outcomes in this area People live in a safe homely environment, however some improvements are required to maintain infection control. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is homely and secure access ensures that people are not at risk from wandering out of the building. There is level access to the home allowing people with mobility issues or using wheelchairs freedom to move about. There is a small car park to one side and an enclosed garden at the back of the home, which is accessible; patio furniture is available for people to use. Handrails are provided throughout the building to aid mobility. There are small sitting rooms and television lounges provided as well as two dining areas. Two chairs in the dining room, used for visitors had the foam coming out of the Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 16 seat. Management were pricing up the cost of replacing these as well as the dining chairs. Bedroom doors had people’s names on them and large numbers to help orientate people to which room was theirs. The home required a spring clean with particular attention to dusting above eye level and the fire extinguishers; to ensure infection control was adequate. In one bathroom the hairdresser had stored some products on a very high shelf in a cupboard. These items were removed and locked away to maintain people’s health and safety. In the downstairs bathroom the bath enamel had worn away in two areas, this must be replaced. Bathroom doors have pictures on them to help people remember where they need to go for the toilet. The laundry was inspected the floor covering was worn under one washer and it did not extend to the walls to ensure thorough cleaning and infection control could take place. This must be addressed. Hand wash facilities are available in the laundry and throughout the home this helps prevent the spread of infection. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 28 29 30 People who use this service experience good quality outcomes in this area People’s needs are met by adequate numbers of well trained staff. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff are recruited using thorough processes, to ensure people are protected from staff who may not be suitable to work in the care industry. Staff receive training at induction in protecting people from abuse. All statutory training is provided to ensure staff can effectively carry out their work. Staff training records are maintained. The home has achieved over a 50 ratio of care staff that hold the National Vocational Qualification In care at Level two or three. This helps to enhance the care given to people and provides staff with good underpinning knowledge. Staff meetings are held regularly to allow them to voice any issues, and raise any areas of training they require. Staffing levels have increased since the last inspection. Kitchen staff now prepare tea instead of a carer being allocated to do this. This allows care staff more time with people. Also there are 2 waking night staff and 3 care staff who start work at 7.00 am to help get people up. There are 5 carers on Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 18 daytime, 4 carers in an afternoon and an extra carer 6.30 to 9.30 to help people get ready for bed. Staff are patient and kind and know the individual residents’ needs. They are skilled at helping people to feel reassured and safe. One member of staff said that she sees the people at the home as “her relatives” and treat’s them, as she would wish to be treated herself. A comment received was “The staff are always pleasant and friendly when I visit and seem to enjoy their work. They seem to be caring for the patients and helping them”. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 33 35 38 People who use this service experience good quality outcomes in this area People live in a well managed home and health and safety checks are undertaken. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is run by an experienced approachable manager, who is well liked and respected by people living there. She operates an open door policy so that people can speak to her at any time. Management observe staff undertaking their duties and spend time talking with people and their relatives ensuring they are central to each decision made. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 20 Audits are undertaken monthly relating to health and safety, and medication. As well as general decoration throughout the home. People’s views are sought by surveys every six months. The outcomes of the surveys is placed in the newsletter or discussed at meetings held in the home. Notifications required to be sent to the Commission for Social Care Inspection are always sent in a timely manner. This ensures that management are constantly checking that the home is providing services at the required standard. Personal allowance accounts are provided for people living there. Balances checked were correct. Each person has an individual statement of transactions and receipts are kept. This ensures that people are protected from financial abuse. Health and safety checks are routinely undertaken. The shortfalls identified in the environment section of the report are to be addressed. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement Timescale for action 14/04/08 2 OP19 13 (3) Medications must be given as prescribed. If medication is not given the reason for this must be recorded. The downstairs bath with 30/04/08 defective enamel, and laundry floor covering, must be replaced to ensure infection control can be maintained. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP18 OP26 Good Practice Recommendations Management should liaise with the local authority and gain advice about situations which may occur to ensure any potential safeguarding issues are dealt with. The home should have a spring clean with particular attention to dusting areas above eye level, and fire extinguishers. Two visitors’ chairs in the dining area with foam protruding through the cushions should be replaced. Hilltop Manor DS0000007652.V349007.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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. 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