Care Home: Hilton Park Care Centre

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What the care home does well People have a good standard of information to help them in their decision where to live and there are systems in place to ensure the home can meet the needs of any person who moves into the home. A person told us that the staff would `Do anything for me.` A relative rated the home and its staff highly. People have opportunities to live a good quality of life. People live in a clean, safe and comfortable home. People can be confident that well-recruited and well-trained staff care for them. What has improved since the last inspection? All of the five requirements have been met. People are safer due to improved care practices. The garden, in front of the Board Room, has been designed and made accessible for people to visit. People are safer due to the improved management of the home. What the care home could do better: Some of the care plans could be more person centred and the set objectives to be more person focussed and measurable. We expect the home to manage this issue as part of good practice. Records made, when medicines are given to residents, must be more accurate, to demonstrate that people have received the medicines prescribed for them. A requirement has been made about this. Every person should be given their drinks at the temperature that they prefer. We expect the home to manage this issue as part of good practice. The seating arrangements should be considered to increase the opportunities for people to communicate with each other. We expect the home to manage this issue as part of good practice. The interaction of some of the staff, with some of the residents, could be better. We expect the home to manage this issue as part of good practice. The number of hours that staff work and how they respond to people`s needs might pose some risks to people`s health and welfare. We expect the home to manage this issue as part of good practice. We saw one resident pushed along in his wheelchair, by a member of the staff, without any footrests. This resident had very long legs and he had to raise his feet in order that they wouldn`t drag along the floor. This is a dangerous practice and could cause serious injury. We expect the home to manage this issue rather than we make a requirement on this occasion.0 CARE HOMES FOR OLDER PEOPLE Hilton Park Care Centre Bottisham Cambridge CB25 9BX Lead Inspector Elaine Boismier Key Unannounced Inspection 17th February 2009 10:00 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 Hilton Park Care Centre DS0000038514.V373914.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. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilton Park Care Centre Address Bottisham Cambridge CB25 9BX 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) 01223 811256 01223 812692 www.barchester.com/oulton Barchester Healthcare Homes Ltd Sharlene Van Tonder Care Home 93 Category(ies) of Dementia (93), Mental disorder, excluding registration, with number learning disability or dementia (93), Old age, of places not falling within any other category (93), Physical disability (93) Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N 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 Dementia - Code DE Physical Disability - Code PD 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 93 9th June 2008 Date of last inspection Brief Description of the Service: Hilton Park Care Centre is owned by Barchester Healthcare Homes Limited and is registered as a care home with nursing. The home is situated in the village of Bottisham and is 7 miles from the centre of Cambridge and 6 miles from Newmarket. The home is arranged into four units called Trinity Unit, Churchill Unit, Kings Unit and Queens Unit. There are 91 bedrooms of which 2 provide shared occupancy. All bedrooms have en-suite facilities. The home provides accommodation, support and care, including personal care and nursing care, for people between 18 and over 65 years of age, some of whom have mental health needs and physical disabilities. Current weekly fees range from £540 to £1000. Additional costs include those for hairdressing, chiropody and toiletries. Further information about fees can be obtained from the home. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 5 An application to register the Manager has been approved, in November 2008. Copies of the last inspection report are available in the main foyer of the home or via the CSCI website on www.csci.org.uk Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 6 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. This summary includes information about any meetings we have attended; information that we have received from the home and our registration and inspection activity. Following our last key inspection, in June 2008, we have attended a number of safeguarding meetings. (Safeguarding was previously known as protection of vulnerable adults or POVA.) 24th June 2008 At our last inspection, of the 9th June 2008, we observed a resident, of Queens Unit, experiencing a choking episode, due to being fed with food that the person had problems swallowing. As a result of this observation the home reported the incident to the local safeguarding team, on the 10th June 2008. A safeguarding meeting was held and the allegations were not conclusively proven or disproved. Part of a follow-on from this meeting it was agreed that the Mental Health Team would carry out a review of the care plan documentation, on Queens Unit. In July 2008 we were informed of the outcome of this review and we were told that six care plans were subject to the review and comparisons had been made with the standards of care planning found during 2007. It was considered, by the Mental Health Team, that there had been little progress in the standard of care planning. One of the six plans reviewed, was that of the person who was subject of the safeguarding meeting, held on the 24th June 2008. This care plan had guidance for the staff, from a dietician, although the care plan itself was not easy to find, due to the amount of documentation in the persons care file. It was also considered that there had been little progress in the overall standard of care plan documentation, since 2007, when the home was provided with support and advice from the Mental Health and the community nursing teams. 4th September 2008 As part of a reconvened safeguarding meeting we were told, by the recently appointed home Manager and a manager for the dementia care services, that that the management of Queens Unit had been that of a reactive nature and that there was a need to improve the standards of care and standards of record keeping. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 7 15th February and 18th September 2008 On the 15th February 2008 and again on the 18th September 2008 we attended a reconvened safeguarding meeting. On the 6th December 2007 we attended the first safeguarding meeting following allegations of poor care practices of one of the residents. The meetings held in 2008 concluded that the resident could have received better care for their complex health needs, including swallowing difficulties and bowel care. 16th October 2008 On the 16th October 2008 we carried out a random unannounced inspection when a representative of the community Mental Health Team accompanied us. During this inspection it was noted that there had been some improvement in the care plan documentation although there remained some deficiencies, such as the lack of a care plan for people with challenging behaviours and how the staff were to reduce such risks and what to do in the event of a person showing such behaviours. We expected the home to manage this issue, rather than we make a requirement. We observed a person who was agitated due to a piece of equipment that had been left in their room. We considered, and reported that care practices should be sensitive to people’s perceptions and how care practices could affect them in a negative manner. The lunchtime experience for some of the people could have been better. We saw care practices that led us to report, We consider that people were placed at risk to their safety i.e. risk of scalding. We also noted that a resident was not given the level of support and encouragement that they needed to eat their lunch. In our inspection report we said We expect the home to improve the lunch time experience for people, for it to be safer, more comfortable and more positive for them, rather than we make a requirement on this occasion. No requirements were made as a result of this inspection. A copy of this inspection report is available, on request, from our local Commission for Social Care Inspection (CSCI) office. 27th October 2008 On the 27th October 2008 we attended a reconvened safeguarding meeting and discussed our inspection findings. An action that the home was to take was to submit care plans, to us, so that we might assess what progress had been made with these care records. In December 2008 we received copies of two peoples care plans and both of these complied with Regulation 15 of the Care Homes Regulations 2001. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 8 11th November 2008 In November 2008 an application to register the Manager was approved and a second application was also approved for her to become the Registered Manager for a nursing home, for people with mental health needs, which is situated on the same site as that of Hilton Park Care Centre. 17th February 2009 On the 17th February 2009 we, the CSCI, carried out a key unannounced inspection by 4 Inspectors between 10:00 and 15:00 taking 5 hours to complete. As part of our inspection we undertook a SOFI (short observational framework for inspectors) observation. SOFI helps us understand the experiences of residents who are unable to tell us themselves and who are most likely to have the greatest care needs. We observed three residents for a two-hour period noting down every 5 minutes how they were feeling, what they were doing and how staff interacted with them. We looked around the premises; observed what people were doing; watched the staff working; spoke with some of the residents and the staff, including the Manager and examined some of the documentation. We visited all of the units with the exception of Trinity. Before the inspection we received some surveys from residents, relatives but none from the staff. For the purpose of this report people who live at the home are referred to as ‘people’, ‘person’ or ‘resident/s’. What the service does well: People have a good standard of information to help them in their decision where to live and there are systems in place to ensure the home can meet the needs of any person who moves into the home. A person told us that the staff would Do anything for me. A relative rated the home and its staff highly. People have opportunities to live a good quality of life. People live in a clean, safe and comfortable home. People can be confident that well-recruited and well-trained staff care for them. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? What they could do better: Some of the care plans could be more person centred and the set objectives to be more person focussed and measurable. We expect the home to manage this issue as part of good practice. Records made, when medicines are given to residents, must be more accurate, to demonstrate that people have received the medicines prescribed for them. A requirement has been made about this. Every person should be given their drinks at the temperature that they prefer. We expect the home to manage this issue as part of good practice. The seating arrangements should be considered to increase the opportunities for people to communicate with each other. We expect the home to manage this issue as part of good practice. The interaction of some of the staff, with some of the residents, could be better. We expect the home to manage this issue as part of good practice. The number of hours that staff work and how they respond to people’s needs might pose some risks to people’s health and welfare. We expect the home to manage this issue as part of good practice. We saw one resident pushed along in his wheelchair, by a member of the staff, without any footrests. This resident had very long legs and he had to raise his feet in order that they wouldnt drag along the floor. This is a dangerous practice and could cause serious injury. We expect the home to manage this issue rather than we make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 10 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. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 11 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 Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 12 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): 1 & 3 Quality in this outcome area is good. People have a good standard of information to help them in their decision where to live and there are systems in place to ensure the home can meet the needs of any person who moves into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven of the 9 residents surveys said the person had received enough information, about the home, to help them decide if it was the right place for them to live. One of the people we spoke with said their relative visited the home before the person moved in. The Statement of Purpose has been updated to reflect the change of home manager and the change of categories of registration. The four care plans that we examined provided evidence that the person had an assessment of their needs before the person moved in. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 13 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): 7,8,9 & 10 Quality in this outcome area is good. People are safer due to improved care practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have commented, in detail, about the standard of care planning, on Queen’s Unit, in the summary part of this inspection report. In December 2008 we received copies of care plans of two people who were living on Queen’s Unit. We saw that there was an improvement in the standard of these records; they were person centred and gave the staff clear guidance in how to meet the assessed needs of the person. During this inspection we spoke with and observed four of the residents and we looked at their care plans. Evidence suggests that generally the care plan documentation has improved and provides clear guidance for risk assessments, Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 14 that were actively reviewed, and there was detailed guidance for the staff in how to meet the needs of the person. We noted that, although the existing care plans meet the standard and regulation, the care plans, on the Kings and Churchill units, are not person centred with particular regard to the long term objective of the care plan. In addition the terminology used, in this area, is generally not specific. For example we read, in the care plan for breathing, the long term objective was To maintain a normal respiratory function. We do know that the person had their respirations monitored each month although this information was not transferred to the care plan documentation; this would provide the care plan to be more person centred and for the care provided to be measurable. Another example we noted that for a person, who had been risk assessed and assessed by the speech and language therapist (SALT) to have a swallowing difficulty, the guidance for the staff in how to ensure the person was safe when eating and drinking, this guidance was buried in the care plan for nutrition. This practice could improve to ensure that such an identified risk has a clear and separate care plan that would be more evident to the reader. There has been an improvement in the evaluation of the care plans and we also saw there were short term care plans for a persons change of needs, such as when they had developed an infection. Another improvement was the presence of written evidence that the person had been consulted, and consented, to their care plan. There is work in progress on improving information about peoples life histories and one of these was of a good standard although this was at the back of the file. During our SOFI all of the three residents that we observed spent the majority of the time in a positive or passive state of being. The only occasion where one resident showed any sign of distress was when she was being hoisted, but staff worked hard to calm her and distract her from her ordeal. The rest of the time this resident had the most positive state of all, talking out loud, fiddling with the flowers on the table and her teacup, and actively watching the other residents. The other two residents slept much of the time, but showed good signs of well-being when staff gave them a hand massage, or gave them a drink or banana to eat. The interactions we saw between staff were mostly positive or neutral and with some relating very well to residents, laughing with them and encouraging them to sing. One member of staff started singing a Carpenters tune to one of the residents. This resident responded well and began to clap his hands and laugh, other residents around him smiled. Most staff took time to speak clearly and slowly to residents, kneeling down to their level so that their faces could be seen. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 15 However we also saw some instances of poor interaction, with staff failing to explain adequately to residents what they were doing to them. For example one resident had a runny nose, the member of staff just came up to her and wiped her nose suddenly. The resident shouted get away from me and pushed the carers arm. Other residents were moved in their wheelchairs without warning or being told where they were being taken. All of the 9 residents surveys said that the person always, or usually, received the care, including medical care, and support that they needed. All of the 6 relatives surveys said the home met the needs, including the care and the support, of the resident they were connected with. One of the residents surveys told us, My mother appears to be cared for well. She is clean and tidy. A requirement was made for peoples physical and mental health and welfare to be safeguarded with regards to the management of their skin integrity, their weight, the risk of choking and any distress caused due to anxiety. The timescale for action to be taken was by the 23rd October 2008. Since our inspection of the 9th June 2008 we have received information, in November 2008, that two of the people living on Queens unit, had developed grade 2 pressure sores; both of these people had acquired these on their buttock area and whilst living at the home. The information told us what action had been taken, such as the provision of pressure relieving equipment and helping the person to change their positions, to prevent the pressure sores from becoming worse. We examined four people’s care records and we spoke with some of the staff. Evidence suggests that this requirement has been met. Currently there are no people who have acquired a pressure sore due to a lack of care; peoples weights were taken each month and their body mass index was monitored, with no person having unintentional weight loss and risks assessments for choking had been carried out. We have received no information of any untoward incident of a person choking on unsuitable foods. The care record for one person who has his medication administered via a feeding tube did not carry any written guidance for staff of how this was to be done. We expect this to be managed by the home as good practice. The people we spoke with said that they were Very happy living at the home with one person telling us that the staff would Do anything for me. From the examination of the people’s care records and discussion with some of these people we saw that the home supports the people in accessing general practitioners, SALT, tissue viability nurses, opticians and dentists. We also noted that where a person was showing sign of agitation, a monitoring form Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 16 was used to monitor the persons behaviour, how this affected the person and what action the staff took to reduce the persons agitation. The standard of personal care was good with people dressed in clean clothes and they had clean hair and clean fingernails. A pharmacist inspector examined practices and procedures for the safe handling, administration and recording of medication. The home has good clear written policy and procedures on the safe use of medicines to protect residents. Secure storage is provided for medication to prevent unauthorised access to medicines. The temperature of the storage rooms is recorded regularly and is acceptable so ensuring the quality of medicines in use. Medication record forms and medication in use were examined for a number of residents. Records are kept of when medication is received into the home, when it is given to residents and when it is disposed of. These records were of a reasonable standard providing an audit trail and very few discrepancies were found in the records on Kings Unit. However, the records of medicines administered to residents on Queens Unit carried a number of unexplained omissions giving no indication of whether medicines were administered or not. Where medicines are given in variable doses e.g. “one or two tablets” the actual dose given is not always recorded. This could result in people being given too much or too little medication. For two people who are prescribed a medicine which should be given at least half an hour before the first food, drink or other medication, the record shows that the medicine is given at the same time as all the other medicines. Although staff reported that the special instruction is followed, the record made is therefore inaccurate. The homes management carry out regular audits of medication and medication records and this is good practice although these were not available for inspection. A requirement has been made to ensure records of medicines administered are accurate and complete. We watched some medicines being given to residents at lunchtime and this was done in a professional way that respected individual choice. A requirement was made, after our inspection of June 2008 that medication must be given as prescribed to safeguard residents’ health and welfare. This requirement had been met. Following the inspection of June 2008, we made a requirement for residents dignity to be respected. The timescale for action to be taken was by the 23rd October 2008. The people we spoke with said that the staff were Very good and we saw people interact with the residents in an appropriate manner. We saw no instances of personal care, including bathing, being carried out, unless in private and out of view. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 17 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): 12,13,14 & 15 Quality in this outcome area is good. People have opportunities to live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are 4 activities co-ordinators and each of these members are allocated to work on one of each of the 4 individual units. There is a mini-bus, on site, to take people out of the home. Seven of the 9 residents surveys said the home always, or usually, provided suitable activities that the person could take part in; the two remaining surveys were less positive: one survey said that the home sometimes provided suitable activities and the remaining survey said that the home never provided such activities. We spoke with a member of the staff, on Churchill Unit, and it was clear that the range of activities has improved there within the last 18 months. Activities offered include developing scrapbooks with items of a personal interest, flower arranging and shopping trips. Other activities included watching television, DVDs and choosing to be alone. Records Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 18 of activities are kept although those maintained in the care plans were not as detailed as those records kept by the activities co-ordinators. All of the 6 relatives surveys said that the home supported the resident in keeping in contact with their relative. We saw people receiving their guests. People we spoke with said that they could get up and go to bed when they wanted to and were able to chose what clothes to wear. All of the relatives’ surveys considered the home supported their relative in living their life as they chose to. During our random unannounced inspection of the 16th October 2008, we considered that the lunchtime experience could have been a safer and more positive experience for people, as described in the summary part of this inspection report. We saw, on Churchill Unit, a member of the staff helping a resident with their meal and this was done on a 1:1 basis with the member of the staff sitting down by the side of the resident. Of the 9 residents surveys 7 said that they always, or usually liked the meals. In two of these 7 surveys we received the following comments I feel the meals provided could be improved. Often taste as if they have not been cooked for the full period and To (sic) pasta on menu. Always running out of bread. The two remaining surveys said that sometimes the person liked the meals. We examined the menus and we saw that the people were offered a range of food, including a vegetarian option and a hot option at suppertime. People we spoke with said that they liked their food and confirmed that they did get a choice of menu, including a cooked breakfast. We saw the staff serve the pureed food, making sure that each portion of food was separate from the other portions. We saw one carer help a resident drink a cup of tea at the breakfast table: the resident was very reluctant to drink it and pushed the cup away. When we checked the cup afterwards the tea was very cold clearly having been left there some time. We talked to a relative of one of the residents, who had been at the home for over two years. The relative rated the home and its staff highly and told us that their relative, when that had come into the home, they needed their food by artificial methods but their health had improved so much they could now manage solid foods During our 2 hour SOFI observation we saw residents being offered plenty of tea and juice, and they were also given bananas and biscuits with their morning coffee. This is good practice and will ensure residents maintain good hydration and nutrition. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 19 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): 16 & 18 Quality in this outcome area is good. People are listened to and are safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eight of the 9 residents surveys said that the staff listened and acted on what was said to them. The remaining residents survey said that this was not the case and qualified it by adding Not always. Have to repeat request for assistance. The majority of the relatives surveys (5) said that the person knew how to make a complaint and were satisfied with the response they had received, from the home. The people we spoke with said that they knew who to speak to if they were unhappy about something but they had nothing to complain about. We looked at the record of complaints and, since our inspection of the 9th June 2008, the home has received two formal complaints and both of these were resolved within the 28 day required timescale. We have received no complaints about the home. All of the 9 residents surveys said the person knew who to speak to if they were unhappy about something and the majority (7) of these surveys said that the person knew how to make a complaint. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 20 The home has co-operated during the safeguarding meetings that have been held since our inspection of the 9th June 2008 (see the summary part of this inspection report). The staff told us that they have attended training in safeguarding and they told us what they would do if they suspected any incident of abuse against any of the residents and we were satisfied with their response. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 21 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): 19 & 26 Quality in this outcome area is good. People live in a clean, safe and comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a comfortable and well-maintained place for people to live. One person said that they were able to get around the outside of the home in their electric wheelchair. Since our inspection, in June 2008, the garden, in front of the Boardroom, has been improved with raised flowerbeds and a path leading up to a pergola and seating area. The atmosphere in Queens Unit, during our SOFI observation, was calm and orderly. There was a large screen TV in the main lounge, however, this was turned off and relaxing and age appropriate music was played which the Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 22 residents seemed to enjoying. A few were moving in time to the music. However, residents chairs were placed in a horseshoe shape around the room, making it very difficult for them to see and hear one another. Putting chairs in smaller groups would make it much easier for them to communicate. All of the 9 residents surveys said that the home was always, or usually, clean and fresh and we found no offensive odours. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 23 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): 27,28,29 & 30 Quality in this outcome area is good. People can be confident that well-recruited and well-trained staff care for them although some of the work patterns might pose some risks to people’s health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven of the 9 residents surveys said that the staff were always, or usually, available when the person needed them. The two remaining surveys said that sometimes this was the case. One of these two surveys said Sometimes the buzzer does not work. Another of these surveys told us that the there was a problem with the Length of time sometimes to answer the bell. Have had to wait up to 20min, no explanation when arrive, no sorry. Level of staff could be increased. Comments from relatives surveys included the following (the staff) were slow to respond to calls. Wait 40 minutes to go to loo even with us asking’ and More carers to speed up help to residences (sic). Another of these surveys said Dementia people need more help and understanding, more staff would help. Could do with extra staff at meal times to help with feeding. We spoke with both residents and the staff and we were told that sometimes the responsiveness of staff in meeting the residents needs could be better, including responding to call bells and helping the people with their personal Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 24 care. We timed the response to call bells and we found that the staff had responded to these within 3 minutes. We saw that the staff rosters had some of the staff working 12-hour shifts, some up to 6 days or nights with one day or night off before resuming to work for another 6 days or nights. We reported our concerns about this issue, in December 2007 and we were informed that this issue was being addressed with an expected improvement by 2008. We discussed our concerns with the Manager and we were told that, although agency staff have been used, the standard of care, provided to the residents, was at risk, and therefore, until more permanent staff are working at the home, some of the staff are working these lengths of time. The Manager told us that currently there has been active, and successful, recruitment of new staff who should start working at the home once all the recruitment checks have been received. A requirement was made, after our inspection of June 2008, for the residents to have their assessed needs met safely, by competent staff. The timescale for action to be taken was by the 30th October 2008. All of the 6 relatives surveys said that the staff always, or usually, had the right skills and experience to look after people properly. The people we spoke with said that they received the right care and had no concerns about the competencies of the staff. Currently the home has 50 care staff of which 38 have the National Vocational Qualification level 2, or equivalent, in care i.e.76 . We noted that some of the staff, who do not have English as their first language, were difficult to understand when they spoke. The Manager was aware of this issue and explained that, at the recruitment stage, the manner that the candidate can be understood, when speaking, is taken into consideration, when assessing the suitability of the person to work at the home. We made a requirement, after our inspection of June 2008, for full and satisfactory information to be obtained, before any member of staff was allowed to work at the home. The timescale for action to be taken was by the 17th October 2008. We examined three files of staff who had been most recently recruited and we found that there was all the required information, including a written explanation of a persons gap in their employment history. This requirement has been met. The staff told us that they have attended on-going training to include care of a person who has difficulties in incontinence, dressings of wounds and medication practices. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 25 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): 31,33 & 38 Quality in this outcome area is good. People are safer due to the improved management of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An application, to register the Manager, was received on the 25th September 2008 and this was approved on the 6th November 2008. She is a registered general nurse and has worked, as a registered manager, in another care home, before being appointed as the Manager of Hilton Park Care Centre where she has worked since June 2008. In 2006 the Manager completed the Registered Manager’s Award. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 26 Two senior nurses and a quality and audit monitoring senior member of staff support the Registered Manager, who is also the Registered Manager for a newly registered service that is located in the same ground of Hilton Park Care Centre. Since our inspection, in June 2008, we have found that there has been an improvement in the standard of care and the standard of management of the home with the previous requirements being met and the quality outcomes for people has improved from that of ‘adequate’ to that of a ‘good’ rating. Residents and relatives meetings are scheduled and information about forthcoming meetings was available in the areas that we visited. The minutes of the last two residents meetings, held in December 2008 and January 2009, provided evidence that people are given the opportunity to give their views in areas such as the food and activities. Copies of the last two regulation 26 visits, reports, written by a representative of the registered company, were seen and these showed that audits had been carried out on areas such as health and safety checks and we saw that views of some of the residents were recorded. The home does not safeguard any peoples personal monies. This standard, Standard 35, is not applicable. The staff told us that they have attended up to date training in fire safety and moving and handling. Training certificates of these courses were seen in three staff files and the 2009 staff-training matrix indicated that 17 of the staff have attended fire safety training, since 1st January 2009. Service checks have been carried out, on the 15th January 2009, by an external contractor, for fire alarms and emergency lights and certificates of these service checks were seen. The home carries out routine checks on both of these areas with the last checks being carried out, for emergency lights on the 6th February 2009 and checks on the fire alarms had last been carried out on the 13th February 2009. Hoists were seen and labels told us that the next service checks were due in January 2010 and we saw a certificate of a safety check, for the passenger lifts, dated 12th January 2009. An environmental health officers report, dated 29th January 2009 said that Several aspects of your business were consistent with good practice. Records of the temperatures of food fridges and freezers were seen and these were satisfactory. Portable appliance tests for electrical equipment were in date with labels (on the equipment) indicating that their next safety test was due in June 2009. People’s care records indicated that the hot water, for showers or baths, is checked before the person is fully immersed and records of these indicated Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 27 that the hot water is accessed at no more than the safe level of 43 degrees centigrade. We saw one resident pushed along in his wheelchair, by a member of the staff, without any footrests. This resident had very long legs and he had to raise his feet in order that they wouldnt drag along the floor. This is a dangerous practice and could cause serious injury. We expect the home to manage this issue rather than make a requirement on this occasion. Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 28 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A x x 3 Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 29 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) 17(1)(a) Requirement Record made when medicines are given to residents must be more accurate to demonstrate that people have received the medicines prescribed for them. Timescale for action 15/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hilton Park Care Centre DS0000038514.V373914.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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