Care Home: The Hillings

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What the care home does well Medicines, including controlled drugs, are stored securely for the protection of residents . The manager investigates complaints fully and takes any necessary action and replies to the complainant within the 28 day timescale. What the care home could do better: Records made when medicines are given to people must be more accurate to demonstrate that people have received their medicines as prescribed and to prevent people being given medicines too close together. Records of medicines awaiting disposal must be up to date to account for all medicines held in the care home. Staffing levels must meet the needs of the residents living in all areas of the home. This will help to ensure the safety of the residents. Residents must be helped to maintain their dignity by assisting them with personal care when needed. There must be an adequate stock of flannels for residents to use. Residents property must be treated with respect and stored in an appropriate manner. When it has been identified that a fluid chart is needed for a resident this must be accurately completed to ensure that the resident is being offered regular fluids. Random inspection report Care homes for older people Name: Address: The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ two star good service 15/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Joanne Pawson Date: 2 3 0 2 2 0 1 0 Information about the care home Name of care home: Address: The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ 01480214020 01480475755 admin@thehillings.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Matthew Brian Cox Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Hillings Limited care home 64 Number of places (if applicable): Under 65 Over 65 0 54 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 30 0 1 5 1 0 2 0 0 9 The Hillings is situated at the end of a cul-de-sac in a quiet residential area of Eaton Socon a few minutes walk from local shops and about two miles from the busy market town of St Neots. The Hillings is registered to provide accommodation and support for 64 people. The home offers single storey accommodation in seven units each comprising of single bedrooms, a lounge/dining room, kitchen, toilets and bathroom. Three of the units are for people who need extra care due to dementia (up to twenty eight residents) and there are several respite care places. A large conservatory links the two extra care units, which is also used as an activity centre. There is a main Care Homes for Older People Page 2 of 10 Brief description of the care home kitchen, laundry, staff facilities and sluices. The weekly fees range from £378.90 to £645. The CQC report is made available in the foyer of the home. Care Homes for Older People Page 3 of 10 What we found: We carried out this inspection in response to information that had been passed onto the commission. Staffing Levels We looked at the staffing levels on the flats where residents who have dementia live. We found that for the majority of the time in Daisy flat there are only two members of staff on duty to care for ten residents who have dementia. There is a senior member of staff who floats over all three of the flats where people live with dementia but that they would be absent from the flat for long periods of time i.e. when administering medication in the other two flats. We spoke to the staff working in Daisy and the unit leader for Daisy. They confirmed that out of the ten residents living in Daisy six of them require two members of staff to assist with personal care tasks. This could potentially leave nine residents unattended in the other areas of the flat for long periods of time i.e. if the two members of staff are assisting a resident with a bath. The care staff confirmed that some of the residents are unsteady on their feet and this has resulted recently in a resident falling as there was not a member of staff available in the lounge to support them when walking. Another member of staff told us that the staffing levels meant that they have to rush through personal care tasks with the residents. We looked at the rota for the weekend previous to our inspection. We found that for flats Daisy, Evergreen and Foxglove there were five carers. One of these carers was working one-to-one with a resident. There was a senior floating over all three flats. There were 25 residents living in the three flats that weekend. We also discussed the needs of the residents and the staffing levels with the manager who confirmed that when there is sickness or absenteeism staffing levels have not been high enough at all times to meet the assessed needs of the residents. Personal Care and Dignity Two of the residents we spoke to during the inspection had dirty fingernails. We looked at their care plans but there was no evidence that they resisted help with personal care. One of the residents care plan stated that due to gum disease they should be assisted to freshen her mouth every hour with water. We asked the member of staff responsible for the residents care what the care plan stated about her oral hygiene. The member of staff stated that she was aware that she had gum disease but not that she should assist to refresh her mouth hourly. The member of staff stated that she did not usually work on that flat. The manager stated that staff should read the care plans before working with residents they are not familiar with. We also looked at the fluid charts for the same resident. There were long periods of time when there was no record of fluids being offered i.e. from 4pm until 9.30 pm on the 19th February. Care Homes for Older People Page 4 of 10 Complaints We looked at the complaints log and found that all of the complaints received by the home had been appropriately investigated and any necessary action taken. Part of the complaint received by the commission in relation to the inappropriate use of bad language by a staff member had already been investigated and dealt with. Laundry We also received a complaint that there were frequent times when there is not enough flannels for the residents to use. We spoke to the staff on shift on the day of the inspection and looked at the stock levels and confirmed that there were not many flannels available for the number of residents. The manager stated that staff sometimes throw the flannels away rather than putting them in the laundry and stated that the housekeeper will always purchase more if she is told there are not enough. One member of staff also told us that residents clothes are often just put in the bottom of their wardrobes rather than being stored appropriately. We looked in four wardrobes and found there to be clothes in the bottom of the wardrobe of all four that should have been on hangers. The manager stated that this could be the residents putting the clothes in the wadrobes when they have a change of clothing rather than the staff. Training The senior in charge of the home at the time of the inspection confirmed that all staff have completed their moving and handling training. Medication At the key inspection on 15/10/09 we made a requirement that controlled drugs must be stored securely and in compliance with the Misuse of Drugs (Safe Custody) Regulations 1973 so that unauthorised people did not have access to controlled drugs stored in the home. On this inspection we looked at the storage of controlled drugs and found that it was acceptable, keys to the cupboards were held by a staff member and that storage was in compliance with the Regulations. So this requirement has been met. We also left an immediate requirement that a full audit of the stock of medication must be completed. We looked at the records of the audits undertaken and the last audit was completed on 23/11/09. We also looked at the medication and medication records in use for several people in all areas of the home and did not find any stock discrepancies. We therefore consider this requirement has been met. Again at the inspection on 15/10/09 we left an immediate requirement to ensure that the recording of all medication is accurate. We looked at the records made when medicines are received into the home, when they are given to people and when they are disposed of. In general, these were improved over previous inspections but we still found some unexplained omissions in the records giving no indication of whether people had been given their medicines or not. We also saw that when medication was given at a time different to that on the printed medication record, the actual time it is given is not recorded. This could result in people being given medicines too close together. We looked Care Homes for Older People Page 5 of 10 at the records of creams administered by carers and the records of this kept in peoples rooms and found these were of an acceptable standard. We found some small pots containing medicines which we were told were waiting to be disposed of, but there was no record of what these medicines were. The requirement has therefore not been met by the given timescale of 17/11/09, but given the improvements in the records, this has been rolled forward with a new timescale. But future failure to comply with the requirement may result in enforcement action. Environment On Daisy all of the bedrooms doors had the same picture on them. This could be confusing for a resident with dementia who may not remember where there bedroom is and is looking at the picture to see if it is there room. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be accurate 15/03/2010 administration and recording of all medication. To ensure that the residents receive the medication that has been prescribed for them. Previous timescale of 17/11/09 not fully met. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Staff must assist residents with personal and oral hygiene. This will help to maintain their dignity and health. 22/03/2010 2 10 12 Ensure that residents clothes 22/03/2010 are stored appropiately. his will help to maintain the residents dignity. 3 15 17 Fluid intake charts must be completed accurately. This will help to ensure that the resident is being offered regular drinks. 22/03/2010 4 27 18 Staffing levels must be 22/03/2010 appopiate to meet the needs of the service users. This will help to ensure that residents are not put an unecessary risk and receive they support they require. Care Homes for Older People Page 8 of 10 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 10 There must be an adequate stock of flannels for the residents to use. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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