Inspection on 11/03/08 for Hillside Nursing Home

This is the latest available inspection report for this service, carried out on 11th March 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillside Nursing Home 31/01/06

Hillside Nursing Home 06/08/05

Hillside Nursing Home 02/02/05

Hillside Nursing Home 25/10/04

Hillside Nursing Home 14/07/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillside Nursing Home Bicester Road Aylesbury Buckinghamshire HP19 8AB Lead Inspector Christine Sidwell Unannounced Inspection 11th March 2008 09:30 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 Hillside Nursing Home DS0000019229.V359361.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. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address Bicester Road Aylesbury Buckinghamshire HP19 8AB 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) 01296 710011 01296 484731 aylesbury@schealthcare.co.uk www.southerncrosshealthcare.co.uk Trinity Care Limited Elizabeth Patricia Nicholas Care Home 67 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (36), of places Physical disability (11) Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: Hillside Nursing Home provides care for sixty-six adults, eleven of whom are younger adults with physical disabilities. The building is divided into three units two for older people and one for younger people with disabilities, who have a range of social, nursing and personal care needs. All rooms are single. The home is situated in the centre of Aylesbury and is close to shops and transport links. There is access throughout the home for people with disabilities and those who use a wheelchair. Fees range from £481.00 to £1145.00 per week. Information about the home is available from the home by requesting a brochure, statement of purpose and service user’s guide or by visiting the home at any time. Hillside Nursing Home DS0000019229.V359361.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 3 stars. This means the people who use this service experience excellent quality outcomes. The inspection was conducted over the course of five days and included a two day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an annual quality assurance self-assessment and questionnaires were distributed to residents, relatives, visiting health and social care professionals and staff. Eighteen residents or their families, one healthcare professional and four staff members returned the questionnaires. Residents and families were also spoken to on the days of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. An ‘expert by experience’ spent some time in the home with the inspector on the unannounced visit. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. What the service does well: There is information available to potential residents who are welcome to visit the home before deciding to move. The manager or a senior team member meets with potential residents or their families to assess their needs and agree that they can be met. The assessment documentation is comprehensive and describes resident’s diverse needs. The standards of care are good. Care plans are developed and evaluated regularly and the home works closely with the local Primary Care Trust to ensure that resident’s healthcare and medication needs are met. They offer a specialist palliative care service and support residents at the end of their life. Residents made comments such as, “ I am extremely happy with my care here” and “the staff are caring and thoughtful”. Residents have a choice as to how they spend their day and a range of activities is provided to bring interest and diversion to the day. Meals are of a high standard, meet resident’s cultural and nutritional needs and are served in attractive dining rooms, making them a pleasant and sociable occasion for Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 6 residents. Residents were complimentary about the food saying “ I am fussy about my food, they (the meals) are very good really” and “ the food is very good and I have a choice”. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection and has been told of one safeguarding allegation reported by the home to the local authority, which is the lead agency in these matters. The home is purpose built and there is an ongoing programme of refurbishment. It is centrally located and there is easy access throughout the home for people with disabilities. In general infection control management is good and steps are taken to minimise the risk of infection for residents. Residents are encouraged to personalise their rooms and many had chosen to do so. There are sufficient staff on duty during the day, who have received relevant training, to meet resident’s care needs. The recruitment procedures are thorough and the required checks are undertaken to protect residents for unsuitable staff. Residents were complementary about the staff team commenting that “ the carers are marvellous, do their job well”, “ they are pretty good, have hard job and a lot to do”. The management team is experienced, well qualified and is responsive to resident’s views. The quality of care is monitored on a regular basis and steps are taken to ensure residents safety. What has improved since the last inspection? What they could do better: All residents, irrespective of their funding source, should have a copy of their terms and conditions, the fees and who is responsible for paying them. Residents should be given twenty-eight days notice of fee increases. Consideration should be given as to how residents could be supported to undertake more activities on a one to one basis. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 7 Infection control measures would be improved if residents did not share hoist slings. The home should undertake the Department of Health’s recommended audit of infection control management entitled ‘Essential steps’ and available on their website www.dh.gov.uk to ensure that their practices meet the latest guidance and protect residents from acquired infection. The night staffing levels should be monitored to ensure that resident’s needs are met in a timely way at night. 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. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 8 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 Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 9 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): 2, 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There is information available to potential residents and their diverse social and care needs are identified with them, prior to their move to the home, to ensure that they can be met. EVIDENCE: The home has an up to date statement of purpose and service users’ guide, which is displayed in the main entrance to the home. All the residents, or their families, who returned the questionnaires, said that they had received information about the home. One said “they couldn’t have been more helpful” and one commented “my daughter inspected the place and had heard good reports about it before I moved in”. The families spoken to said that they had been made welcome at the home and invited to look around before their family member moved to the home. Two new residents were expected on the day of the inspection and the manager said that she had additional staff on duty to welcome them and to help them settle in. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 10 The manager said that all residents who fund their own care have a contract and these were seen in their files. Only three of the eleven residents who returned the questionnaires said that they had received a contract, the others either said no or did not answer the question. The manager said that, up until now, residents who were funded by a local authority or the Primary Care Trust did not receive written terms and conditions, although they may have a copy of the local authority care services order. All residents should have a statement of their terms and conditions and the fees payable and by whom. Two of the residents whose administrative files were seen had been in the home longer than a year and the fees had gone up in that period. Only one had been given twenty–eight days notice of the fee increases. The manager said that this was managed from the organisation’s head office. Residents confirmed that someone had visited them to assess their needs before they moved to the home and copies of the assessment were seen in the files. Residents’ social, cultural and religious needs had been had been identified at the initial assessment The home does not offer intermediate care although does offer respite care and specialist palliative care, in conjunction with the local Primary Care Trust (PCT). Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 11 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 and 11 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Resident’s personal, healthcare and medication needs are met, promoting their dignity and wellbeing. Residents and their families are supported at the end of their lives. EVIDENCE: The care of three residents was followed through. Their files contained comprehensive care plans and there was evidence in some files that both residents and families were involved in planning their care. The staff spoken to were knowledgeable about residents’ care wishes. The care plans had been reviewed regularly and updated when appropriate. The residents who returned the questionnaires and those spoken to on the day of the unannounced visit said that they were involved in planning their care and that the staff were responsive to their wishes. Residents had had assistance with their personal hygiene. Most had had their hair dressed recently. There is a dedicated hairdressing salon in the home, which one resident spoken to said that she enjoyed. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 12 Resident’s risk of acquiring pressure damage due to immobility had been assessed and appropriate equipment was available. Two residents had pressure damage on the day of the unannounced visit to the home. Both had been assessed, a care plan developed and had the appropriate pressure relieving mattress. The damage was monitored carefully and advice had been sought from the general practitioner. One nurse within the home has additional training in tissue viability and acts as a knowledge resource for others. Nutritional risk assessments had been undertaken. The staff and chef were aware of residents’ dietary needs and could provide special diets to meet residents’ health and cultural needs if necessary. The chef was aware of the need to provide some people who suffer from dementia with a high calorie diet. Residents are weighed regularly and two of those residents whose care was followed through had maintained their weight on moving to the home. One had lost weight. This had been recognised quickly by the staff and a nutritional plan had been agreed. Dietary intake was monitored and the weight loss had stabilised. The home is implementing a computerised menu planning system, which has the potential to tailor menu plans for individuals to meet their specific dietary needs. There was evidence that falls assessments are undertaken and the advice of the local Primary Care Trust specialist falls prevention team is taken where necessary. Residents register with local general practitioners, who visit the home regularly. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled drug register were signed. A contract is held for the disposal of unused medication. The registered nurses spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. There is a clinical incident reporting system in place to address any error in medication. The nursing staff wear red tabards to show that they are administering medication to discourage others from interrupting them. None of the residents were managing their own medication on the day of the unannounced visit, although the manager said that there were policies and procedures in place to allow for this. She said that they were working with a resident on the young disabled unit who may be moving to supported living, to Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 13 help him manage his medication, although he was not as yet taking responsibility for this. The staff were observed to be respectful towards residents and to protect their dignity. All care is given in residents’ rooms. All the residents or their families who returned the questionnaires said that the staff listened and acted on what they say. Residents and relatives spoken to on the day said that staff were kind and caring, always asked them what they would like to do and gave them a choice. The home has worked closely with the local Primary Care Trust to offer specialist palliative care and to support residents at the end of their life. They have implemented the latest best practice advised by the Department of Health (DH) in ‘The End of Life Programme’. The records of one resident were seen and detailed care plans were in place to guide staff on how to meet his needs in the last few days of his life. Records were seen to show that the staff not only support residents, but also their families. A number of letters from relatives were seen thanking the staff for their support. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 14 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 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents have a choice as to how they spend their day and a range of activities is provided to bring interest and diversion to the day. Meals are of a high standard, meet resident’s cultural and nutritional needs and are served in attractive dining rooms, making them a pleasant and sociable occasion for residents. EVIDENCE: The residents spoken to said that they had a choice as to how they spent their day. Those who returned the questionnaires said that the staff listened to them and acted upon what they said. There are two activities coordinators in post who offer a range of activities, including armchair physical exercises or games, art/craft, bingo, quizzes, musical, discussion, board/parlour games and reminiscence. There are some outside trips to local garden centres and shops. There is a small chapel. An Anglican priest was visiting on the day of the unannounced visit to hold a communion service. He said that he came monthly and colleagues from other Anglican denominations came on the other weeks. He also said that he had links with other faith groups. The activity coordinator has developed a sensory room, which has subdued lighting and a calm atmosphere. She is able to take some of the equipment to resident’s own rooms if they wish. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 15 The activities coordinators have worked hard to improve the support they offer residents to help them participate in daily activities, which suit their expectations. Each resident has an individual activity assessment covering social history, life events, personal preferences, capabilities and aspirations of others, such as family members. The activity programme is publicised on the three notice boards in the home. The activities coordinators said that they put aside two days a week to work with residents on a one to one basis where they did not wish or were unable to join in group activities. All the residents who returned the questionnaires, or were spoken to, said that activities were available, one commented that she had a choice as to whether she joined in, another “activities are all very interesting, you can make your own bed if you want to”. Two less positive comments were made, one resident saying “ I have a bad leg, it’s awful, I just sit here” and another said “ I like them (the activities) but it is dead at the weekend”. Overall,however, the support and activities on offer to residents has improved considerably since the last inspection with the development of a range of activities and a greater focus on individual needs and abilities. Consideration should be given to building on the good work by developing more one to one activities and considering how activities can be offered at the weekend. There is a varied menu with more than one choice of dish at all meal times. The organisation is implementing a new computerised menu planning system, which relies on freshly cooked foods, made using fresh ingredients. This has meant that the menus have been revised. The chef said that she was anxious to begin with but was now very enthusiastic about the project. The computerised data allows the dietary content of the menus to be calculated and has the potential for specific menus to be developed to suit individual’s dietary needs. The chef said that as more homes used the system a databank of dishes to meet resident’s cultural and religious needs was being built up. All the residents who returned the questionnaires said that they enjoyed the food. The main meal was observed to be a sociable occasion. The dining rooms have been recently redecorated. Dining tables were laid attractively with good crockery and a clear menu on each table. The manager said that mealtimes were ‘protected’ and no other activities would be carried out and that all staff would be expected to help at meal times. This was observed to be the case and in one lounge there were four to six members of staff assisting twelve residents. Three who needed help eating were being helped sensitively and unhurriedly with staff sitting with them. Residents were complimentary about the food saying “ I am fussy about my food, they (the meals) are very good really” and “ the food is very good, I have a choice”. One person however said that she would prefer the meat not always to be in gravy and for the vegetables to be crisper. The chef compiles a daily list of individual preferences. A range of fruit was available in bowls in the dining rooms. The Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 16 chef said that she would consider presenting fruit as a platter or fruit slices for those who would be daunted by a whole piece of fruit. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 17 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 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents. EVIDENCE: There are complaints policies and procedures in place. The manager has received eight complaints since the last inspection. Records were seen to confirm that they had been dealt with within the timescales and that action had been taken to address the concerns. All the residents who returned the questionnaires said that they knew who to speak to if they were unhappy. One resident said she had never had to make a formal complaint and that if she was unhappy with any aspect of the service it would usually be dealt with immediately. The home has an up to date copy of the local multi-agency strategy for safeguarding vulnerable adults. Most staff have had safeguarding training and those spoken to said that they would have no hesitation in reporting any concerns about resident’s welfare. There are whistle blowing policies and procedures in place. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection and has been told of one safeguarding allegation reported by the home to the local authority, which is the lead agency in these matters. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 18 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, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The home is clean and well maintained and is a safe and accessible home for residents. Residents are encouraged to personalise their own rooms to make them more homely and to reflect their own tastes and memories. EVIDENCE: The home is purpose built and is near Aylesbury Town centre. There is access throughout for those with disabilities and easy access to a small garden area. There is an ongoing programme of maintenance and redecoration. A new dining room has been created in one unit and an entertainments room on the young disabled unit. A quiet, sensory room has also been developed. The Fire Officer last visited in January 2007 and the Environmental Health Officer in November 2007 when all matters were considered satisfactory. Two recommendations relating to the environment were made at the last inspection, one for some worn chairs to be replaced and the other that services Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 19 and equipment should be maintained on a regular basis. These had both been addressed. All residents have their own room. They are encouraged to bring in small items of furniture and ornaments and pictures. Many had chosen to do so and their rooms were personalised and homely. The maintenance team were very conscientious and saw it as an important part of their role to ensure that resident’s rooms were to their liking. There are infection control policies and procedures in place. These were updated in January 2006. The home was clean and tidy on the day of the unannounced visit. There were no offensive odours. Protective clothing and gloves are available for staff to help minimise the risk of cross infection. Alcohol hand gel is available at the entrance to the home and the units. The staff said that residents had individual sliding sheets if they were needed to help them move or transfer. Residents had individual hoist slings if they have an infection but the manager said that some hoist slings were still shared between residents although laundered regularly. The latest guidance from the Department of Health (DH) says that residents should not share hoist slings. The guidance can be found on the their website www.dh.gov.uk. It is recommended that this guidance be implemented. The laundry was clean and tidy and the washing machines had suitable programmes to sluice soiled linen and to wash at high temperatures if necessary. The manager said in the annual quality assurance self assessment that the home has not yet used the Department of Health’s (DH) guide ‘Essential Steps’ to assess their current infection control management. It is recommended that the home do so and develop an action plan to address any deficits, which the assessment may show. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. There are sufficient staff on duty during the day, who have received relevant training, to meet resident’s care needs. Night staffing levels should be monitored carefully to ensure that resident’s needs are met in a timely way. The recruitment procedures are thorough and the required checks are undertaken to protect residents from unsuitable staff. EVIDENCE: A staff rota is kept and showed that there are qualified nurses and care staff on duty on each shift. The staff spoken to said that they usually worked in the same unit to provide continuity of care for residents. The residents and families who returned the questionnaires said that their needs were met in a timely way. All residents, who were getting up, were up by mid morning on the day of the unannounced visit. The manager said that there were additional staff on duty at busy times of the day. She also said that she had a regular staff team and did not need to use agency staff. In addition to the nursing and care staff employed to cover the 24- hour rota there are additional staff providing housekeeping, maintenance and catering support to residents. Residents were complementary about the staff team commenting that “ the carers are marvellous, do their job well”, “ they are pretty good, have hard job and a lot to do”. One however said, “the night staff are the longest (responding to help call)…20 minutes is my longest wait”. The manager said that there are usually four members of staff on duty at night on each floor but that this may drop to three if the home is not fully occupied. The night staffing Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 21 levels should be monitored to ensure that resident’ needs can be met in a timely way. There is a training programme available for staff. Fifty percent of care staff hold the National Vocational Qualifications in Care at Level 2 or above. The training matrix showed that most staff have had mandatory training in safe working practices and that staff undertake an induction programme on appointment to the home. Registered nurses have also undertaken refresher update courses in practical skills and the care of people with specific conditions for instance diabetes. The training statistics seen did not show that staff had undertaken any training relating to equality and diversity issues. The recruitment files of four recently recruited members of staff were reviewed. All had the required documentation to show that checks as to the potential staff member’s identity and suitability to work with vulnerable people had been undertaken. All had submitted an application from, which showed their work history. Interview records had been kept. Two references had been sought and Criminal Records Bureau checks had been undertaken before the staff member commenced work. There was evidence in the files seen that work permits had been obtained where necessary. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 22 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, 35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The management team is experienced, well qualified and is responsive to resident’s views. The quality of care is monitored on a regular basis and steps are taken to ensure residents safety. EVIDENCE: The manager is experienced and has been managing the home since March 2003. She is a qualified nurse and holds the National Vocational Qualifications in Management at level 4. She said that she had an open door policy. Families, residents and staff were observed to speak to her frequently and in a relaxed manor throughout the unannounced visit. Residents, families and staff said that she was approachable and dealt with issues promptly. There are clear lines of accountability within the home and with the organisation’s senior management team. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 23 There is a comprehensive quality assurance programme and evidence was seen of regular audit of care plans, medication management, and training compliance. In addition the incidence of pressure damage and falls are monitored. Recruitment and training files are also audited regularly to ensure that they meet the company’s standards. The activities team interview ten percent of residents on a monthly basis and the outcome is sent to the organisation’s head office. The manager said that relatives were also sent questionnaires but that these were returned directly to the organisation’s head office. No analysis or summary of these interviews was available on the day of the unannounced visit. The manager said that the response rate was usually low. This system of surveying residents and relatives does not appear to be providing useful information at home level to assist in improving resident’s care and may benefit from review. There is a resident’s committee, chaired by a family member, which appears to give residents a greater say in the running of the home. Minutes were seen to show that they met regularly and contributed to the way in which the home is managed. The senior management team visit the home regularly and records of their visits are kept at the home. The home has addressed the requirements of the previous report. Residents are helped to maintain control of their finances if they wish. They may also deposit small amounts of personal money with the home for safekeeping. A computerised record is kept and receipts are given for all transactions. There are health and safety policies and procedures in place. Regular health and safety meetings are held and minutes kept. Mandatory training in safe working practices is monitored as well as accidents and incidents. Medical device alerts are brought to the teams notice immediately to ensure that the equipment referred to is not in use in the home. The maintenance team undertake regular checks of fire procedures and hot water temperatures. All residents have height adjustable beds with integral bedrails. Risk assessments and regular checks of these are undertaken. The annual quality assurance questionnaire sent by the manager showed that the maintenance of services and equipment was up to date up to date. The records verified this. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 24 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 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 Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP2 OP2 OP12 Good Practice Recommendations All residents should have a statement of their terms and conditions, which includes the fees and who is responsible for paying them, irrespective of their funding source. Residents should be given twenty-eight days notice of fee increases. Consideration should be given as to how residents could be supported to undertake more activities on a one to one basis. Consideration should also be given as to how activities could be provided at the weekend. Residents should not share hoist slings to minimise the risk of cross infection. The home should undertake the Department of Health’s recommended audit of infection control management entitled ‘Essential steps’ and available on their website www.dh.gov.uk to ensure that their practices meet the latest guidance and protect residents from acquired infection. DS0000019229.V359361.R01.S.doc Version 5.2 Page 26 4 5 OP26 OP26 Hillside Nursing Home 6 OP27 Night staffing levels should be monitored to ensure that resident’ needs can be met in a timely way. Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Hillside Nursing Home DS0000019229.V359361.R01.S.doc Version 5.2 Page 28 - 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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