Inspection on 12/02/08 for Hill House Nursing Home

This inspection was carried out on 12th February 2008.

CSCI found this care home to be providing an Adequate 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

Hill House Nursing Home 18/03/09

Hill House Nursing Home 29/11/06

Hill House Nursing Home 14/12/05

Hill House Nursing Home 28/06/05

Hill House Nursing Home 24/11/04

Hill House Nursing Home 27/04/04

Hill House Nursing Home 15/01/04

Hill House Nursing Home 03/09/03

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Hill House Nursing Home Park Avenue Brixham Devon TQ5 0DT Lead Inspector Judy Cooper Unannounced Inspection 12th February 2008 9:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hill House Nursing Home DS0000028683.V356136.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. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill House Nursing Home Address Park Avenue Brixham Devon TQ5 0DT 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) 01803 853867 01803 854757 Mrs Ann Margaret Stockwell Ann Margaret Stockwell Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (38) of places Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old Age not falling within any other category (OP) 38 Physical Disability (PD) 38 Date of last inspection 29th November 2006 Brief Description of the Service: Hill House Nursing Home is set in Higher Brixham; it faces northeast and is built into a hill, thus giving it its name. A former Manor House, it was built in the 14th century and is listed as an important building in Torbay. Exposed beams, inglenook fireplaces and uneven floors give part of the home a homely, cottage feeling. Due to the age and construction of this part it is unable to accommodate selfpropelled independent wheel chair users. However a two-storey purpose built extension registered last year which created an additional 18 bed places, can accommodate people with or without independent mobility. A passenger lift provides access between floors. The home now caters for up to 38 older people of either gender with physical disabilities and/or frailty. A range of equipment and adaptations are available to people following an assessment of their care needs. A registered nurse is on duty at all times supported by a team of Health Care Assistants. Information about the home was found in the entrance hall. The owner will make the inspection report available within this area as well. Information given to the Commission by the provider indicates the current range of fees is a standard £600 a week. Hill House Nursing Home DS0000028683.V356136.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 1 star. This means the people who use this service experience adequate quality outcomes. This site visit took place on a Tuesday between 9.45 a.m. and 4.00 p.m. and two inspectors were involved in the inspection. Opportunity was taken to observe the general overall care given to the people who were living at the home. The care provided for four of these people was also inspected in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were both assessed prior to admission and were then being met appropriately once the person came to live at the home. A tour the premises, discussions with the owner of the home, as well as discussions with the home’s qualified staff and unqualified staff, some people living at the home, a visiting external trainer and an outside professional were undertaken during the course of this inspection. Staff generally were also observed, in the course of undertaking their daily duties. Surveys from 3 relatives and 4 people who live at the home were returned to the Commission, prior to the inspection, and comments from these questionnaires have also been used to inform this report. Likewise information collected from all other sources has been used in the writing of this report. All required core standards were inspected (as well as some additional ones) during the course of this inspection. What the service does well: The service provides good care for people with a high degree of physical need or who are deemed to need “end of life care”. Well trained staff are sensitive and responsive to the peoples’ needs and the home is fully adapted to provide for their needs with specialist equipment having been provided, for example each bedroom has a profile type bed to aid the nursing of the people and to ensure the peoples’ comfort. Peoples’ individuality is respected and upheld and the staff treat people with respect and dignity. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 6 The atmosphere within the home is calm and caring and the home’s environment is clean, warm, welcoming and well maintained. The new extension, has been completed to very high standard and has provided an extra 18 beds which were much needed within the locality and which are extensively used by the local hospice and hospital, whose professionals both support the care given at the home. The management of the home continues to be overseen by Mrs Stockwell who is the registered owner. Her extensive experience of patient care is evident in the way she has an in depth understanding of each person’s complex needs and the best way to meet these identified needs. An experienced deputy matron and a team of registered nurses and health care assistants support her in this. Those staff spoken with clearly had the peoples’ best interests at heart and were seen carrying out their duties in a professional, sensitive and compassionate manner. What has improved since the last inspection? What they could do better: The home’s service user guide and statement of purpose should be amended to ensure it contains up to date information which will allow people to know the services and facilities the home can make available as well as the collated findings resulting from quality auditing undertaken within the home. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 7 Peoples’ care plans must be up to date and reflect the current care being provided with any changes to that care recorded. This is so all staff can be aware of what care has been agreed, of any changes noted and therefore allow staff to know how best to meet someone’s needs. The manager provided written confirmation that this requirement had been meet prior to the publication of the report Any form of restraint used i.e. the use of a cot side, recliner chair etc must always be regularly risk assessed by the home’s management staff, with advice sought from outside professionals, as well as agreement obtained from the person themselves and/or their family/advocate as to the use of such restraint. These details must be kept in the individual person’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual person and fully meets their individual needs, whilst at the same time respecting their right to freedom and choice. The manager provided written confirmation that this requirement had been meet prior to the publication of the report Medications disposed of should always be signed for. Dressings used should also be recorded on the medication records. This is to fully protect people who live at the home by keeping records of such things. A menu should be displayed communally to allow all people to know what is for each meal so that they can make an informed decision as to what they would wish to choose. Cleaning products should be stored securely to prevent any risk to the people or to the staff working at the home. There should be a training plan for each individual staff member and a collective one for the home, to ensure that staff fulfil there personal needs as well as the overall aims of the home in meeting the changing needs of the people who live at the home effectively. An in depth induction training programme, covering all required training needs of newly appointed staff must be provided. Equal opportunities training should also be made available to all staff. This is so that new staff will be aware of their duties and responsibilities and that all staff will be aware of how to best provide for peoples’ differing individual/chosen lifestyles. The management must provide regular supervision to all staff, including newly appointed staff members, and keep written records of the same. This is to ensure that all staff have individual time with the management of the home to allow each staff member the opportunity to discuss any issues regarding their role and for the management of the home to be able monitor Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 8 the progress of each staff member over a period of time and offer support/training as required. All record keeping should be maintained in accordance with Data protection Act 1998 requirements in ensuring peoples’ right to confidentiality is maintained. The management must continue with the formal quality audit of the service, taking into account the views of the people who live at the home, their relatives/advocates and any other interested parties that may have contact with the home and from this information received produce an annual development plan for the home. This plan must reflect the aims and outcomes of the service, using feedback from various sources, including the people who live at the home as well as other people who have an interest in the service. These measures will help ensure the home is always run in the best interests of the people who live there. All of the homes’ policies and procedures should be updated as required to include current good practice and up to date information. This is so that all staff are aware of what criteria they need to work to and are aware of what standards and guidelines they need to work within to provide the required and agreed care to the people. This will ultimately help ensure that the people receive good quality care. The management of the home must always inform the Commission of any serious illness, untoward incident or death involving any person living at the home. This is so that the Commission can be aware of and monitor any such incident and therefore be aware how the organisation/home responds. This will help ensure the well being of the people is upheld. 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. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 9 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 Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 10 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): Standards 1, 3 The quality in this outcome area is adequate. The assessment process adopted by the manager and staff at Hill House should ensure that people have their care needs fully assessed prior to admission. This will ensure that staff have the information they need to provide continuity of care for the person. The home’s statement of purpose and service user guide was not fully up to date and as such would not allow a prospective person and/or their family/advocate to make an informed decision about admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nature of the care (an increase in “end of life” care) now provided is such that there is naturally a high turnover of people receiving care at the home. There was adequate pre assessment documentation to ensure that staff knew a persons needs prior to admission. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 11 A great deal of effort goes into the pre admission processes, involving the home’s owner and the qualified nurses based at the home. Four peoples’ admission details were inspected. They had comprehensive assessments completed, which were dated on the day of their admission. Each contained copies of social services/health assessments and care plans or a summary from the previous placement. The assessments identified their main health problems and their self-care abilities. Manual handling, pressure sore and nutritional risk had all been assessed using the home’s risk assessment process. Where it was possible the person and/or their relative had signed and agreed their plan of care. The manager confirmed that, where possible, people are assessed prior to being admitted to the home. She also commented that if the person is unable to visit the home relatives are encouraged to do so before the person is admitted. However due to the nature of care provided and often urgent requests for admission this cannot always take place, but in these instances pre-admission documentation is received from professional sources. One person spoken to during the inspection, who was not part of the case tracking, said they had chosen to come to Hill House and had had the opportunity to speak to staff before they were admitted. This level of pre-admission preparation ensures that the home takes people that they feel they can meet the needs of, i.e. people with a high level of physical dependency and/or people who require “end of life” care. Liaisons also take place with other professionals prior to admission, including G.P’s, District Nurses, care managers, staff at the hospital or staff at the local Hospice etc. It was noted that the home’s Service Users Guide/Statement of Purpose contained information about the service, which is no longer current (for example the results of the quality assurance audit were from 2003). This means that people coming to live at the home and/or their relatives/advocate would not be able to view up to date information which may help them in their decision as to whether or not Hill House could meet their needs/expectations. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 12 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 The quality in this outcome area is good. Staff on duty understood the care needs of the people they were caring for. However people who live at the home could be at risk from care plans not being up dated and reviewed to record changes in care needs. This may mean that people are therefore reliant on regular staff who understand their needs always being available in order to allow their care needs to be fully met. Although there was a good risk assessment process for manual handling, pressure sore risk and risk of poor nutrition are not always fully completed or up dated when needs of the individual change. This may mean that people living at the home do not have their heath and safety fully protected. The majority of the medication practices in the home are safe and ensure people receive the treatment they need. Staff are friendly caring and supportive to the people they care for at Hill House. People can have confidence that staff will be respectful, polite and listen to them and act on what they say. This judgement has been made using available evidence including a visit to this service. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 13 EVIDENCE: Four people had their care followed as part of this inspection. These people all had care plans completed, which identified how staff should meet their care needs. However there was no record in any of the four care plans that showed these had been reviewed monthly. The manager advised that a computer system had been introduced and care plan reviews and updates were entered on to this before being printed out. However one persons information viewed on the computer records had not been updated to reflect that the care plan had been reviewed. Each person had their care plan, medication sheet and information about the home in their individual rooms. The nurse in charge of the shift confirmed that all the people have personal information care plans and medication records in their own rooms. This information was stored in a wall mounted document shelf. One person whose care needs have changed considerably since the care plan was written had not had the changes recorded in the plan of care. The care plan stated that they required a diabetic diet and had reduced mobility however discussion with the manager revealed that all treatment had since been withdrawn and the person was being kept comfortable in bed whilst the medication record for this person had been crossed through on 08/02/08 and indicated that the person could no longer swallow. However their care plan did not reflect this. The manager confirmed that the persons G.P. had been consulted about the person’s care and he had agreed that it was in the persons best interests to stop treatment. This person was visited in their own room. There was a tray of mouth swabs next to the bed for ensuring that their mouth was kept clean. An airway pressure relief mattress had been provided for the bed. The bed was a hospital style profiling bed, which could be easily adjusted by staff when providing care. A record of the revised manual-handling plan had been pinned to the wall in the persons bedroom. However the care plan, which was being kept in the persons room, did not have a completed record of the updated manual handling plan. Risk assessments for the use of bed guards, which were in use, had also not been completed and the reason for bed guards being used had not been recorded. Another person whose care was followed had been admitted from another nursing home. The care plan contained a summary of the care needs provided by the home they were transferring from. The staff at Hill House had completed a clear assessment of need at the time of their admission. A plan of care had been developed from this assessment of need, which was dated August 2007. There was no evidence that the care plan had been reviewed on a monthly basis thereafter. The manager advised of some of the changes that occurred with this persons care and explained how staff were managing these. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 14 The daily records for this person showed how other health professionals had been involved in advising staff how to manage this persons care, which helped guide staff how they should care for this person. However the person’s plan of care did not reflect any of this information. Two staff spoken to were aware of this person’s care needs. The person was sitting in the communal lounge during the inspection. They had a specialist chair that reduces the risk of falls. The care plan identified that the person was at risk of falling because of uncontrolled movements. Although there was a risk assessment for use of the chair they were seen in as the chair did not allow them to stand independently, the assessment had not been fully completed and did not identify how the decision to use this type of chair had been reached. Information about other health professionals involved in the decision to use this type of chair had also not been recorded. There was information in the initial assessment and care plan and the information from the previous nursing home about the risk of the person falling. However these had not been updated in the care plan, at Hill House since August 2007. The persons room was visited and it was noted that they had a hospital style profiling bed with bed guards attached. Again the persons care plan did not contain a risk assessment for use of bed guards, which are again considered to be a form of restraint. Although care plans were not up to date the staff caring for this person appeared to know what their care needs were. A staff member was observed speaking to this person. Although the person was unable to communicate verbally and had difficulty getting across what they wanted the staff member spent time explaining and talking to the person. Another person whose care was followed had a plan of care completed that showed they needed a catheter to manage their continence needs. However discussion with the nurse in charge of the shift revealed that the catheter had been removed one month earlier. They further commented that since the catheter had been removed the episodes of infection had decreased. From the daily statement it was unclear when the catheter had been removed and how the care had been changed. Again this was not recorded within the person’s care plan. The initial assessment identified that this same person did not like being alone and called out when they were left on their own. The care plan identified that they were now being cared for in their own room, which actually meant that they had less contact with other people. The person appeared well cared for and had a good rapport with the staff members speaking to them while they were providing care for them. The person did not appear distressed by being alone in their own room but none of this updated information was recorded in the person’s care plan. The staff providing the care for this person were however aware of the changes. Information about wound care plans had been recorded this showed how infection was being managed. The person’s room contained gloves and aprons and a clinical waste disposal bin, for staff use. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 15 The gloves and aprons were stored in wall-mounted boxes that did not detract from the homeliness of the person’s room. The registered nurses had recorded how the wound was healing, what dressings had been used and the size and position of the wound being dressed. The nurse in charge of the shift during the inspection advised that usually the same nurse completes the dressings as this enables them to clearly see how the wound was healing. One entry in the daily statement made by a registered nurse on 14.12.07 indicated that they had responded to an immediate clinical need by providing a specialist procedure three times, however there was no record that the person’s GP had been informed of this nurse’s action. No other incidents of this procedure were recoded in the daily statement from this date to the date of the inspection. The manager advised that the registered nurses always discuss changes with the persons G.P. however the person’s plan of care had not been up dated to record this. Another person whose care was followed was occupying a shared room with their partner. When asked the partner said they had chosen to share a room. The care plan for one of the people was viewed. This contained their initial assessment of care needs from 2006 and an up dated assessment from 2007. However the care plan did not have a record that the care had been reviewed monthly. A high risk of pressure sore development had been recorded. The person had an airflow mattress on their bed, which was a hospital style profiling bed. Manual handling risk assessments had been completed and up dated in July 2007 but not since. The person was sitting in a bucket style chair, which would not enable them to stand independently and could be classed as a form of restraint. Risk assessments for use of this type of chair did not fully identify how the decisions to use the chair were made and which health professionals had been involved in the decision. One person who had been admitted to the home for “end of life” care also had their care plan viewed. This person had been admitted to the home two days before their death. There was a clear assessment of their care needs and goals for their “end of life” care. The Liverpool care pathway document had been used as a care-planning tool to ensure that the person’s end of life needs were fully met. The Liverpool care pathway is a plan of care that involves all professionals who may be involved in the care of a person who is designated as being at the end of their life. It allows for all involved with the care of the person, including the person themselves where possible, their family/carer, staff and other professionals to agree and follow the same plan of care. This ensures a continuity of care and an understanding of the person’s very specific needs at this sensitive and often challenging time. The training facilitator, from the local Hospice, who was present in the home during the inspection, stated that Hill House is excellent at returning their Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 16 evaluation documentation that informs the hospice as to how the staff found using the Liverpool care pathway had helped them provide care to the person concerned. There are links with specialist services such as the Parkinson’s nurse and the Parkinson’s Society. The home also works closely with local G.P.’s and the local Hospice. The palliative care nurse from the Hospice was contacted and spoken with. She confirmed that the owner and staff work closely with her and seek her advise on any matters that they need clarification on. She stated that she has confidence in the staff to provide the correct care to people who live at the home who are in receipt of “end of life” care. The completed care plan showed that the person had received the care they had needed. The involvement of family and the views of the person were recorded. Staff spoken with understood the Liverpool care pathway and how it is used to ensure people at the end of life receive the care they need. Staff observed and those spoken to appeared knowledgeable about all the people they were caring for. They were able to say what was important for each individual person they were caring for. People seen speaking to staff or receiving care appeared to have a genuine rapport with the staff who were providing their care. Staff spoken to said they have a handover at the start of each shift and each person’s care needs are discussed. The manager advised that agency staff who work at the home always work with a member of the home’s staff who know the people they are caring for. Each person had a locked medication storage cupboard in their room for storage of their individual medication. The four people whose care was followed had the contents of these cupboards examined. All had the current medication prescribed for the person, which was in date. Where eye drops had been opened the date they were opened had been recorded. Further storage for medication was in a locked cupboard in the hallway of the home. A lockable drug fridge, which had a record of the temperature, was also in this area. The nurse in charge of the shift advised how the medication for individuals was ordered and how medication no longer required was disposed of. A book recording the medication disposed and the date that this happened was being kept. However the staff member disposing of the medication had not signed the book. The controlled drug book was checked. This had been completed as expected. Where such medication had been disposed of this was signed and dated by two members of staff. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 17 The nurse in charge of the shift advised that one registered nurse takes responsibility for ordering and checking medication for the people. The four medication records viewed showed that the medication and the amount had been checked and initialled by the nurse checking this. Although the dressings, being used to dress wounds were not recorded on the medication sheets, information that the dressing used had been discussed with the persons G.P. had been recorded in the person’s daily statement. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 18 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 The quality in this outcome area is good. People benefit from a peaceful and calm environment, with visitors encouraged and welcomed, where they also have the opportunity to participate in activities should they choose to. Staff respect peoples’ personal choices and the home provides good nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner’s vision is a service where the needs of those needing “end of life” care can be met. This means accommodating all peoples’ individual lifestyles and the owner stated: “The house has no rules, people who live at the home live their life as they want to, as far as possible” The staff are skilled at recognising peoples’ individual lifestyles and try their best to ensure that they maintain these. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 19 Staff do this skilfully by allowing the person to undertake tasks, as they are able but being available for support as required. The home takes accounts of peoples’ personal choices and preferences, for instance the home employs a male carer, however where a female person may not wish to have personal care delivered by a make this is facilitated. Meals provided are nutritionally balanced with choice available. On the day of inspection the meal was liver and bacon, potatoes, cabbage, carrots and gravy followed by homemade rice pudding. Although choice is available menu choices showing this, were not communally displayed and people would not always be aware, unless they asked, what was for lunch or tea or what alternatives there were. Several people (sixteen) at this inspection, needed purred food. It was pleasing to be told that each separate component of the meal is pureed separately to provide a visually pleasing and pleasantly tasting meal. It was noted that several people who live at the home also need help with feeding. Staff were observed undertaking this task and it was noted that it was done sensitively, gently and sufficient time was taken to ensure that the person being helped was able to eat their meal as they chose to. Staff spent time with each person individually and spoke with the person during the time they were with them. The consequence of this is that people were encouraged to eat as much as they could manage and did so. One relatives’ feedback indicated that they felt their relative had been left to manage alone on occasions, but did need help with feeding. This was discussed with the owner who stated that this was unacceptable and would immediately look into the matter of ensuring all who needed support with feeding were automatically provided with this support. This evidenced that the manager has the welfare of the people who live at the home at heart and will do all possible to ensure their needs are fully met. Meals are served either communally in the home’s pleasant, light airy lounge areas or individually in bedrooms. It is the person’s own choice with this as it is with all other aspects of care. The home’s cook was spoken with and it was clear that she was aware of the peoples’ nutritional needs. There is always a cook on duty to provide breakfast, lunch and tea. Staff are not responsible for the preparation of any meal. Visitors were noted as coming and going freely from the home, and were always spoken with on arrival by a member of the home’s staff. It was noted that the owner was available to have several in-depth conversations with those Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 20 visitors that wanted to speak with her regarding their relative’s/friend’s care needs. There are daily activities including music sessions, animal therapy, aerobics and massage, occupational therapy sessions as well as weekly visits from the hairdresser. There is an in-house library, videos and audio books also made available. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 21 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. The quality in this outcome area is good. Arrangements for protecting people and responding to their concerns are such that they should be protected. Staff have an awareness of adult protection issues, which will allow them to maintain the peoples’ welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no formal complaints received about the service since the last inspection. The homes complaints procedure was available within a communal area and details on how to complain were noted to be in the home’s service user guide. The owner stated, and staff confirmed, that they had received vulnerable adult training. The home does not deal with the peoples’ money and encourage families of peoples’ advocates to take on this responsibility. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 22 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 and 26. The quality in this outcome area is good. People who live at Hill House have a pleasant well-maintained environment to live in, which has been adapted to meet their care needs in a sensitive way. This helps to maintain a homely atmosphere for people living at the home and for staff who work there. Vigilance needs to be taken regarding the correct storage of any chemicals to ensure the people who live at the home remain safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the building was undertaken with a staff member. Each area of the home was viewed however not all individual rooms were entered. Four people who live at the home’s rooms whose care was followed were visited in their own rooms. The home, overall, was fresh, clean and free from any odour. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 23 The bedrooms seen were pleasantly furnished with a person’s own belongings if wished and were nicely decorated. The recently completed purpose-built new extension has all en suite rooms. These rooms have a toilet, and wash basin and walk-in shower. In addition to these en suite rooms there are bathrooms available for people to use with assistance if this was required. Two of the disabled access bathrooms had bottles of cleaning chemicals, which were with in easy reach. The manager advised that these had been put in the bathrooms when there had been a recent outbreak of a stomach bug. The manager confirmed these would be moved. She also commented that shelving and cupboards were to be fitted in the bathrooms, which would make it easy to store chemicals safely. The manager confirmed that all the people living in the home have hospital style profiling beds, which makes it easier for the staff to provide care and easier for people to be independent if they are able. It was noted that beds could be adjusted to the optimum height to allow the person to get in and out of bed with minimal assistance. There are three lounges areas for people to use. One is in the older part of the building and two in the new extension. One of the lounge areas was of a conservatory style, which gives good views of the surrounding area and has a patio area off. The manager advised that people enjoy sitting on the patio area in the better weather. People spoken to who, were using this lounge during the inspection, said they enjoyed spending time there. One relative was playing a game of dominoes with one of the people living at the home. Other people were speaking to each other or reading a book. The manager advised that the three lounge areas allow people to choose if they want to take part in the activities provided or spend time in a quiet area or seeing visitors. The laundry area was sited well away from the peoples’ accommodation and the kitchen of the home. The laundry had washing machines capable of disinfecting soiled laundry. The space in the laundry enabled soiled and clean laundry to be easily separated. The home has disinfecting sluice rooms for the disposal of necessary waste and for the cleaning of commode pots and bedpans etc. The owner and the staff confirmed that all towels, flannels, napkins etc are freshly laundered on a daily basis, to ensure the peoples’ comfort. During the visit to the home the manager advised of further improvements she intended to make to the environment for example, the re-positioning of the office that staff use in the home was discussed. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 24 The manager advised that she was looking at the possibility of moving this to provide a more secure space for storage of confidential information. Routine general upgrading continues to take place, including re-decorating, refurbishment and re-carpeting etc, which ensured that the accommodation is maintained to an excellent standard. The new works to create the new extension have been undertaken to a very high standard ensuring that people benefit from a very pleasant environment overall which is in keeping with their needs whilst the tour of the home confirmed that the owner and staff maintain excellent environmental standards, overall, within the home. Privacy locks to peoples’ bedroom doors are in place in the new extension and the management confirmed that all hot surfaces are protected and all hot water outlets regulated to a safe temperature with a sample seen and tested confirming this. Attention to detail has enhanced peoples’ lifestyles. For example, specialised comfortable chairs have been provided as needed and specialised profile beds have been provided in all bedrooms. The home presented as very clean and feedback given from various parties, during the visit, indicated that this was normal. There were no unpleasant odours what so ever throughout the home. During the visit staff were noted as observing routine health and safety procedures, such as using gloves and washing hands which helps prevent any unnecessary cross infection within the home. All bedrooms are equipped with gloves for staff use therefore helping prevent the risk of cross infection within the home, which ultimately protects people. The home has the necessary collection of clinical waste as required. The home’s external gardens have been/ and continue to be landscaped and provide a relaxing safe area for people to enjoy looking at or walking in with the garden being easily accessible and pleasant to look at. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 25 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. The quality in this outcome area is adequate. Trained, experienced staff at the home are employed in adequate numbers to meet the peoples’ personal care needs. However the home’s induction programme for new staff and the home’s staff recruitment procedures do not always fully protect the people who live at the home. EVIDENCE: At the commencement of the inspection the owner, Mrs Stockwell was on site. Care observed evidenced that people who live at the home did not have to wait long if they called for help and that staffs’ responses were kind, professional and helpful. There was an induction programme in place but although some completed records were seen, the programme did not appear to be in-depth, rather just covering the very basic requirements. However there was evidence that the induction training had later covered areas such as fire training, safeguarding adults and dementia awareness training. Although the matron stated that there is now a permanent member of staff with responsibility for the training within the home (and who is undertaking a formal teaching qualification) a list of what training staff had had or of what was needed could not be located at the inspection, so it was not possible to Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 26 fully verify which staff had received which training although staff, spoken to, confirmed that they received a variety of training and an NVQ assessor, who was in the home during the inspection, confirmed that she had had a regular input into the home’s staff training programme for about four years and had taken at least 30-35 staff through NVQ training. Also on the day of inspection there was a trainer from the local hospice who had come to give a training update on the use of the Liverpool Care Pathway programme. All staff further confirmed that they had received food hygiene training last week. The matron did however confirm that there had not been any equal opportunities training provided. There was no written evidence of any staff supervision having taken place, although the owner did state that she felt it took place on a daily basis, with herself and other senior staff continually observing staff practice and making suggestions as to how best to deliver good quality care. Recruitment records were looked at for the staff employed at the home since the last inspection. They were mostly in order, however new Criminal Record Bureau checks had not been undertaken for some staff employed from another care home and in one case a CRB had not been undertaken at all. Neither was there a named supervisor for these staff, all of whom were already working within the home, some providing personal care. Additionally, there were not always two written references available for each employed staff member. This could compromise peoples’ safety by personal care being given by inappropriate staff. One comment received from a relative stated that they felt there was shortage of staff on duty on occasions, however the rota showed that the staffing levels were in order and staff confirmed that, apart from unexpected sickness or annual leave they felt there was enough staff employed to allow them to provide the required care. A typical days staffing for a full house (36 people who live at the home) would be: The owner/matron who is always available. The deputy matron who works 9-3 Monday to Friday. 1/2 Registered Nurses. 9 Health Care Assistants. 4 Cleaners. A Cook and an assistant cook. On the day of inspection there were 31 people in the home. Therefore the staffing was: The Matron. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 27 2 Registered Nurses. 7 health care assistants and 1 agency staff member (where possible the home tries to use an agency staff member who is known to the home as was the case on this occasion). Night cover is provided by 1 registered Nurse and 2 Health Care assistants. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 (Some parts of standard 37 was also inspected) Quality in this outcome area is adequate. The management of the home is generally good with the owner and her deputy ensuring the physical and health care needs of the people are well met. However some slippage of required management administration tasks needs to be addressed to ensure that the home continues to be run in people’s best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has undergone an intensive period of Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 29 change due to the changing nature of the home in providing an extra 18 beds and with the provision of a very busy and much needed “end of life” care provision. Staff spoken to stated that they found the owner and her deputy approachable, with time to listen and help. The owner and the deputy are helped in the administration tasks by two administrators whose role is the day to day general tasks associated with the running of a home such as payment of accounts etc. It was noted that the nurses station /office staff use within the home was open plan and opened onto a corridor used by visitors staff and people living at the home. The walls of the office had notices pinned on them giving personal information about the people who live in the home (name, room number, date of birth and a medication prescription for one person). There was also confidential information pinned to the notice board in respect of staff, for example, personal telephone numbers etc. Having this information on display does not fully protect peoples’ confidential information. Following discussion with the manager personal information was moved during the inspection and stored in a locked cupboard. Accident reporting was noted as in order, within the home, and the home had let the Commission know of most of the deaths that had occurred since the last inspection. This number has increased significantly since the last inspection, due to the nature of the service now provided. It was noted that some regulation 37 notices, in respect of some other deaths had not been forwarded to the Commission but the Matron stated this had been an administration error, which was unlikely to occur again. Although the owner stated, and evidence was seen of a large quality audit having been undertaken last year, there was no evidence that the information had been collated in such a way as to allow the management to see what strengths and weaknesses the home has and how this information can be used to better the service provided. The people who may have been involved in providing any feedback within this process, had not been made aware of how their views would be acted upon or taken into account in the future planning for the home. The most up to date collated quality audit findings that were publicly available, within the home’s current statement of purpose were dated 2003 and therefore clearly out of date. There was no also current action plan available for the home. There were policies and procedures available but there was no date as to when these had been last reviewed, although the home’s completed Annual Quality Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 30 Assurance Assessment had indicated that all policies had been reviewed in November 2007. However it could not be verified at the inspection that this had taken place at this point as no date was confirmed on each policy. Also it was impossible to verify whether or not staff had read them as there was no indication of this either. The owner stated that the home’s health and safety procedures were being maintained as required. The home’s administrators stated that the home does not hold any monies on behalf of the people who are staying there, therefore there are no systems in place for this facility. Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 31 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x N/A 1 2 3 Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15(1) and (2)(b) Requirement The registered owner must ensure that the care plans are reviewed monthly and any changes noted. This will ensure that the people receive mutually agreed continuing support that meets their needs. The manager provided written confirmation that this requirement had been meet prior to the publication of the report The use of restraint measures such as cot sides, or recliner chairs, must be risk assessed by the management of the home and advise sought as to the extent and use of such restraint from other relevant professionals. The use of such measures must always be discussed with the person it affects and /or their family/advocate. The final decision and the reasons for it should be fully recorded. DS0000028683.V356136.R01.S.doc Timescale for action 12/04/08 2. OP8 13 (7) 12/04/08 Hill House Nursing Home Version 5.2 Page 33 This will ensure that the peoples’ health care needs are being met. The manager provided written confirmation that this requirement had been meet prior to the publication of the report The management must ensure that the staff working at the home receive appropriate training for the work they do. This refers specifically to ensuring that new staff receive an appropriate induction training programme. This will ensure that the people who live at the home are cared for by an aware and understanding staff group and as such receive the correct care. 4. OP29 19 (1) (b) (i) The registered owner must ensure that there is a robust recruitment programme operating within the home, which includes the receipt of two written references and completed enhanced Criminal Record Bureau checks. This will ensure that only suitable people are recruited to provide care to the people who live at the home and therefore protect the people who live at the home. The registered owner must continue to provide a structured system to monitor the quality of the service provided. This should include obtaining the views of service users and other stakeholders. An annual development plan must be drawn up after DS0000028683.V356136.R01.S.doc 3. OP28 18 (c) (1) 12/06/08 12/04/08 5. OP33 24 (1) (a) and 2 12/06/08 Hill House Nursing Home Version 5.2 Page 34 obtaining this information and this report must be made available to the Commission. This will ensure that all involved in the receipt of care are able to have a say into how that care is delivered and that the home has a structured plan to address any shortfalls and build on the positive aspects of the home. The management must provide 12/05/08 regular supervision to all staff and keep records of the same. This will ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member to discuss any issues of their role that they may wish to have extra support with and also for the management of the home to monitor the progress of each staff member and to offer support/training as required. This will ensure that staff are enabled to feel confident in their role. 7. OP37 37 1(d) The management must ensure that the full details regarding the circumstances of any serious illness or the death of any person at the home, are forwarded to the Commission. This is so the Commission can monitor any such events and ensure correct action has been taken which will help to protect the people at the home. The registered owner must ensure that the home’s polices and procedures are regularly reviewed and updated. 12/03/08 6. OP36 18 (2) 8. OP37 24 (1) (a) (b) 12/05/08 Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 35 This will ensure that those working at the home are aware of the expectations and guidelines in place to ensure that a good quality of care is provided as laid down in the home’s polices and procedures. 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. Refer to Standard OP1 Good Practice Recommendations The home’s service user guide and statement of purpose should be updated to reflect up to date information about the home. Medications disposed of should be signed for and dressings used to provide for clinical needs should be recorded. The registered person should ensure that there is a menu available displaying the choice of meals which are available at the home. All cleaning materials should be stored securely. The home should keep a record of all training provided to all staff. Equal opportunity training should be provided to all staff. All record keeping should be maintained in accordance with Data protection Act 19988 requirements. 2. 3. 4. 5. 6. 6 OP9 OP15 OP19 OP30 OP30 OP34 Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Hill House Nursing Home DS0000028683.V356136.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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