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Inspection on 14/12/05 for Hill House Nursing Home

Also see our care home review for Hill House Nursing Home for more information

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The recruitment process is more consistent and ensures that all staff employed at the home are checked in the same way to ensure they are suitable and have the aptitude to work with elderly residents.

What the care home could do better:

The plans of care should be regularly reviewed by the staff in the home and agreed by the individuals for whom the care is to be given, failure to do this poses the risk of care being inconsistent and some needs not being met. A safer system for the storage of medication no longer in use needs to be put in place to reduce the risk of medication being misused. Environmental risk assessments should be performed and appropriate action taken to negate the risk posed through practises such as wedging doors open.

CARE HOMES FOR OLDER PEOPLE Hill House Nursing Home Park Avenue Brixham Devon TQ5 0DT Lead Inspector Fiona Cartlidge Unannounced Inspection 14th December 2005 11:15 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.V259566.R01.S.doc Version 5.0 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.V259566.R01.S.doc Version 5.0 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 23 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (23), Terminally ill (23) of places Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service Users aged 65 years and over PD Maximum registered 23 service users (both) OP Maximum registered 23 service users (both) TI Maximum registered 23 service users (both) Date of last inspection 28th June 2005 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 on the Schedule 11 listing for Torbay. Exposed beams, inglenook fireplaces and uneven floors give the house a homely, cottage feeling. The 23 registered beds are provided in 6-shared rooms and 11 single rooms. Some of the rooms in the main house are oddly shaped and small; an extension has larger rooms some with en-suite facilities. Due to the age and construction of the building, the home is currently unable to accommodate self-propelled independent wheel chair users. A passenger lift is provided to the first floor and ramps are provided along some corridors. The home caters for older people with physical disabilities and frailty. A range of equipment and adaptations are provided for Service Users following an assessment of their care needs. A registered nurse is on duty at all times supported by a team of Health Care Assistants. A two storey extension was under construction at the time of this inspection. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours 15 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 2 residents and personnel records of 2 members of staff were inspected. The inspector spent the majority of the time talking with 15 residents, 3 visitors, the registered manager/provider and took time observing actual practise. What the service does well: This home has an organised, cheerful and friendly feel to it. The residents spoken to confirmed that the staff are kind, helpful and hardworking. The inspector observed that the interaction between the staff and service users was extremely good, each individual being treated with respect in a supportive manner. Feedback about the food served in the home was also good, people said it was of good quality and served in ample portions, options to the main dishes are always available and individual dietary needs are catered for. Drinks were seen to be available and regularly offered. The environment is clean and cheerful; the décor and furnishings in bedrooms are based on the individual choice of those living with in them. The management of the home is professional and approachable. Quotes received from residents during this inspection included: ‘ I’m being looked after very well, couldn’t be better’ ‘the carers and the nurses are wonderful’ ‘the foods good, nice choice’ ‘can’t fault it, the matrons lovely’. The home has a good range of equipment to assist in the safe moving and handling of residents. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5 Sufficient information is obtained about prospective residents to ensure the admissions process is safe. People are invited to visit the home before making a decision about admission. EVIDENCE: The inspector randomly examined personal documentation held on behalf of 2 residents; both included pre-admission information supplied from care management or hospital settings about the residents assessed needs. The inspector spoke to a number of residents about how they had made the decision to be admitted to the home, the inspector was told by one person that they had known the owner for a number of years and knew of her high standards. Another told the inspector that she had heard about the homes good reputation from people who had visited the home. Another resident said they and their relative had been given the opportunity to visit the home and assess its suitability before making a decision to stay. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The Care plans seen had not been reviewed by staff in the home on a monthly basis, this may pose a risk to residents, as staff may not formally recognise changes and be consistent in their approach to meeting needs. The health care needs of residents are regularly reviewed and action is taken to meet those needs. Poor and inaccurate recording of medication administration has the potential to place residents at risk of either over medication or not receiving medication as it has been prescribed. EVIDENCE: The 2 documented assessments seen, provided information about skin integrity, moving and handling, safety - including risk of falls, only 1 had a nutritional assessment completed and only 1 of the 2 included social care needs assessment. This information obtained following admission and the information supplied before the individuals admissions generates the plans of care, which provide the basis for the care to be delivered. The inspector viewed 2 residents’ care plans; these had not been reviewed as recommended by staff in the home on a monthly basis. Daily records are not Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 10 maintained rather an entry is made when care provided or residents conditions warrant it. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, chiropodists, physiotherapists and dentists also visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. One resident told the inspector that they were expecting a consultant ophthalmologist to visit them in the home later that week. Residents told the inspector that the staff respect their privacy and dignity, the inspector observed that when personal care was being provided this was done behind closed doors, the staff spoke to residents in a polite manner and were witnessed to knock on the doors to private accommodation before entering. The inspector examined the system of medication management, one administration record lacked signatories where medication should have been administered as prescribed, another medication was written as 1 or 2 tablets to be given, there was no indication of how many had actually been administered. Medication no longer in use had been placed in the correct bin for disposal by a licensed waste contractor; however this bin was being stored in a cupboard, which could be accessed by non-nursing staff. The records of controlled medication held in the home were seen and balances were checked against the records and found to be correct. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Social activities are organised and provide stimulation and interest for residents on most days. Meals are nutritious and balanced offering a healthy and varied diet for residents. The arrangements for residents to receive visitors are good. EVIDENCE: Following admission to the home, the staff usually record details of each residents social history which includes past occupations, experiences, hobbies and interests this information aids the staff to put an individual social care plan in place. Some residents were seen socialising in the lounge or watching television others were spending time in their rooms, reading, listening to music and knitting. On the afternoon of the inspection a visiting therapist provided an light exercise class in the lounge. A notice in the office indicated that newspapers are ordered for those who would like them. The feedback about food was positive all of the residents spoken to said how good it was; on the day of inspection lunch was served, residents were offered cottage pie with carrots and Brussel-sprouts, followed by rice pudding. 6 residents ate their meals whilst sat in the lounge at individual tables; those requiring assistance were given this in an appropriate supportive manner. All Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 12 other residents ate their lunch in their own accommodation. Records seen provided evidence that resident’s weights are regularly monitored. The people living in the home told the inspector they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 People’s complaints will be listened to, taken seriously and acted upon. EVIDENCE: The complaints procedure is communicated to residents and/or their representatives, a notice explaining the procedure was found displayed in the residents lounge, the information is in enough detail to ensure people have the means to refer a complaint to the Commission at any time. Residents told the inspector if they had issues or concerns they would speak to the matron/manager who is ‘very approachable’, and asks regularly if residents have any problems. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Hill House is simply decorated and furnished in a homely fashion and is clean, pleasant and hygienic. EVIDENCE: Most of the building is old and has been converted for its current purpose; it provides a homely environment for people who like a ‘cottage’ feel to their home. The floors are uneven and therefore advice is given in the information for prospective patients, that the home is not suitable for those who use selfpropelling wheelchairs. A passenger lift provides access between the 2 floors. The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses were seen in place for those residents requiring them as were height adjustable beds. Resident’s rooms contained personal items of furniture, ornaments and pictures Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 15 The home was fresh and clean in its appearance, hand washing facilities are available throughout as were protective gloves and aprons and procedures followed by the staff minimise the risk of cross infection. An extension was under construction in the grounds adjacent to the existing building at the time of the inspection. Only 2 of the residents spoken to communicated dissatisfaction with the works in progress one because they no longer had birds visiting the part of the garden their room overlooked and the other because of the noise of the diggers which they said had got better since the footings had been finished. Residents and their representatives have been consulted about the extension. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 The procedures for the recruitment of staff are robust and offer protection to people living in the home. The deployment and number of staff on duty during the inspection met the needs of the residents. EVIDENCE: Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 17 Most of the residents told the inspector that there were enough staff on duty, they said they ‘worked hard’ and were ‘very caring’ –‘nothing is too much trouble’. One resident said sometimes they felt the staff were rushing when assisting them at meal times. The manager showed the inspector the record of the response times to the call bells and said these are regularly reviewed. On the day of inspection there were 23 residents in the home the manager was available in the home with additional Registered Nurse cover from 8.00am to 8.00pm and 5 carers in the morning, 3 carers in the afternoon and evening and 1 Registered Nurse and 1 carer at night. In addition to the care staff there were 7 ancillary staff on duty for catering and domestic/laundry duties. The staff spoken to said that they felt there was sufficient numbers of staff on duty and said they had access to training and development. The inspector examined the personnel files of 2 recently employed members of staff these provided evidence that the recruitment process is fair, equitable and safe and all required checks are performed to ensure the safety and welfare of those living in the home. Two relatives/visitors told the inspector that in their opinion there are enough staff on duty to meet the needs of residents. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38 The home is being managed effectively and in the best interests of its residents. Failure to ensure that bedroom doors are held open with ‘safe’ devices poses a fire risk to residents. EVIDENCE: The registered manager/provider is an experienced 1st level registered nurse. Patients, visitors and staff made positive comments about the manager in the home saying they felt comfortable approaching her with Issues. Communication systems are regular through staff handovers and regular formal appraisals for all staff. The inspector found a number of doors to resident’s bedrooms wedged open this dangerous unacceptable practise poses additional risks in the event of a fire and was discussed with the registered provider at the time of the inspection. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 19 Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 2 Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Medication administration records must be accurate. The storage of medication no longer in use and awaiting collection for destruction must be stored securely. When a resident wants their bedroom door open this must be done so by a ‘safe hold open’ device approved by the Devon Fire rescue department. Doors must not be wedged open. Timescale for action 01/01/06 1 OP38 23(4) 01/02/06 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 OP7 Good Practice Recommendations Care staff in the home should review all residents care plans at least once a month, and update them to reflect changing needs and current objectives for health and personal care. Hill House Nursing Home DS0000028683.V259566.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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.V259566.R01.S.doc Version 5.0 Page 23 - 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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