Inspection on 18/03/09 for Hill House Nursing Home

This inspection was carried out on 18th March 2009.

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

Hill House Nursing Home 12/02/08

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

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Poldhu

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Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hill House Nursing Home Park Avenue Brixham Devon TQ5 0DT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Proctor     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Hill House Nursing Home Park Avenue Brixham Devon TQ5 0DT 01803853867 01803854757 hillhousenh@btinternet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Ann Margaret Stockwell Name of registered manager (if applicable) Mrs Ann Margaret Stockwell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 4 bedrooms (identified and recorded on site visit) not to be used for Service Users until a site visit has been performed by the Commission for Social Care Inspection and confirmation of their fitness for purpose has been agreed Old Age not falling within any other category (OP) 38 Physical Disability (PD) 38 Date of last inspection Brief description of the care home 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 self-propelled independent wheel Care Homes for Older People Page 4 of 35 care home 38 Over 65 38 0 0 38 Brief description of the care home 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. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection took place on 18th March 2009 between 09:30 am and 4:30 pm. There were 30 people living at the home at the time of this inspection. During the visit a tour of the home was completed. People living at the home and staff were spoken to and some records were inspected. Three of the people living at Hill House had their care followed as part of this inspection. The room they occupied in the home, their records of care were seen. And where possible people were spoken to about their experience of care. Information received from the home since the last inspection was reviewed, this included the AQAA (Annual Quality Assurance Assessment). This was received prior to Care Homes for Older People Page 6 of 35 the visit to the home. Anonymous survey forms were returned from five people living at Hill House, one relative, four health professionals and four staff. Some of the comments made in the survey forms and during the inspection have been incorporated into this inspection report. The Requirements made at the Commissions last key inspection were also reviewed with the manager. All required core standards were inspected during the course of this inspection. What the care home does well: What has improved since the last inspection? Hill House has an up dated service user guide and statement of purpose, which reflects the changes made. This allows people to make an informed choice about whether the services and facilities Hill House offers can meet their needs. Peoples care plans were up to date and reflected the current care being provided. Changes in care needs had been well recorded. This ensures all staff are aware of what care has been agreed, and therefore allow staff to know how best to meet a persons needs. Complex care needs were clearly recorded and included specialist health care professionals advise for staff. Restraint used i.e. the use of a cot side, recliner chair had been risk assessed by staff, with advice sought from outside professionals. Agreement from the person themselves and or their family,advocate as to the use of such restraint had been recorded. Where a person lacked capacity best interests risk assessments had been completed. This should ensure any equipment used was in their best personal care interests. Medications disposal records were complete and had been signed by the member of Care Homes for Older People Page 8 of 35 staff disposing of the medication. This should protect people who live at the home. A menu was displayed in the lounge to allow all people to know what was available for each meal. This enables them to make an informed decision as to what they would wish to choose. Cleaning products had been stored securely to prevent any risk to the people or to the staff working at the home. Records kept at Hill House were being maintained in accordance with Data protection Act 1998 requirements. This ensures peoples right to confidentiality was maintained. The management has completed a 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. The results of this had been made available for people in the reception area of the home. This should ensure Hill House operates taking into account peoples best interests. Hill House policies and procedures had been updated as required to include current good practice and up to date information. This should ensure 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 should ensure that the people continue to receive good quality care. The management of the home has inform the Commission of any serious illness, untoward incident or death involving any person living at the home. This will ensure that the Commission can be aware of and monitor any such incident and therefore be aware how the home responds. This should ensure the well being of the people is upheld. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 35 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes statement of purpose and service user guide had been up dated to reflect the changes made in the services provided. This provides sufficient information to allow people to make an informed decision about whether the home can meet their needs. 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. Hill House does not provide intermediate care, but does offer respite care. Evidence: The statement of purpose and service users guide had been updated since the last inspection. A copy of this was available in the office of the home. The manager advised Care Homes for Older People Page 12 of 35 Evidence: that copies are left in the reception area of the home for people to see. The information contained in a statement of purpose give sufficient information to allow people to make an informed choice about whether Hill House can meet their needs. Three people living at Hill House had their care followed. This included speaking to the person where possible. Visiting the room they were occupying at the home. And looking at the documentation, assessments and care plan relating to the care they were receiving. Two other care plans and assessments were looked at as well as these. The assessments for these people had been recorded very clearly. They identified the care needs and a care plan had been developed from their assessment of need. Risk assessments were an integral part of the assessment process. These included nutrition using the MUST Tool, pressure sore risk, risk of falls and manual handling needs. Where risk has been identified a plan of care had been put in place to reduce the risks for the individual. One person whose care was followed lacked capacity to make an informed choice about their care. The mental capacity assessment had been completed by the deputy manager. This clearly showed how decisions about the persons care had been made in their best interests. The involvement of the multidisciplinary team in their decisionmaking was also apparent. The deputy manager advised that staff had received training with regard to assessing mental capacity. The documentation for the mental capacity assessment had been provided by Torbay Care Trust. The assessment of individual needs covered the activities of daily living for the person. Assessments included what was important to the person and what their interests were. The deputy manager advised that as part of the assessments the person and their family are encouraged to provide a personal history. This provides information about what the person had achieved and who or what was important to them. The deputy manager advised that this process has been very important to helping new people settle into the home. A great deal of effort goes into the pre admission processes, involving the homes owner and the qualified nurses based at the home. The deputy manager confirmed that, where possible, people are assessed prior to being admitted to the home. She also commented that if the person was unable to visit the home relatives are encouraged to do so before the person was admitted. However due to the nature of care provided and often urgent requests for admission this cannot always take place. In these instances pre-admission documentation had been received from care managers or health care professionals. These assessments identified their main health problems and their self-care abilities. Care Homes for Older People Page 13 of 35 Evidence: Comments received in anonymous surveys included. Matron and deputy spent time with my sister and myself prior to as choosing Hill House and then accepting mum. We were shown around and given both verbal and written information, A comprehensive brochure provided more information than the three previous homes lived in. Matron visited me in hospital, prior to my moving to Hill house in order to answer my questions. My sons were invited to visit and inspect Hill house twice before my moved there and were able to discuss the type of standards of care I would like to receive, given the changes for me from residential (via hospital) to nursing home care Although Hill House provides respite or short stay placements for people. They do not currently provide intermediate care. Care Homes for Older People Page 14 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way peoples health and personal care was monitored and planed by the staff recognizes the persons individuality, while meeting their complex needs. The competent well-trained staff team are committed to improving peoples experience of care at Hill House. People can have confidence that staff will be respectful, polite and listen to them and act on what they say. Medication practices are safe People who live at Hill house are treated with respect and dignity, their individuality recognized when their care is planned. Staff endeavor to understand what is important to the person they are caring for and provide care that recognizes their individuality. Evidence: The care of people living at Hill House was being overseen by registered nurses who were available each shift. They are supported by a team of health care assistants who have been trained to care for people with complex health care needs. Three people Care Homes for Older People Page 15 of 35 Evidence: had their care followed as part of this inspection. This involved speaking to the person where possible and visiting the room they occupied. Individual care plans; assessments and medication records were also viewed. Two other plans of care for people living at Hill House were also viewed. Each care plan had being reviewed monthly or sooner if the persons needs had changed. The deputy manager advised that the computer care planning system they operate generates core care plans and these are updated to reflect the individuals care needs. The three people whose care was followed had clear information about their health and personal care needs. Their past medical history and the personal preferences were also recorded. The care plans clearly showed the person self-care ability and how staff should support them. The care plan included preferred times for personal hygiene tasks, getting up or going to bed and preferences for food. One person whose care was followed lacked capacity to make an informed choice. Their care plan clearly recorded the care they needed and how staff should provide this. The risk assessment and the mental capacity assessment clearly showed the decision-making process for the use of restraint. The person was being cared for in the lounge on the day of the inspection. They were using a specialist chair, they appeared comfortable and relaxed. The manual handling risk assessment for this person showed that they needed a hoist and two carers for all transfers. The individual room the person was occupying had hospital style adjustable bed with bed guards fitted. A risk assessment had been included in their care plan for use of bed guards. Individual care plans and medication records were being kept in the persons room. A lockable medication cabinet was provided contained the medication that person was taking. The manager advised that they had worked closely with members of the multidisciplinary team and the persons family to ensure their care needs could be met in a way that ensured care was being given in their best interests. One person whose care was followed had complex health care needs. Their care plan contained information about the specialist care they needed. In addition to the homes own care plan, information had been provided by the community specialist nurse. The manager advised that the home staff have access to advice and support regarding treatment and equipment the person was receiving from the specialist nurse. This person was spoken with in the privacy of their own room. They said they had chosen to stay in their own room because they had been unwell recently. The persons room has been cleaned that morning. They said the staff at the home always make sure they had everything they needed and they couldnt fault the care of the registered nurses and care staff were giving them. The plan of care indicated that the person was partially managing their own medication. A risk assessment had been completed. The person advised that they had discussed managing one of the medications themselves with one of the senior nurses. They also commented that their care needs had been Care Homes for Older People Page 16 of 35 Evidence: discussed with them and they were aware of the care plan that had been written for them. One relative commented in an anonymous survey, Matron and staff put themselves out to gain the necessary training to deliver my mothers complex nursing needs. There have liaise with several teams in a positive manner both professionally and as individuals, The emphasis is treating each individually. The deputy manager provided the following statement about the care provided at Hill House. We plan our nursing care individually and alter plans as required, checking them monthly, more often if changes have occurred. Where possible we take a life history from each of our patients to give us an insight into how they have reached who they are now. This helps us to individualize care more and understand how we can reach them especially when there are communication difficulties. Health care professional comments received in anonymous surveys included very up to speed on the individual they care for. Always have good information to hand during any contact. Very good two-way discussions with patient care.Very impressive care both medically and holistically. This shows that people who live at Hill House have access to a knowledgeable staff team; who use current clinical guidelines to provide best care practices for the people they care for. The medication was checked for the three people whose care was followed. Their medication was being kept in a locked medication cupboard in their individual rooms. Medication charts were also being kept in their rooms. The deputy manager confirmed that all the care plans records, medication records and the majority of medication people need are kept in their individual rooms. The medication charts seen had been signed and dated by the registered nurse administering the medication. One person was receiving eye drops. These had the date when they were opened recorded on the bottle. One person had had the frequency of one of their medication reduced by their GP. This had been clearly recorded in the plan of care and altered on the medication record. However the alteration had not been signed by the registered nurse and did not include the name of the GP who had authorized the change. Controlled drug records were checked against the stock for one person as correct. Disposal records for controlled drugs had been signed by two members of staff. A system for disposing of medication no longer required was in place. A record of medication disposed of was being kept. This had been signed by the registered nurse completing the record. Medication storage was checked this showed good stock control. A lockable drug fridge was provided for medication needing to be stored at low temperatures. A record of fridge temperatures was being recorded each day. This should ensure that medication continues to be stored at the correct temperature. Care Homes for Older People Page 17 of 35 Evidence: The manager advised that Hill House specializes in care of people who are terminally ill. It was clear form the information available at the home that they had good support from the hospice team. The deputy manager provided the following information prior to the inspection. We have a high intake of patients with End of Life(EOL) issues and we have developed a sound knowledge base and good practice in this area. The Liverpool Care Pathway(LCP) is one of the most valuable nursing tools we use and we encourage all grades of our staff to attend the relevant training. The LCP was seen in use for one person being cared for at the home. This clearly demonstrated how the person care was meeting their expressed wishes for end of life care. Staff have access to information regarding the care of people who are terminal ill. Training records showed that palliative care training and end of live care were part of the core training for staff at the home. One health professional made the following comment in an anonymous survey. Im very impressed. I have had a lot of patients at Hill House and Hill House staff stand out from the already good homes in our area. Hill House exceeds at terminal and palliative care Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Meal times are a pleasant social occasions for people living at the home. Evidence: The information received prior to this inspection stated that Hill House staff team, bases all care on individual needs. Each person asked for their personal preferences regarding, getting up time, mealtimes and hygiene requirements . This was found to be the case during the inspection. People were being given the opportunity to choose how they spent their day. The care plan records had clearly recorded the persons interests and what was important to them. The deputy manager advised that where possible people are asked about their interests and hobbies when they are first admitted to the home. Where family are available they are asked to provide information. This shows that the home staff try to understand the person as well as their care needs. One relative commented in a survey form. Mum cant always Care Homes for Older People Page 19 of 35 Evidence: participate due to her condition, but the staff make sure that she can join in those that she chooses. The deputy manager commented. We try to encourage the people to join in with the activities of our home as much as possible but we take into account that sharing these events and communal areas is not to everyones liking. People spoken with individually said they were happy with the activities provided for them and they were able to choose if they wanted to take part. One person commented that they really looked forward to the animals being brought to the home. They said they enjoyed being able to see the black Labrador dog and give him treats. On the day of the inspection pet rabbits, the Labrador dog and two other animals were brought in for people to see and hold. The manager advised that this was one of the most popular activities provided at the home. The person providing this provided a written account of what had been provided and who had taken part. One person living at the home made the following comment in a survey form. We have twice-weekly quizzes twice-weekly armchair exercise sessions. I always have aromatherapy massages every week. We have an animal (pat) therapy man weekly and regular entertainment (about every one to two weeks). Where we all sing along. Plus, the staff sometimes provide entertainment (Hawaiian dancing etc) Visitors were coming and going through out the inspection. They were seeing people in the privacy of their own rooms or in one of the three lounges. The manager advised that they had been able to organize a family party to celebrate a special occasion for one of the people living in the home recently. There are daily activities including Music and Movement, reminiscence therapy, live music, quiz time, aromatherapy and hairdressing. There is an in-house library, videos and audio books also made available. During the lunch time period people had chosen the music they wanted played on the CD. One relative commented this often started a sing-a-long with the people in the lounge. The manager advised that people are encouraged to bring small personal possession into the home to personalize their individual rooms. Peoples roomed entered during the inspection had been personalized with items of their choice. This included pictures, ornaments and photographs. The lunch time meal observed was unhurried with people eating their meals at their own pace. People who needed help to eat their food were being given this by staff in a sensitive supportive way. Staff assisting people to eat their meals were engaging them in discussion as they helped them. This made the lunchtime experience a social, pleasant experience for them. Two relatives who were visiting during the lunchtime period said the meals are always very good and there was always something their relative liked to eat. People who needed their food pureed were being given this in a Care Homes for Older People Page 20 of 35 Evidence: way that enabled them to experience the different tastes of the food. The cook was spoken with during the inspection. They said the meals are planned around the likes and needs of the people living in the home. Specialist diets are catered for. One person said they had commented to the manager that they would really like a kipper for breakfast. They said the following day this was provided for them and they really enjoyed this. Other comments received prior to the inspection in anonymous surveys were. Mum has found the meals fresh and tasty, which has helped increase her appetite Cooking is for the most part exceptional. Everything is freshly prepared even the soup, which have for supper every day (plus a main course and pudding). All food recognizes my diabetic status. As mentioned if I dont like something I have ordered the staff were very quick to prepare me an alternative on the spot Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust complaints policy in place, people are able to raise concerns easily and know the staff team will deal with their concerns sensitively. 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. 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. Details on how to complain were also seen in the homes service user guide. One health professional commented in a survey form, always willing to listen to feedback and improve things People who returned survey forms all indicated they knew who to speak to if they had any concerns. Two comments received were. Although theres never anything to complain about. We have been encouraged to say if we are unhappy about anything so that it can be rectified if possible. The deputy manager advised, they had provided comment; complaint slips at all the reception desk. These comment slips were seen in Care Homes for Older People Page 22 of 35 Evidence: reception areas during in the inspection. These can be filled in anonymously, if wished, and posted into the post-box inside the external office door. She further commented that they have found this a useful tool. The manager and deputy manager confirmed, that staff had received vulnerable adult training. Information was also provided for staff in the office relating to adult protection. Video training material was also available for staff to use. Staff spoken with and staff surveys returned indicated that they understood how to protect vulnerable people and the processes to follow. The manager advised that the home does not deal directly with the peoples money. And encourage families or peoples advocates to take on this responsibility, when the people are unable to do this for themselves. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Hill House have a homely environment, which has been adapted to meet their needs. The home was being kept clean, fresh and pleasantly decorated for the people who live there. Evidence: A tour of the home was completed as part of this inspection. Some individual peoples rooms were entered. Five people were spoken with in their own rooms included two of the three people whose care was followed. The individual rooms had been personalized with items of the persons choice. Rooms in the new extension all have en-suit facilities with walk in showers a toilet and hand washbasin. The older part of the building had had work done to increase the size of the smaller rooms on the first floor. This had created more space for people to use and had not detracted form the character of the older building. People spoken to who were using these rooms were very happy with them. The manager advised that these changes had meant some of the double rooms in the old side of the building had been converted to large single rooms. There are three lounges areas for people to use. One was in the older part of the building and two in the new extension. One of the new 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 Care Homes for Older People Page 24 of 35 Evidence: weather. People spoken to who, were using this lounge during the inspection, said they enjoyed spending time there. The homes external landscaped gardens continue to provide a relaxing safe area for people to enjoy Locks to peoples bedroom doors are in place in the new extension. People are able to have keys for their room door after a risk assessment shows this would be safe. The manager confirmed that all hot surfaces are protected and all hot water outlets regulated to a safe temperature. Records of water temperature checks were provided. 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. These beds could be adjusted to the optimum height to allow the person to get in and out of bed with minimal assistance if this was required. People spoken with during the inspection said their rooms are cleaned regularly. Cleaners were working cleaning the home during the inspection. One commented that the laundry was always fresh and they enjoyed being able to keep this at a high standard. All five people who returned surveys indicated the home was always fresh and clean. The laundry room was sited away from areas were food is prepared and peoples own rooms. The washing machine has a sluice cycle for soiled laundry. The manager advised that a new laundry was in the process of being fitted. A laundry chute had been created on the first floor of the home to enable staff to deposit laundry bags directly to the new laundry. The manager was hopeful that the new laundry would be completed soon. One comment received form a person living in the home was, I just take my lucky stars that have been able to live here. Hill House is a place where I really feel cared for and loved by those who look after me from the laundry staff to the owner and even the kitchen porter makes time to ask after me. Staff observed providing care during the inspection were using gloves and aprons appropriately for personal care as required. Gloves and aprons were seen to be available for staff in the home to use. These were in self-dispensing holders, which had been placed in each persons room and bathrooms. The way they were placed in individual rooms did not spoil the look of the room or its homely character. Infection control policies and procedures were available for staff in the office. Other reference information was also available for staff. The deputy manager confirmed that infection control training had been provided for all staff. Records of training were provided in staff files. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that suitably trained and experienced staff are employed to meet the peoples health, personal and social care needs. This should ensure that people have their needs met by a knowledgeable staff team who have their best interests at heart. However the homes staff recruitment procedures do not always fully protect the people who live at the home. Evidence: A duty rota was provided, which shows which staff are on duty and in what capacity they are employed. This shows that more staff are on duty at peak times. The deputy manager advised that staffing levels continue to be planned around the needs of the people living at Hill House. The manager advised that because the home specialized in caring for people who needed end of life care, this has meant staffing levels are increased to ensure these people and their families have the care and support they need. A comment received from a person living at Hill House stated if not immediately physically available, the intercom system allows them to know that they have been heard and that they will be available as soon as possible. There hasnt been a time when she had an extended wait. Care Homes for Older People Page 26 of 35 Evidence: There are registered nurses on duty to cover a 24-hour period seven days a week. The registered nurses direct and monitor the health care of the people living at Hill House. A team of health care assistants supports them. The manager and deputy manager were available at the time of this inspection and both assisted with the inspection. Staff observed during the inspection providing care for people who lived Hill House had a good rapport with the people they were caring for. People asked said staff are polite and caring towards them. A comment received in a survey form indicated, Staff always give me more than is required. Couldnt fault them. The pre inspection information indicated that ten of the twenty six permanent staff employed have achieved and NVQ 2 in care or above. Staff spoken to during the inspection said they were encouraged to attend courses and complete training relevant to their jobs. The deputy manager provided the following information prior to this inspection regarding what they had achieved since the last inspection. To continue with as much training as we can with emphasis on increasing the responsibilities of our HCAs in line with the hospitals. Most are training towards or have achieved their NVQ 2 and are encouraged to attain NVQ 3. Staff spoken with during the inspection said they were supported in the work they were doing by the manager and deputy manager. They also commented that their access to training was good. One comment received in a survey form stated. Working at Hill House has encouraged me to do my nurse training. Another comment received form a staff member stated. If not available matron ensures that the skills are there by the time of admission to Hill House. Staff are encouraged to develop skills. One person whose care was followed said a specialist nurse had visited them and shown the nurses how to manage the equipment they needed. Their care plan showed that the manager had involved specialist nurses to provide advise and support for the staff at Hill House. Four staff files were viewed during the inspection. The information needed for staff files to support safe recruitment practice was discussed with the manager and deputy manager. The information included in the staff files seen included an application form, two references and proof of identity. However evidence of a police check had been completed for one member of staff whose file was seen had not been provided. Two other staff files had copies of police checks from their last employment in the care industry. The deputy manager advised that new police checks were in the process of being completed. The manager provided verbal confirmation that these had been completed prior to this report being published. A comment in a survey form returned before this inspection stated. Hill house is a happy place to work matron and her team are very committed to hands-on care and the patient support comes first above all else. Care Homes for Older People Page 27 of 35 Evidence: When asked what the home does well Health professional visiting the home made the following comments in anonymous surveys. Listens to and meets the needs of patients and carers. A high-class service. good nursing. Holistic care. Continuity of care The deputy manager advised that since the last inspection they had appointed a Training Officer who co ordinates all training and looks after the Staff Files. And ensures new staff have undergone the necessary checks prior to recruitment. This person was spoken with during the inspection. They confirmed they were over seeing training and had developed a system to ensure mandatory training for staff was kept up to date. They also said they co-ordinated recruitment of new staff making sure pre employment checks were completed before they started work. However they did say there had been some problems getting police checks completed. Although staff spoken with confirmed their access to training was good, a record of their training and development plans was not being kept. A senior member of staff who had recently taken responsibility for co-ordinating supervision for staff said training and development was part of the supervision process. And this would be discussed at supervision and records made. An example of how this was recorded was seen in two staff files. However not all staff had yet had the opportunity to discuss their training and development plans. The senior staff member confirmed that they were working towards completing these for all staff with the registered nurse team. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home was generally good with the owner and her deputy ensuring the personal and health care needs of the people are well met. The registered manager, provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of people living at Hill House and staff who work there. Evidence: The registered manager, provider is an experienced 1st level registered nurse with several years experience. She was supported by a deputy matron who is also a 1st level registered nurse. People living at the home, visitors and staff made positive comments about the manager and deputy manager saying they felt comfortable approaching them with any Issues. Communication systems are regular through staff hand overs and regular staff meetings. The manager and deputy manager make themselves available to speak to people living in the home and their relatives on a Care Homes for Older People Page 29 of 35 Evidence: daily basis. People and their relatives spoken with during the inspection said they were always kept informed and had no concerns about the way care was being managed. The deputy manager provided the following information prior to the inspection regarding management arrangements at Hill House. Each staff member who works in the office has a share of the administration that was different to the other but all interlinked. They all have good communication skills and deal with issues arising from staff, patients and relatives. The matron and her Deputy work together running the home. Deputy Matron mainly oversees the nursing and its documentation. Matron takes care of the finance, business and recruitment of new staff. Matron also looks after the general well being of her employees. Matron also plans the ongoing development and improvement of the fabric of the Home. The results of a recent quality audit were made available during the inspection. The deputy manager advised that the results of the audit are passed on to people living at the home and the staff team. Results of surveys were available from relatives and staff. The manager advised that as a result of feedback from these some changes in working practices had been introduced. The Requirements made at the last inspection had been met with in the time scales set. The manager has shown that she acts to improve peoples experience of care at Hill House. The manager advised that people are encouraged to manage their own financial affairs where possible with the support of family or advocates. Lockable storage was provided for individuals in their own rooms. The office administrator advised that people are billed for services such as hairdresser or chiropody on a monthly basis. Since the last inspection a member of the registered nurse team has been appointed to coordinate the supervision process for staff at the home. They advised that all the registered nurses would receive training for supervision and each would be responsible for a set number of health care assistants supervision. She also advised that the registered nurses would be completing supervision. A record of supervision for one member of staff was seen with their permission. This showed that supervision covers all aspects expected and included training and development for the individual. This showed that a good system for staff supervision had been put in place. However not all staff had received the recommended six supervision session a year prior to this inspection. Informal supervision has continued and staff reported they felt supported to do their work and had access to training that helped them do their work well. Accident reporting was noted as in order, within the home, and the home had let the Commission know of untoward incidents and deaths that had occurred since the last inspection. It was noted that Regulation 37 notices, in respect of deaths had been Care Homes for Older People Page 30 of 35 Evidence: forwarded to the Commission as required. This ensures that the Commission was kept up to date. Information provided by the deputy manager prior to the inspection showed that the policys provided had been reviewed in the last 12 months. The sample of these were seen during the inspection were found to have been reviewed in the last 12 months. The deputy manager advised that policies had been changed and up dated as required and made available for staff. The type of induction new staff receive was discussed with the administrator coordinating training. They advised that the skills for care information was used when planning induction for staff. They also advised that they were planning to use an induction program, which had been developed specifically for care homes for new staff. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person shall 18/03/2009 not employ a person to work at the care home unless(b) subject to paragraph (6), he has obtained in respect of that person the information and documents specified in -(i) paragraphs 1-7 of Schedule 2 The registered owner must ensure that the recruitment programme operating with in the home includes a completed enhanced police check (CRB) for all staff Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The Registered manager should ensure that changes a GP makes to prescribed medication for a person are recorded on the medication record with the date and signature of the registered nurse receiving the new instructions. The manager should consider making the menus provided in the communal areas for people who choose to stay in their own rooms. This will enable them to have the Page 33 of 35 2 15 Care Homes for Older People information they need about the meals on offer. 3 36 The supervision system implemented should ensure that a formal record of supervision staff receive is kept. 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