CARE HOMES FOR OLDER PEOPLE
Hill House Nursing Home Park Avenue Brixham Devon TQ5 0DT Lead Inspector
Fiona Cartlidge Announced 28 June 2005
th 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 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 D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hill House Nursing Home Address Park Avenue, Brixham, Devon, TQ5 0DT Telephone number Fax number Email 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 Mrs Ann Margaret Stockwell Care Home with nursing 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 D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users aged 65 years and over 2. PD Maximum registered 23 service users (both) 3. OP Maximum registered 23 service users (both) 4. TI Maximum registered 23 service users (both) Date of last inspection 24/11/05 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 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. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 5 and quarter hours and was announced. Information was received from the registered provider before the inspection as was written feedback from 3 visitors/relatives. A full tour of the home took place and personal records of 3 residents and 3 staff were inspected. The inspector spoke to members of staff on duty and 18 of the residents as well as the registered owner. What the service does well: What has improved since the last inspection?
The manager has commenced the process for meeting with staff on an individual basis and appraising their work this has proved to be a positive experience for both the manager and the staff and has provided better cohesion between the staff team. A large number of the staff team are completing National Vocational Qualifications and have received training in first aid, dementia and health and safety issues. More adjustable beds have been supplied increasing the safety level and comfort of patients and staff. The laundry has been relocated and improved, changing facilities and training rooms have been provided. The office has been improved and a new computer system to maximise efficiency has been purchased. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 6 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 D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 standard(s) 3 The admissions procedure is safe; it enables the staff to make a professional judgement about how the needs of individuals will be met. EVIDENCE: The inspector examined the personal records of three recently admitted patients; these showed that when patients had been admitted through care management arrangements information is provided through the care management assessment and care plans. Where service users had been admitted from other care settings the registered provider had visited the service user to perform a full needs assessment before their admission to Hill House. The registered nursing input required by patients had been determined by NHS registered nurses with a brief summary of their needs included in their records. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 standard(s) 7,8,10 The health care needs of patients are regularly reviewed and action is taken to meet those needs. EVIDENCE: The inspector examined documented care plans for 3 of the homes patients; 2 of the plans set out in detail the action which care staff need to take to meet the health personal and social care needs of the individuals the other lacked a plan to minimise the risk of falling despite this being assessed as a problem the assessments that had been completed lacked signatures and dates. All of the patients and representatives spoken to at the time of the inspection said that the care they received was good and met their needs. Documentation included assessments of skin integrity, mobility, moving and handling, nutrition and continence. Specialist equipment and aids, to meet individually assessed needs is available and a plan is in place to increase the number of mechanically adjustable beds. All patients resident in the home are registered with a GP and correspondence provided evidence that they are referred and enabled to access the services of specialist community and hospital health professionals. All of the patients spoken to confirmed their privacy is maintained especially at times of personal care giving the staff were observed interacting with patients in a respectful and dignified manner.
Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 10 Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15 Meals are nutritious and balanced and offer a healthy and varied diet for residents. The visiting arrangements are flexible and meet the needs of residents and visitors alike. Residents are encouraged to make choices about how they live their lives within the community of this home. EVIDENCE: Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 12 The inspector can confirm through observation of individual records that for 2 of the three patients who records were examined their interests, past occupations and life’s experiences were documented on a social care plan. The inspector did not see any adverts referring to group social activities although service users spoken to by the inspector confirmed that they were able to choose their leisure and social activities, routines of daily living and their personal and social relationships. The inspector spoke with 3 visitors to the home and received written feed back from three visitors/relatives; all confirmed that they feel welcomed by the staff and were happy with the visiting arrangements, being able to visit privately in the patients own accommodation or socially in the communal area of the home. All of the patients spoken to during the inspection were complimentary about the food served within this home. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 standard(s) 16,18 People are safe living in this home and know who to speak to if they are dissatisfied. EVIDENCE: The home has a complaints procedure in place, which provides information about how to make a complaint, to whom and how it will be handled in a timely fashion. The complaints procedure is displayed in large print in the lounge. The registered person confirmed there have been no complaints documented since the last inspection. The Commission has not received any complaints about this home. The home has policies and procedures relating to adult protection and staff have received training on the protection of vulnerable adults. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 standard(s) 19,26 The home provides a safe, well-maintained ‘cottage’ type environment, which is not suitable for people who use self- propelled or electric wheelchairs. EVIDENCE: Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 15 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 relatives of one patient told the inspector that the service user had moved to Hill House from a purpose built Care Home and they feel that the good standard of care their relative receives entirely makes up for the smaller less practical room they now occupy. All of the patients who have single rooms told the inspector they were happy with their private accommodation, 2 of those who share accommodation would like single rooms but accepted admission into shared accommodation to ensure their place at Hill House. Records provided by the owner indicate that all fire equipment is checked regularly, fire drills and staff training in fire safety were held in April and May. Gas appliances and central heating systems are regularly serviced by approved engineers, as are the lifts and mobile hoists and wheelchairs. The home was clean and odour free at the time of the inspection. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The procedures for the recruitment of staff are not consistent and therefore cannot always offer protection to people living in the home. The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: The Patients told the inspector that there were enough staff on duty, they said they ‘couldn’t be looked after better’, ‘can’t better the care they give us’ ‘the staff are so friendly they will do anything for us’. The staff have access to training and development and a visiting tutor stated that Hill House is sincerely committed to the certification of its staff, there are currently 12 carers working towards NVQ2 and 3 working towards NVQ3. The inspector examined the personnel files of 3 recently employed members of staff, two of these provided evidence that the recruitment process is fair and safe the other lacked written references. Written feedback from 2 relatives/visitors was received both indicated that in their opinion there is always sufficient numbers of staff on duty. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,,3738 The home is being managed properly, there is clear leadership, support, guidance and direction to staff to ensure residents receive consistent quality care. EVIDENCE: Patients, visitors and staff made positive comments about the manager in the home saying they felt comfortable approaching her with Issues. One resident told the inspector the best thing about the home was the matron ‘she’s kind, helpful and has a sense of humour’. Communication systems are regular through staff handovers and the manager has commenced regular formal appraisals for all staff. A visiting tutor who has become conscious of the management style and culture at Hill House describes the ethos as exceptional ‘it is seemingly ordered, controlled and generally committed to the care function. This ethos,
Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 18 naturally, has its origin in a dedication, which is characteristic of the matron in charge’. Questionnaires/surveys are performed on an annual basis and include patients, visitors and staff, information from these is collated generally the feedback is positive but where issues are raised actions are taken to improve the service. The provider demonstrated a responsible attitude towards health and safety – notices were displayed throughout the home. Equipment is regularly maintained and staff are trained on health and safety matters during their induction and updated regularly. All of the records seen during the inspection were clear, well maintained and secure. The owner told the inspector that she does not handle or keep personal allowances for patients; those not handling their own affairs are cared for financially by those who have power of attorney for them. Invoices for extras and shopping are sent and have always been met in full. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 4 x 3 x 3 3 Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 20 no Are there any outstanding requirements from the last inspection? 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 29 Regulation 19(1) Requirement The registered person must not employ a person to work at the care home unless she has received 2 written references and is satisfied with the authenticity of the references. Timescale for action 01/08/05 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 7 Good Practice Recommendations A comprehensive plan of care should be drawn up based on assessed needs for each patient and should be reviewed at least once a month.The person(s) responsible for documenting and agreeing the plan should sig and date the document at the time of its inception. Hill House Nursing Home D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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 D54-D07 S28683 Hill House Nursing Home V222221 280605 Stage 4.doc Version 1.40 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
