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Inspection on 03/11/05 for Hill House Nursing Home Limited

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

This inspection was carried out on 3rd November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The service users once again spoke highly of this home, and the CSCI confirmed that the home provides a pleasant and comfortable environment. The home has a motivated staff team who are very caring. Visiting professionals such as Palliative Care Nurses and Occupational Therapists have confirmed that clinical care is also competently managed. This home provides rehabilitation for short stay service users and again they found the home most helpful in preparing them to return home with greater confidence.

What has improved since the last inspection?

The new arrangements for admitting service users, including those referred by the local PCT [Primary care Trust] are now ensuring more appropriate referrals to the home. Having demonstrated their skills in manager palliative care for terminally ill service users the home is now preparing to provide end-of-life care known as the `Liverpool End of Life Pathway`. This is aimed at providing a coordinated approach to the care of people near to death.

What the care home could do better:

Some requirements remain outstanding and are reiterated in this report. Outstanding, but underway, is the need for hot towel rails in ensuite facilities to be made safe. A wheelchair was seen to be lacking its footrests. A `Multiplug` (electrical) adaptor was again seen in use. Fire door on landing wedged open; magnetic door holders must be fitted if they need to be held open for any reason. A cupboard used to store electrical goods and chemicals was not locked. The manager confirmed that all such safety requirements are attended to without delay.

CARE HOMES FOR OLDER PEOPLE Hill House Nursing Home Limited Hill House Nursing Home 48-50 Park Road Kenley Surrey CR8 5AR Lead Inspector Michael Williams Unannounced Inspection 3rd November 2005 10:00 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 Limited DS0000019029.V263768.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 Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hill House Nursing Home Limited Address Hill House Nursing Home 48-50 Park Road Kenley Surrey CR8 5AR 020 8660 9336 020 8668 0210 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) Hill House Nursing Home Limited Mrs Elana Pamela Follwell Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (0), Terminally ill (10) of places Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 10 service users in the category of Terminally Ill aged over 40 years. Eight intermediate care places provided in rooms 102, 108, 110, 111 and 112. A variation has been granted to allow day care to be provided for one specified service user. Date of last inspection Brief Description of the Service: Hill House provides personal care, including nursing care, for older people but does not provide care in other categories such as dementia care or people with mental illness. Its services include Intermediate Care and care of the Terminally ill. Both of these specialist services are supported directly by the relevant Health Authority agencies. The hotel-style home comprises 35 single rooms and 15 shared rooms. There are 4 dayrooms plus bathrooms, showerrooms and there are toilets sited throughout the home. There is a library, a hairdressing salon plus the usual facilities, including a laundry, offices and staff rooms. There is a garden to the rear plus an enclosed courtyard and to the front off-street parking is available. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This care home continues to achieve high standards throughout. The Directors of this care home can be satisfied they are maintaining a very good service. Only a small number of requirements arose and the CSCI is confident any outstanding matters will be addressed. The purpose of this unannounced visit was to monitor safety issues and to confirm that key standards continue to be met. What the service does well: 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 Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 6 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 Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 7 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 New service users are now being admitted only on the basis of an assessment undertaken by people trained to do so. This involves the service user or, in some cases, their representative so they will be assured that their needs will be met. EVIDENCE: During previous inspections it was clear that some services were being referred by hospitals to the home when admission was not entirely appropriate and necessitating the person return to hospital. The manager states that this situation is now improved and referrals are now more appropriate. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 8 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 11 Key standards were evaluated in the previous inspection and were found to have been met. One of the service user’s care plans was out of date and this person could not be assured that his current care needs were known to the staff team. The introduction of the Liverpool End-of-Life Pathway means service users are assured that this home is providing excellent care for terminally ill service users. EVIDENCE: One service had made such good progress that his care plan was out of date and needs to be updated. The Nurse also confirmed that with this partial recovery a revised assessment of all is needs, medical and social, will need to be made by specialists and this is to be arranged shortly. In respect of the dying, the manager explained in some detail how the end of life pathway is intended to offer a package of care which is documented and coordinated with all parties, including the service user. This will provide decisions and agreements about how their last days will be managed including decisions about sustenance, pain relief, hospital admission (or not) and so forth. Equality issues are also taken into account such as the family’s cultural, social and religious beliefs and wishes and proposed funeral arrangements. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 9 It is also to be noted that some service users with a poor prognosis receive such good care in this home that their life expectancy is extended. The exceptional arrangements for the provision of care the dying is beyond the basic requirements of this standard and justifies a judgement that this standard is exceeded. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 10 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): 15 Key standards were evaluated in the previous inspection and were found to have been met. On this occasion service users again complimented the home for providing very good food and they confirm they are receiving a wholesome diet in a congenial setting. EVIDENCE: This inspection was conducted at midday and gave the service users the opportunity to comment on the meal of the day. A choice of three meals was offered including mixed grill and vegetables; beef stir fry or a vegetarian dish. The service users variously commended the chef for giving them “very good, very nice or lovely food”. One service made a suggestion that the ‘correct’ condiments and sauces be provided with the meals, for example salt, vinegar or tomato sauce with fish dishes. This suggestion is passed on to the staff. This service user also asked for confirmation that his drinking water is only supplied from a mains water supply and not from cold water tanks; staff have been asked to confirm this point. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed on this occasion but were confirmed as met during the previous visit so as to ensure service users know how they may make their concerns known to staff and know that they will be protected from abuse. EVIDENCE: The findings in the previous inspection confirmed that complaints are dealt with in a sensitive and professional manner; this ensures service users and their representatives feel free to make their concerns known and know they will taken seriously will be acted upon. Policies, procedures and staff training are in place for the safety and wellbeing of service users so as to protect them from abuse. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 12 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): These standards were assessed in the previous inspection and there was no evidence to suggest that they not being met on this occasion. EVIDENCE: Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 13 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 30 Staffing levels are adequate for the home’s stated aims and objective enabling staff to meet the wide range of service users’ needs. Recruitment procedures in this home are sound and so will ensure service users are appropriately supported and protected. Training is comprehensive meaning staff are competent to care for service users. EVIDENCE: Staffing levels are based upon the home’s existing Staffing Notice issued under previous guidance. The staff rosters indicated that staffing levels are frequently above those minimum levels. On duty on the day of inspection were 4 qualified nurses, and 14 care assistants. In addition to the Nursing and Care staff, the home employs a large ancillary staff team including a professional chef and assistant in the kitchen plus catering assistants; housekeeper and domestics and gardener/maintenance persons. The CSCI is therefore satisfied that staffing levels in this home can meet the current needs of service users. The recruitment records were examined in some detail to ensure all necessary checks are being made prior to employment including references, police checks and the qualifications of nurses. One of the Directors of the home provided details of the staff training programme including induction, support and supervision and ongoing training sessions and courses. The range of courses provided is appropriate to the needs of service users and include standard instruction in fire safety, moving and handling, health and safety and so forth. Other more complex guidance is given on matters such as care of the dying and staff supervision. The staff confirmed that they are offered regular training and receive regular supervision from senior staff. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 14 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 35 38 Residents are confident that they live in a home which is run by a person that is experienced and fit to be in charge and who will maintain their safety. Systems are in place so as to ensure that the property and money of service users (held by the home) can be held securely and is safeguarded. Provision is also made for service users to control their own money. EVIDENCE: The registered manager is a qualified Nurse; she is competent and experienced in the care of elderly people and she has demonstrated over a number of years that she has the skills to meet Hill House’s stated purpose, aims and objectives. On this occasion the money records were examined to ensure service who deposit their cash, and other valuables, can be assured it is managed in accordance with good practice. The home acts as appointee for one service user; it is therefore expected that the home will maintain an account for that service user, the home will provide a regular statements of account, will Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 15 provide interest at standard high-street rate and will make service user’s money readily available. These arrangements are in place. Other cash held was also checked to confirm is held safely and accurate records are being maintained. In addition to these arrangements the home now provides small safes for service users who wish to hold cash and other valuables in their own rooms. This is clearly a well managed care home, that is run in such a manner as to ensure the health and well being of the service users but a number health and safety hazards were identified and need to be addressed to ensure the continuing safety of service users. These matters are listed in the requirements table at the end of this report and include matters such as a fire door that need to be kept shut; door to chemical cupboards need to be kept locked; electrical plug needs to be of a safe (fused) type; hot surfaces must be protected. Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 16 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 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? Yes 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 OP38 Regulation 13(4)(b) Requirement Management: The home must risk assess hot surfaces, towel rails, and must take steps to reduce those risks by reducing the temperature to 43 degrees C. or by fitting protective covers. This remains an outstanding requirement from 30/7/05 Fire safety: It is required that all fire doors on fire exit routes must be kept shut or be held by a magnetic door holder. Chemical Hazards: it is required that hazardous chemical be stored in a locked cupboard. Aids and adaptations: Wheelchairs must have their footrests in place when in use by staff. Electrical hazards: Multiplug adaptors should not be used; either increase the number of wall-mounted sockets or use fused extension units. Care Plans: must be reviewed and updated including those occasions when service are recovering from serious illness. Timescale for action 30/02/06 2. OP38 23(4)(c) 30/02/06 3. 4. OP38 OP38 13(4)(a) 23(2)(n) 30/02/06 30/12/05 5. OP38 13(4)(a) 30/12/05 6. OP7 14(2)a b 30/12/06 Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hill House Nursing Home Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Limited DS0000019029.V263768.R01.S.doc Version 5.0 Page 20 - 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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