Random inspection report
Care homes for older people
Name: Address: Hill Top Manor Care Home High Lane Chell Stoke-on-Trent Staffordshire ST6 6JN one star adequate service 19/08/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Yvonne Allen Date: 1 0 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Hill Top Manor Care Home High Lane Chell Stoke-on-Trent Staffordshire ST6 6JN 01782828480 F/P01782828490 hilltop.manager@fshc.co.uk www.fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 80 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 80 0 old age, not falling within any other category physical disability Conditions of registration: 0 10 The maximum number of service users who can be accommodated is: 80 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 80, Physical disability (PD) 10 Date of last inspection Brief description of the care home Hill Top Manor is a care home that can provide nursing care for people both male and female requiring long, short or respite care. The majority of people cared for by the
Care Homes for Older People Page 2 of 13 1 9 0 8 2 0 0 9 Brief description of the care home home are frail elderly people but the home can also accommodate people above the age of 18 who require intermediate care. The home has a separate dedicated intermediate care unit for up to 19 people with its own facilities. The home is a twostorey purpose built building situated in Chell, a small residential suburb within the Potteries conurbation. It is situated on a main road and provides easy access to local shops and amenities. It is within walking distance of bus routes and the home provides ample parking space. There are well-tended gardens that are accessible to people who live in the home. The home provides care for up to 80 people on two floors. There is lift access between floors. The majority of rooms at the home are single but there are four companion rooms available. Many of the rooms have en-suite facilities. There are a number of communal rooms, three dining rooms, an activity room and adapted bathing facilities. There is a central kitchen and laundry. Fees charged by the home range from 348.00 to 694.96 per week. Additional charges are made for hairdressing, private chiropody, private dentistry, newspapers and magazines, private transport and special toiletries. Care Homes for Older People Page 3 of 13 What we found:
We carried out this Random Inspection visit to confirm whether the service had met with the legal requirements we made in our last key Inspection report on 19th August 2009. We had also recently received a safeguarding referral from Stoke On Trent Social Services department in respect of the service. This safeguarding referral contains allegations of poor care practices by staff who work in the home including contraventions of infection control guidelines. This referral is currently being investigated under the Staffordshire Intra Agency Vulnerable Adults Policy. This inspection visit was carried out by two inspectors, Yvonne Allen and Rachel Davis from the Care Quality Commission and Kim Gunn, Head of Infection Prevention and Control NHS Stoke-On-Trent. The inspection visit took almost six hours to complete. Kim Gunn looked at whether the service had improved in infection control. She concentrated on the specific issues of concern raised at the previous inspection and found that the service had improved in several of the areas highlighted. However there are areas still in need of improvement, which have not been addressed by the service. These areas still pose a risk to the control of infection at the home. The areas are as follows Carpets have not been replaced as recommended and the service should now start to implement this. Several of the bed frames were heavily dust laden and the service should improve the cleaning schedule and monitoring of this. Toilet brushes are still being stored in soiled water in their holders. Although this job had been signed off on the cleaning rota, there needs to be closer monitoring of this. Hand hygiene sinks for use by staff are unsuitable and do not meet with current standards for clinical hand hygiene. We were told that the service had a programme to replace strategically placed hand hygiene sinks but there is no evidence of this. Although sluice rooms are better organized some of the foot operated bins were not working properly and staff were having to lift them by hand. These bins require replacing or making good in order to help prevent the spread of infection. The bedpan washers were showing signs of wear and tear, especially around the seals, and there had been no progress with replacement of the these. We left an immediate requirement for the service to gain an engineers opinion on the functionality of the machines within two weeks and to replace them if not functioning properly within a further two weeks. In rooms 3a and 3b the flooring is lifting away by the toilet allowing water to penetrate. No progress has been made with this and the service will need to address this as a matter of urgency.
Care Homes for Older People Page 4 of 13 Cleaning equipment used for general cleaning was being stored inappropriately in the sluice room. We made an immediate requirement and this was addressed by the service at the time of the inspection visit. Staff do not always have easy access to Personal Protective Equipment (PPE). We have made a requirement that this be made more readily available for staff use. Some clinical equipment meant for single use was clearly being re used by staff. We made an immediate requirement for the service to address this. We looked at how the service has met the requirement to improve the monitoring of individual fluid intake. We found that all of the fluid balance charts had been correctly completed and contain records that people are being offered regular drinks, including drinks during the night. We spoke to some visiting professionals including a District Nurse, an Occupational Therapist and a Social worker. They confirmed that they had no concerns that was specifically relating to the intermediate care unit but said that sometimes there is a difficulty to access staff. We met with some visitors on the second floor nursing unit. They told us that they have the following concerns The small lounge is not supervised for most of the time and there does not appear to be many staff around. They told us that they had seen the following One gentleman fell through the hoist sling, sometime before Christmas. A lady fell back wards onto the floor in her wheelchair when there was no staff member in the room. Very often there is only one staff member using the hoist. The lounge is very rarely supervised by staff members. We observed this lounge and found that there are a significant number of elderly people with dementia care needs. There was no staff supervision of this area whilst we were visiting. We looked at records relating to falls and accidents and noted that this lady had sustained a fall backwards in her wheelchair whilst there was no staff around and that a visitor had had to fetch a staff member when this happened. We also found that the gentleman had a guided fall as he slipped out of the sling attached to the hoist and that he had been lowered to the floor by the staff member. We also identified that this same gentlemen had sustained a number of other falls whilst unattended in the lounge and that he had been found on the floor on several occasions. Although there were records to identify that these peoples risk assessments in their care
Care Homes for Older People Page 5 of 13 plans had been reviewed and updated when these incidents occurred. This had not resulted in any action being taken to provide more supervision of the lounge area. We made an immediate requirement for the service to address this and ensure that people who live in the home are adequately supervised and kept safe. What the care home does well: What they could do better:
There are still areas of cleanliness and infection control which have not been addressed. Some of these issues have been raised by the infection control nurse specialist on several occasions over the last two years and have been identified on audits carried out by her department. These concerns are basic fundamental areas of hygiene and do not meet with current and future guidelines for infection control. The service will need to address these areas which are still outstanding in order to ensure that current infection control guidelines and future regulations relating to the Health and Social Care Act 2008 are met. We identified that people who live in the home do not receive adequate supervision in order to guarantee their safety. This was observed when we visited the nursing unit on the second floor. We made observations, spoke to visitors and looked at records relating to falls. There was also some suggestion that sometimes the hoist is used by one member of staff when there should be two. We discussed the necessity for the service to monitor staff activities on the floor, as part of its Quality Assurance programme and the deputy manager explained that he is aware of how this should be done but that there are not enough staff on duty to implement this. The service will need to ensure that sufficient staff are on duty at any one time in order to provide monitoring and supervision of staff. The service will also need to ensure that staff are effectively deployed in order to provide supervision of people in communal areas. Staff must also adhere to the policy for correct manual handling in order to ensure that people are moved and handled correctly. This will help to keep people who live in the home safe from harm or injury. In light of the above the service will need to review its Quality Assurance Programme. In our Key Inspection of the service we highlighted that the quality monitoring does not always identify areas of weakness and therefore no action is taken to improve these areas. We left the service with a good practice recommendation to improve in this area and this clearly has not been addressed effectively. This now needs to be actioned by the service to ensure that audits include regular monitoring of activities on the floor and that the systems in place are effective. Clearly a major area of concern is the cleanliness and infection control within the home and this needs to be monitored very closely in order to guarantee improvements in this
Care Homes for Older People Page 6 of 13 area. The registered manager and other staff members told us that there are currently insufficient hours provided at the home in order to facilitate quality auditing and monitoring of domestic staff the service. This is a large home which provides accommodation to some very highly dependant people and there is a great need to ensure cleanliness and infection control across all of the units within the home. As highlighted above there is a need for further monitoring and supervision in this area and therefore more domestic hours will be required in order to implement this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 13 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 26 13 13(3) The registered person shall make arrangements to prevent infection, toxic conditions and the spread of infection at the care home In respect of clinical equipment - nebulisers, suction and PEG feeding equipment. This equipment must be claen and fit for purpose. Any consumables which are for single use only must be used for one episode of csre only and never reused. 16/02/2010 2 38 12 12(1)(a) The registered 16/02/2010 Person shall ensure that the care home is conducted so as to make proper provision for the health and welfare of people People who live in the home must be appropriately supervised in order to ensure their safety. Also correct moving and handling techniques must be used at all times including correct use of the hoists and slings. Care Homes for Older People Page 9 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 1 13 13(3) The registered person shall make arrangments to prevent infection, toxic conditions and the spread of infection at the care home In rooms 3a and 3b the flooring is lifting away by the toilet allowing water to penetrate. This must be made good in order to ensure that the floor can be adequately cleaned. 22/02/2010 2 18 27 18(1) The registered person 22/02/2010 shall.... (a) ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of people who live there There must be an increase in the provision of domestic hours in order to help ensure that cleanliness of the environement and infection control is maintained and further improved at the care home. Also there must be sufficient numbers of care staff provided to ensure that people who live in the home are supervised and kept safe. 3 26 13 13(3) The registered person shall make arrangements to prevent infection, toxic conditions and the spread of infection at the care home In respect of the bedpan 10/03/2010 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 washers these must be inspected by a suitably qualified engineer and, if the bedpan washers are deemed unsafe to use or ineffective then these must be replaced with bedpan washers which are effective and safe 4 26 13 13(3) The registered person shall make arrangements to prevent infection, toxic conditions and the spread of infection at the care home Staff must have easier access to Personal Protective Equipment (PPE) in order to reduce the risk of infection and cross contamination. care home. 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 22/02/2010 1 26 The foot operated bins located in the sluice areas should be replaced or made good so that the foot operated lids work in order to help prevent the spread of infection. The service should commence the replacemnt programme for hand wash sinks in order to ensure that they meet current and future infection control guidlines. The service should now start to implement the carpet replacement programme in order to help prevent the spread of infection in the care home. The service service should improve the monitoring of the cleaning schedule especially in respect of dusting and storage of toilet brushes in order to help minimise the
Page 11 of 13 2 26 3 26 4 26 Care Homes for Older People 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 spread of infection 5 33 The Quality Assurance programme should be reviewed and improved in order to ensure that the systems in place are effective in delivering required standards of cleanliness and hygiene of the environment and care and supervision of people living within the home. Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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!
