Inspection on 19/10/09 for Hillcrest Care Home

This inspection was carried out on 19th October 2009.

CQC found this care home to be providing an Good 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

Hillcrest Care Home 24/08/10

Hillcrest Care Home 07/07/10

Hillcrest Care Home 09/12/08

Hillcrest Care Home 19/03/08

Hillcrest Care Home 21/03/07

Hillcrest Care Home 05/07/06

Hillcrest Care Home 06/12/05

Hillcrest Care Home 02/08/05

Hillcrest Care Home 22/03/05

Hillcrest Care Home 30/09/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hillcrest Care Home Wear Street Jarrow Tyne And Wear NE32 3JN Lead Inspector Clifford Renwick Key Unannounced Inspection 19th October 2009 7:30am DS0000000234.V377951.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Care Home Address Wear Street Jarrow Tyne And Wear NE32 3JN 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) 0191 489 0200 0191 428 6343 Hillcrest Care Homes Limited Jaqueline Karen Wallace Care Home 49 Category(ies) of Dementia (49), Old age, not falling within any registration, with number other category (49) of places Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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, Code OP - maximum number of places 49 2. Dementia - Code DE, maximum number of places 49 The maximum number of service users who can be accommodated is: 49 19th March 2008 Date of last inspection Brief Description of the Service: Hillcrest Care Home is a purpose built three-storey building located within the busy town centre of Jarrow. The building has 49 single bedrooms all of which have an en-suite bathroom. Access around the building is made easier by a passenger lift or there are two staircases, which are located at either end of the building. There are a number of communal areas, such as lounges, dining rooms and quiet areas. A fireplace with surround and easy chairs is located in the corridors of both the first and second floor and provides a popular place where service users can choose to spend their time. A staff call system, which is accessible to the service users, is provided in all parts of the home. The laundry and staffroom are located on the second floor of the home. There is a garden to the rear of the home and parking facilities are available for the convenience of visitors. The home is registered to provide care for up to 49 people, 26 people who have varying degrees of dementia and 23 people who are elderly. The home is now registered to provide nursing care Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 5 A place at this home costs £395 - £541.73 per week. Additional charges are made for toiletries, newspapers / magazines, and hairdressing. Items, which are included in the cost, are listed in the homes terms and conditions. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience Good quality outcomes. The last inspection of this service was carried out in January 2009. Before the Visit. We looked at. Information we have received since our last visit. How the service has dealt with any complaints or concerns. Any changes to how the service is run. The providers view of how well they care for people from information they provided in the annual quality assurance document (AQQA) that they sent to us. The Visit. An unannounced visit was made on the 19th October 2009 and announced visits were carried out on 20th and 21st October 2009. During the visits we. Met with the people that live in the home. Spoke with the staff that was on duty. Held discussion with the operations director who was present. Spoke with relatives who were present during our visit. Had breakfast and lunch with the residents. Observed staff’s working practices. Looked at information about the people who are receiving support and how well their needs are met. Looked at other records that have to be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was accessible, well maintained, safe and free of any hazards. We also gathered information from looking at, care records to assess how staff supports people with their assessed needs. We also focused upon looking at the records for the 4 people who are currently receiving a service we refer to this as case tracking. And this involves looking at all of the records for a named individual. We told the manager and the operations director what we had found. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 7 What the service does well: The registered provider and registered manager ensure that any requirements and recommendations made in previous inspection visits are addressed. Each person has a written plan of care so that staff can follow consistent practices when supporting people. A good range of activities and outings are provided to ensure that residents receive appropriate stimulation. Nutritious meals and snacks are provided and any special diets are catered for. Good staffing levels ensure that residents can be supported in w ay that suits them. The building is well maintained, clean and warm and presents safe environment in which to live. Matters that relate to health and safety are addressed so that all staff follows safe working practices at all times. What has improved since the last inspection? What they could do better: Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 8 The records of administration of medicines in the home for all residents must be completed in accordance with the guidance issued by the Royal Pharmaceutical Society. And all nurses must undergo the same training as care staff in the safe handing of medicines in order to ensure that they are up to date with best practice. The complaints record should be amended so that it includes more detail as to what actions have been taken in how a complaint has been addressed. And also whether the complainant is satisfied with the actions that have been taken. The communication systems need to be improved when a nurse is left in charge of the building. In order that the manager and deputy manager can be fully appraised of any events that occurred when they have been absent from work. The manager should ensure that all of the care documents in use are dated and signed. And daily records that are used to record day to day events in the home need to contain more detailed information. 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 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. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.2 Page 9 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 Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 ensures that people are only admitted after a full assessment of their needs has been completed and they are confident that the person’s need’s can be met in the home. EVIDENCE: At the time of our visit where were 47 people living in the home of whom 18 people had been assessed as requiring nursing care and 29 people assessed as requiring residential care. In discussion with the manager it was confirmed that prior to anyone being admitted to the home a full assessment of needs is completed. This is to ensure that only people whose needs can be met are admitted. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 11 We looked at the pre admission assessment for three people and which had been completed by staff. And who had carried out this assessment in the prospective residents own home or hospital where one person had been residing. The pre admission assessment covers areas such as medical history, communication, mobility, eating and drinking, and other physical areas of care. It does not however include a lot of information about personal background. For example where is the person living now, what led to the admission into care, what family do people have and what previous lifestyle did the person have. Discussion held with the manager confirmed that the pre admission assessment is used to help complete another document known as the care plan assessment. Information is also obtained from the care manager in the local authority or other person/s who may be making the placement and this is used by staff as part of the overall assessment process. We looked at an assessment provided by a care manager for a person who was due to move into the home on the day of our visit. The home had only received this assessment from the care manager on the day of the planned admission. And the information contained in this assessment was different from the information provided to the home by hospital staff when the home had carried out their own assessment. This potentially highlighted a number of areas of concerns that had not been shared with homes staff when they had completed their assessment. This was discussed with the manager who was advised that steps should be taken to ensure that the information provided by the care manager was verified. In order to ensure that the home had all of the information they needed. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 receive the health and personal care they need from caring staff and Prescribed medicines are generally managed safely. However, the staff needs to keep more accurate records of the administration of medication. EVIDENCE: As part of this visit we looked at care records for four people and we call this process “case tracking”. This involves looking at all health and care records for these people to assess how staff is meeting their assessed needs. There are a number of standardised forms in use that record regular weight checks, nutritional needs, risk assessments, pressure care and moving and handling. However these are not always dated and signed when completed by staff. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 13 A range of information has been collated following the initial assessment and this used to formulate a care plan that sets out how staff is to support people. The care plans vary in the information that they hold some were detailed and listed everything about what the person liked as well as how they had to be supported. It listed how their food had to be presented and also how they liked a drop of sherry every evening before going to bed. Another care plan listed the times of when someone liked to go to bed and also when they wished to arise. One care plan included evidence of how staff were working with a person who at times presented behaviours that challenged some of which were aggressive. A recording chart of behaviours that had been displayed and how staff had dealt with this had been in use as a monitoring tool. However staff had stopped using this valuable recording tool. This was discussed with the manager who was advised of the need to reinstate this record. For some people who prefer not to wear footwear there was no risk assessment in place and this too was discussed with the manager. And this resulted in appropriate risk assessments being carried out. The current format that is used for care plans is easy to understand and still being developed by staff to include more personal information about a person’s previous lifestyle and background. Discussion with staff confirmed that a life memories booklet is being issued to families of new people who move in order to build up a life history of people. The care plans are evaluated monthly and the manager confirmed that if there are any changes in needs then the care plan is amended to show what actions are to be taken. Each resident has an allocated named member of staff as a key worker who are responsible for dealing with personal tasks. Good records are in place to show that residents have access to all NHS services. And the records show when someone has been seen by the G.P or other health professionals. We looked at the procedures in place for receipt, administration and disposal of prescribed medicines. The senior care staff has responsibility for maintaining Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 14 records and for administering medicines for those people who are receiving residential care. For people who have been assessed as requiring nursing care nurses take responsibility for administration and recording of medicines. These nursing records had significant gaps on the records so it could not be determined if people had or had not received their prescribed medicines on certain days. The records had no photographs of residents attached leaving the potential for an error to occur. This was discussed with the manager who took immediate steps to rectify the matter. The manager also stated that these matters would be discussed with all of the nurses as well as a weekly audit system being introduced to ensure that the records are maintained satisfactorily. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 have opportunities to take part in activities both in and out of the home. There are opportunities for people to exercise choice in their lives, and they are provided with a wholesome diet. EVIDENCE: The routines in the home are flexible and revolve around the residents. We arrived early morning for our visits and it was noted that those residents who chose to have a lie in stayed in bed longer than other people. People can also choose what time they wish to go to bed. And as previously stated this is recorded in their individual care plans. Some people also chose to have breakfast in their bedrooms and it was positive to note that staff knew what they liked to have to eat and also how it has to be presented on the tray that was taken to their room. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 16 One person goes to a church in the community every Sunday and arrangements are in place for a member of the congregation to collect them from the home. Another person goes to a club in the community and on the day of our visit chose not to go due to the weather being wet and windy. There are no restrictions on visitors to the home and throughout our visits we had the opportunity to speak with a number of relatives who were visiting. They spoke positively about the home and confirmed that people are well cared for in the home. The home employs an activities coordinator who works Monday to Friday and is responsible for organising activities and outings for the residents. The activities coordinator is flexible in their role and will also work evenings and at weekends if there any special outings or functions arranged. The activities file confirmed that an individual sheet is kept for each person and this list what activities have been provided and whether the person has taken part in them. There is also a social activity timetable in place that lists the activities being carried out Monday to Friday both during the day and the evening. Relatives and their residents have been asked to contribute their ideas towards developing the activity programme and the manager confirmed that this is ongoing. Activities that have taken place include board games, bingo, pampering sessions, baking, watching DVD’s, karaoke and making personal scrapbooks. There have also been a range of outings in the homes minibus. Photographic records are available of trips to Beamish museum. A forthcoming Halloween fund raising party had been organised at a local club and some of the residents were going to be attending with their families. The home have just acquired a large screen television and also a computer game (wii-fit) and when installed will offer the residents the opportunity to take part in gentle interactive keep fit exercises. A hairdresser visits the home once a week and other day’s staff will assist residents with their hair and nails. Some of the residents have pictures and photographs on their bedroom doors to assist them with orientation around the building. And raised pictorial signs on bathrooms and toilets also assist with finding these rooms. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 17 Both breakfast and lunch were taken with the residents during our visit. Tables were nicely set with tablecloths, napkins and condiments. A good selection of meals is provided and meals that were served on the day were well presented. The menus run over a four week period and the cook keeps a daily diary and comments book to record likes/dislikes regarding the meals that are served. Some people required the support of staff to eat their meals and this was provided in a discrete manner and enabled people to eat at their own pace. Both hot and cold drinks were available throughout the meal and it was good to see that the residents were continually asked if they wanted their drinks topped up. In discussion with the manager it was confirmed that residents can choose to have their breakfast and lunch at a time that suits them and this offers flexibility around the mealtime. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures are in place and being followed, ensuring that peoples concerns are dealt with properly and people are protected. EVIDENCE: The home have polices and procedures that explain how a complaint can be made and also what actions the home will take. The manager confirmed that a copy of the complaints procedure is contained in the statement of purpose and service user guide which is made available to everyone who moves into the home in the form of an information pack. In addition to this information is available on a small poster in the entrance lobby advising how a complaint can be made. The complaints procedure is also included in the homes contract and lists the timescales for dealing with a complaint. And also whom to contact if you wish to make a complaint. We looked at the complaints records and this confirmed that three complaints had been made all of which had been addressed by the home. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 19 However the records that were used to record the complaints were not as detailed as they could have been. For example for one complaint it was not dated of when the complaint had been received and neither did it show that the complaint had been resolved. As a result of the way in which complaints records were being kept it was not easy to establish what steps had been taken in investigating the complaints. Though it could be established from other information available that the home had responded quickly and positively to address any concerns that had been raised. As a result of discussion with the manager and also the operations director who was present during the inspection some immediate changes were made to the complaints form. And this ensured that the points covered above were addressed in order to make the complaints records more comprehensive and robust. The home have comprehensive polices and procedures in place that deal with safeguarding adults. And the manager confirmed that the policies have recently been updated but not yet implemented. The manager confirmed that all staff supervisions include discussion about safeguarding adults to ensure that staff are kept up to date with their knowledge. Twenty nine staff has received training in safeguarding adults from the local authority and further training has been arranged to take place between December and March 2010. And one of the improvements that the home are looking to make in the next 12 months is to ensure that all staff and new staff receive updated training in safeguarding adults. So far 22 staff and this included domestic and housekeeping staff as well as care staff have received training in challenging behaviours. At the time of our visit there was one safeguarding matter that was being looked at and this involved representatives of other agencies. Since the inspection was completed this matter had been satisfactorily resolved. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 is maintained to a good standard making Hillcrest a homely, pleasant, comfortable and safe place for residents to live in. EVIDENCE: The home employs their own maintenance person who carries out a daily walk around with the manager to identify any renewal or replacement work that needs to be carried out. Maintenance records are kept and these demonstrated that any matters identified are dealt with quickly. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 21 At the time of our visit new radiator covers were being fitted to 12 radiators and some painting works were being carried out to communal areas and bedrooms. The manager confirmed that she meets frequently with the housekeeper to review the cleaning schedules in order to maintain high standards. However there were no written records to confirm this. The first floor which the manager refers to as the memory care unit and which accommodates people who have dementia. Has been decorated with colours and effects to assist people with finding their way around the building. Handrails have been painted in a bright colour so they stand out. Items such as murals, photographs of the area from many years ago and also posters from the war era. Offer residents the opportunity for stimulation with staff using these as an aid to engage in conversation. In the main lobby area are furniture from the 1930/40’s such as a grandmother clock and other items, and number of people preferred to sit in this area. The home have recently acquired a new large screen television and also a wii computer games facility so that the residents can engage in electronic visual games. And the manager is in the process of having this set up. A number of the residents have personalised their bedrooms with their own personal effects and small items of furniture. Overall the building was in good decorative odour and free of any unpleasant odours with no noticeable defects or hazards. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed safely and training is being provided to help staff do their jobs. And furthermore there are enough staff on duty to provide the care and supervision people need. EVIDENCE: At the time of our visit there were seven care staff and one qualified nurse working on each shift. This reduces during the night to five staff that consists of a trained nurse, one senior carer and three carers. In addition to this the manager was also available and who is supernumerary to the rotas. And housekeeping, catering staff and a maintenance person were also working in the home. As well as the deputy manager who works alongside the care staff team. The current staffing levels are satisfactory to meet the needs of the people who are living in the home. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 23 We looked at staff rotas and this confirmed that consistent staffing levels are maintained and satisfactory arrangements are in place to cover for absences caused by sickness and holidays. In discussion with the manager it was confirmed that the home are now in the process of starting a second nurse to work on the day shift in order to offer increased cover in the home. The manager confirmed that over 50 of the staff have achieved NVQ level 2 training and the home have also introduced the Common Foundation Standards for all care staff. The home has robust recruitment procedures in place to ensure that only persons who are suitable to be employed in caring for vulnerable people are employed. The company have their own training officer who is responsible for carrying out mandatory training and also training in dementia awareness. And the business development officer also carries out training in challenging behaviour and risk and restraint. Training records confirmed that 16 staff has completed a 12 week distance learning course on dementia awareness. And their work was assessed by a tutor from the college to ensure that they achieved the relevant competencies. Other training courses have covered palliative care, healthy eating, safe handling of medicines, food and nutrition and infection control. The manager confirmed that as residents needs change training is identified for staff so that they are kept up to date with best practice. Discussion was held with a new member of staff who had not worked in the care industry prior to this post. And they confirmed that the training provided by the company was good and assisted in them gaining a thorough understanding of the work. Another person who commenced work on the day of the inspection was undergoing induction training and was shadowing an experienced member of staff. In discussion with the manager it was confirmed that regular staff meetings are held. However the records indicated that the last staff meeting was held in July of this year. It was evident from discussion held with staff during our visits and also from observations made that staff morale was good. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 24 Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced and qualified manager is in post, who manages the service so that it is effectively run in the best interests of the residents. And furthermore procedures are in place to ensure the health, safety and welfare of residents and also the staff who work in the home. EVIDENCE: The manager is experienced and qualified in managing a care home. And as part of the support team she is assisted by a deputy manager and also one of the nurses who has been allocated a clinical lead role which involves supervising other nursing staff. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 26 In discussion with the manager it was confirmed that additional management support is offered by the company and the operations manager visits the home on a monthly basis to carry out quality audits. In addition to this the manager also has a range of other audit systems in place one of which includes checking the medication records. As already highlighted in this report the audits on medication particularly in relation to the nursing records need to be more robust. In order to ensure that nursing staff are completing the records in the correct manner. The manager confirmed that one of the developments currently taking place is the implementation and development of the weekly surgery. This will involve the manager making time available every Thursday to solely discuss any matters with relatives or visitors to the home and also staff. We looked at records that relate to accidents in the home and these were well detailed and gave a good account of the actions taken by staff when anyone had an accident. The manager carries out an accident analysis each month and if anyone is prone to regular accidents professional advice is sought. For example for one person who was falling on a regular basis the falls prevention team became involved. This resulted in the number of falls being reduced and also identified that the person required an alternative bed. Good health and safety records are in place and minutes of the most recent health and safety meeting held by the manager were seen. This confirmed that all equipment in the home had been reviewed and also identified if any other equipment was needed. We also looked at the arrangements in place for staff to receive regular fire instruction training and take part in fire drills. All new staff receives fire induction training on their first day of employment and this also includes being taken around the building so that they are aware of all of the emergency exits. Fire alarm zones are checked weekly with the alarm being activated and fire instruction is carried out monthly and at different times with all staff that are on duty. This includes staff who works on both days and nights. Every 6 months a horizontal evacuation process is carried out. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 27 Records are in place to confirm the above however the manager was using the incorrect forms provided by the company. This was discussed with her and rectified immediately. Systems are in place to ensure that all new staff receives induction training in control of infections. And one person has completed a 12 week distance learning course in infection control. This means that they are qualified to NVQ level and are able to mentor other staff and support them in their practices. A supervision matrix is in place that confirms that staff receives formal supervision from the manager. Though as previously stated in this report staff meetings are not held as regular as they could be. This was discussed with the manager who indicated that strategies were in place to deal with this. We also discussed with the manager some matters that were noted during the inspection that related to communication. For example when a nurse is in charge of the home in the absence of the manager and the deputy manager. Information or a description of things that may have occurred in the home is not always shared with the manager. There were a couple of examples where important information had not been passed on and this need’s to be addressed by the manager to ensure that no important information is lost. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 28 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 3 x x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 12,13,17 Requirement The registered persons must ensure that medication charts are always signed, dated and witnessed to confirm that prescribed medicines have been administered. Timescale for action 31/12/09 2. OP9 13 The registered person must 31/01/10 ensure that all nursing staff who administers prescribed medicines receive training in the safe handling of medicines. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Individual plans of care should continue to be developed as advised within this report. And the daily records systems in use should contain more detailed information as to how a person spends their day. General terms such as fair diet and regular diet should be avoided with a more detailed description being kept. DS0000000234.V377951.R01.S.doc Version 5.3 Page 30 Hillcrest Care Home 2. OP7 3. OP16 All standardised forms that are used as part of the assessment and care planning process should be dated and signed at all times particularly when there are changes made. The records that are used to record complaints need to be developed so that there is a clear audit trail of what actions have been taken if a complaint is made. Hillcrest Care Home DS0000000234.V377951.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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