Inspection on 16/05/06 for Hillcrest Manor Nursing Home

This inspection was carried out on 16th May 2006.

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.

Other inspections for this house

Hillcrest Manor Nursing Home 16/11/05

Hillcrest Manor Nursing Home 04/05/05

Hillcrest Manor Nursing Home 20/01/05

Similar services:

Westmead

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillcrest Manor Nursing Home Reabrook Minsterley Shrewsbury Shropshire SY5 0DL Lead Inspector Pat Scott Unannounced Inspection 16th May 2006 09:10 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 Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 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. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Manor Nursing Home Address Reabrook Minsterley Shrewsbury Shropshire SY5 0DL 01743 791851 01743 792573 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) None Kelly Residential Limited Mrs Angeline Dorothea Dilys Thomas Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38), Terminally ill over 65 years of age (3) of places Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels in the home must meet the minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. They include the manager when he/she is engaged in direct care provision and exclusive of the manager when he/she is carrying out managerial duties. The home must provide for 38 service users with low to medium dependency nursing needs: 08.00-14.00 = 2 RN`s and 6 Care Assistants 14.00-20.00 = 2 RN`s and 6 Care Assistants 20.00-08.00 = 1 RN and 3 Care Assistants You may admit up to a maximum of three (3) people requiring palliative/terminal care. 16th November 2005 2. Date of last inspection Brief Description of the Service: Hillcrest Manor Nursing Home is located just outside the village of Minsterley. It is set in mature landscaped gardens surrounded by Shropshire countryside. There is a regular bus service from Minsterley to Shrewsbury and Bishops Castle. The home was originally a farmhouse and then in 1912 was extended and converted into a manor house. When first registered the nursing home comprised of just the manor house but over the years the home has increased in size with the inclusion of all the out buildings. Hillcrest Manor is registered with the Commission for Social Care Inspection to provide nursing care to 38 service users. Hillcrest Manor make their services known to prospective service users in the Statement of Purpose which is on display in the entrance hall. Hillcrest Manor’s rates are reviewed annually and service users are notified one month in advance. The only additional charges to service users are for hairdressing, newspapers, private Chiropody, private Physiotherapy, aromatherapy and escorting to hospital for routine appointments. This is clearly laid out in the terms and conditions. Fees for Hillcrest Manor are: £600-£750. All service users pay monthly by standing order or by cheque. This is two weeks in advance and two weeks in arrears. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, observation of care experienced by people using the service. The CSCI received information from a relative of a service user who had complained to the home and been dissatisfied with their response. This key inspection focused upon the regulatory concerns arising from this complaint which were explored as part of the case tracking process. What the service does well: What has improved since the last inspection? What they could do better: The home needs to work on providing better information to current and potential service users. The statement of purpose provides people with a lot of information, some of which does not reflect what actually occurs in the home e.g. there is a choice of food on the menus which are displayed, neither of which is happening at the moment although it is the intention to implement this soon. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 6 The registered provider has not produced and supplied to service users and the Commission a written guide to the care home. Service users regard the food they are given as one of the most important factors in determining their quality of life. It is important in maintaining their health and well being. Service users must be given a choice of food which the manager intends to implement. Although the staff seek quality assurance on a day-to-day basis, as written above in ‘what the service does well’, there is no formal process that aims to seek the views of those living at the home or their relatives, supporters, advocates etc. The management needs to consider how it will implement this so that it can identify areas in which it delivers a good or poor service to people living at the home. Failings and achievements can then be considered for future delivery of the service and to make improvements where necessary. The registered provider needs to resume the visits required by Regulation 26 in order to ascertain an overview of the conduct of the home. The key national minimum standards under the management section are generally met but there are some areas of improvement that the CSCI is confident the provider can manage. Following consideration of the concerns relating to regulation in the complaint, the manager has agreed the following actions: • To provide more detail for transfer/discharge of service users to other care. • To document all equipment used in pressure relief in the care plans • The manager considers complaints according to the policy of the home. The recording of verbal complaints should be included in the complaint log and the actions taken with any outcomes achieved. Documentation relating to complaints will be better organised to facilitate an audit process by the responsible individual as part of quality assurance and during the Regulation 26 visits into the conduct of the home. 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. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 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 the following standard(s): 1,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level of information available about the home does not provide service users and prospective users with up to date details of the services the home provides, thus not enabling a fully informed decision about admission to the home. Assessment of need is fully considered and recorded so that service users understand their needs will be met during their stay. EVIDENCE: Evidence from previous inspections shows that the organisation of Kelly Residential Ltd has not provided a service users guide for service users and their families/supporters/advocates. The requirement for the provider to produce a service users guide has been outstanding since it’s registration. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 9 There is a statement of purpose on display that contains some inaccurate information about the way the meal service is provided. Service users spoken with were not aware of these documents. Admission assessments on the care files that were read during this visit were comprehensive, clearly written and staff were aware of their content. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The medication at this home is well managed promoting good health. There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The attitude of staff is good and service users are treated with dignity and respect. Personal and healthcare support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life and at the end of life. EVIDENCE: The care plans that were read were very clearly written. Information from the initial assessments had been written into the plan of care. Care plans are reviewed monthly with signed agreement from the service user (if able) and family. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 11 One care plan was examined focussing on the provision of care of the individual until he was admitted to hospital. A concern from a relative had been that the person had been admitted to hospital with pressure sores about which they had not been informed. A pressure ulcer risk assessment was in place that identified the service user was vulnerable to pressure area problems. A clear plan of care had been developed for this problem with recorded evidence of regular monitoring of skin integrity and evaluations. The manager stated that a ‘spenco’ pressure-relieving mattress had been on the electric ‘profile’ bed although there was no record of this. The relative had signed understanding and agreement of the care plans that had been discussed with them on 18.3.06. The actions taken by staff to deal with current and emerging medical problems such as fluid intake/output, nutritional status, catheter care and psychological care were fully recorded and staff had regular consultation with the GPs, Shropdoc and family involved. There was no evidence that the GP or staff did not want him to go into hospital. The GP admitted the service user to the medical emergency unit on 13.4.06 and transferred to a ward on the 17.4.06. The care records show that the pressure areas of this service user were intact when he left the care of Hillcrest Manor. It was agreed with the manager that the discharge letter accompanying the service user could have contained more detail regarding this aspect. Medication charts in general were well organised and fully completed. Reviews are conducted with the GP. The manager and staff at Hillcrest Manor have been working towards providing end-of-life care for service users in line with national frameworks. During the visit staff were seen and heard to treat service users with dignity and respect. They had patience with those whose care was time consuming and staff allowed them to go at their own pace in all aspects of care. Service users spoken with stated that the staff were very good and that they looked after them well. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Service users have many opportunities for community/family contact which enables them to make a choice about who they see and when and where they see them. Dietary needs of service users are catered for but a varied selection of food is not available at lunchtime and so cannot always meet service users tastes and choices. EVIDENCE: Service users were complimentary about the food provided. They stated they were not asked about their choice for lunch, as this is not available from the main menu each day. Service users were heard to ask staff what they were having as lunch was being served. They do have a choice at breakfast when they can have cereals, cooked food, toast or as one service user does, have all of them. The manager stated that now the new catering staff have completed Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 13 basic food hygiene the intention is to implement a new menu system offering more choice to service users. Activity preferences are discussed with service users and recorded. There were many pictures displayed on the notice board of the events that have been recently enjoyed. Service users confirmed that they can participate in anything and can spend their day as and where they wish. Information about forthcoming events is available in the foyer. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 14 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): 17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The CSCI received information from a relative of a service user who had complained to the home and been dissatisfied with their response. Regulatory issues arising from this information have been considered in the health and personal care outcome section of this report. Service users spoken with said that they would be quite happy to speak to the manager or owner and felt that they would be listened to. The home encourages people to put their concerns in writing so that they can be dealt with through the complaints process. However, the manager should record verbal complaints and the actions taken until such time as the written complaint is received. Recording of comments and concerns is useful for a service to identify failings and monitor areas it may need to improve upon. There have not been any adult protection issues. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing service users with an attractive, homely and hygienic place to live. EVIDENCE: The home does review the décor and equipment although this and works carried out are not recorded. All bedrooms and communal areas were in good order. Service users were satisfied with their rooms which were personalised and were aware of the changes that have taken place to improve the appearance of the premises. The gardens were very well maintained. The recent infection control audit has provided the home with an overview of current best practice and the home has implemented some of the relevant points. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 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 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of vetting and recruitment practices is good with appropriate checks being carried out. This ensures that suitable staff are employed to care for service users. The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: The file of a new recruit was seen which showed that robust recruitment practices are carried out. She had also commenced her induction in line with the foundation standards of Skills for Care. Staff confirmed that training is provided and there are many equal opportunities to improve themselves for the benefit of service user care. Six overseas staff are to enrol on NVQ training. Other training organised included health and safety, nutritional support, food hygiene and safe handling of medication. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 17 The home is working towards improving the level of staff having NVQ qualifications at level 2,3 and 4. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by a suitably qualified individual who promotes a professional ethos within the home The management team are developing and maintaining a wellsupported staff group to meet residents’ needs. But, the formal systems for resident consultation are lacking so that they are not able to air their views about all aspects of service provision. Health, safety and welfare of service users and staff are promoted fully by safe working systems in place EVIDENCE: Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 19 Through discussions with the manager she demonstrated that she is confident in her ability to lead a staff team whilst being fully aware of the individual needs of the service users living at Hillcrest Manor. She seeks to continually improve the performance of herself and staff through research into best practice in elderly care. Although she communicates regularly with the Directors of the organisation about improvement of the business this is not formalised into a business plan for her to achieve with a cycle of plan, action and review reflecting aims and outcomes for service users. The responsible individual of Kelly Residential Ltd does not review the conduct of the home on a regular basis through the visits under Regulation 26. The organisation has not made progress towards formalising a quality assurance and quality monitoring system based on seeking the views of service users which would measure the success in meeting the aims, objectives and statement of purpose of the home. Quality assurance takes place throughout the service in an informal manner. The staff do, however, formally monitor the quality of care provided through the regular reviews of the care plans with service users and their families. The home keeps records to show that the health and safety of service users is promoted and protected. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 20 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 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 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 3 3 2 x 3 x x 3 Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 5 (1)(2) Requirement The registered provider shall produce a service user guide and supply a copy to the Commission and each service user. (outstanding from 1.12.05) The registered provider shall establish and maintain a system for reviewing and improving the quality of care provided at the home. The registered provider shall report on the conduct of the home. The registered manager should ensure that all complaints whether verbal or written are logged in an accessible record. Timescale for action 16/06/06 2. OP33 24(1)(2)( 3) 16/08/06 3. 4 OP38 OP16 26(1)(2)( 3)(4)(5) 22(8) 31/05/06 31/05/06 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 Good Practice Recommendations DS0000062189.V295644.R01.S.doc Version 5.2 Page 22 Hillcrest Manor Nursing Home 1. 2. 3. 4 Standard OP1 OP15 OP32 OP7 The registered provider should review the accuracy of the statement of purpose. The registered manager should implement the planned improvement for the provision of choice for meals. The registered manager should provide more detail for the transfer/discharge of service users to other care. The registered manager should ensure that all equipment used for pressure relief is documented in the care plans. Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Hillcrest Manor Nursing Home DS0000062189.V295644.R01.S.doc Version 5.2 Page 24 - 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. 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