Inspection on 16/11/05 for Hillcrest Manor Nursing Home

This inspection was carried out on 16th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Manor Nursing Home 16/05/06

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 Announced Inspection 16th November 2005 09:15 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.V256356.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 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) 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.V256356.R01.S.doc Version 5.0 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 That the goodwill advice of the Fire Authority as per inspection 5th August 2004 be implemented within 3 months of this registration. That the required Regulation 26 visits are conducted for 12 months with a relevant experienced professional, not associated with the running of the home To review the Statement of Purpose and Service Users Guide within the first 12 months of registration That Mrs Rai undertake NVQ 4 in management and care within two years of registration You may admit up to a maximum of three (3) people requiring palliative/terminal care. 4th May 2005 2. 3. 4. 5. 6. 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 Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 5 service users. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 16th November 2005 commencing at 09.15 for the duration of 5 hours. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s claims to be able to meet service user requirements and expectations were being fulfilled. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. What the service does well: The information provided in the home in the statement of purpose is good but could be streamlined to make it more reader friendly. The newsletter provides up to date information about social events and the success of the ‘friends of Hillcrest’ in their fundraising activities. The home provides care for people who may have a life limiting condition. The manager will undertake to provide detailed information on this sensitive issue in the statement of purpose. Hillcrest Manor provides a very comfortable and well presented environment for service users to live in the main house. However, there are areas that need refurbishing and it is the stated intention of the Proprietors to do so. All staff, whether qualified, care assistant or ancillary work hard together to create a homely atmosphere. There is a clear commitment from the owners to maintain a good service at Hillcrest Manor and improving it further. The quality of care Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 7 provided in this care home is strongly influenced by the calibre of the registered manager, who is now supernumerary, and her relationship with the owners which fosters an atmosphere of openness and respect. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 8 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.V256356.R01.S.doc Version 5.0 Page 9 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, 5 The information that the home provides, although good, could be improved so that prospective service users can make an informed decision about admission to the home. The recording of assessment of need is good ensuring that service users who move into the home are assured that their needs will be met. EVIDENCE: The home has a statement of purpose, the content of which is largely carried over from the previous owners of the home. It is lengthy and could be made more reader friendly. The manager should explain in this document how they provide end of life palliative care to people admitted with a terminal illness. The home has not produced a service users guide yet. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 10 The ‘friends of Hillcrest’ group have produced an informative newsletter to update service users in its successes. There has been much improvement in the recording of assessments since the last inspection. From observation, service user comments and talking to staff in the home it is evident that the home does meet the needs of service users accommodated. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 11 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): 7,8,10,11 The care planning system is in a format that provides staff with the information they need to satisfactorily meet service users needs. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Personal support in this home is offered in such a way as to promote and protect service users privacy, dignity and independence. Palliative care is provided in a holistic way that ensures that end of life care is expertly and sensitively provided. EVIDENCE: Care plans seen as part of the case tracking process have improved but staff need to use the correct sheets in order to be consistent, e.g. not using evaluation sheets to write actual care plans on. They could also be enhanced Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 12 further regarding service user consultation about retiring and rising so that any person missing or receiving a late meal by choice is noted and monitored. Clinical nursing care for all service users is provided in a sensitive, tactful manner. Care plans detailed communication between other health care professionals. It is the intention of the manager to implement a document called the ‘Liverpool care pathway’ which is more specific to end of life care. This would be used in the last days or hours of life and would demonstrate the homes commitment to improvement in clinical practice. Standard 11 would be exceeded if this intention is put into practice. Written service user comments received at and after the inspection included: “Every effort is made to accommodate your needs” “I don’t think I could find a better place”. “Although I only come for a week at a time, I am always happy to come back”. “I am cared for very well and I feel very safe”. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 13 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 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. 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. EVIDENCE: The home produces a seasonal newsletter providing a diary and resume of planned events. Other events to be taking place are displayed around the home. Sight of these shows that a varied amount of events take place. An activity co-ordinator is in the home most days. Service user comments were that they felt their recreational preferences were being addressed and that they were tailored to individual needs. A reminiscence group was taking place on the morning of the inspection. A new television and DVD player have been purchased providing service users with a better range of programmes to watch e.g. for those who like history and documentaries. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 14 The service users at Hillcrest Manor have very individual lifestyles and interests and some preferred very much doing their own thing as stated on the preinspection comments received. This was reflected in the way they could personalise their rooms, have contact with family and the choice available for meals. The new menus seen showed that nutritious food is provided. All of the respondents to the questionnaires ticked the ‘yes’ column that they liked the food and that it was “good” or “very good” and that “it has been good to have home cooked food again”. Kitchen staff are trained to level NVQ2. Visitors commented that they are able to enjoy a meal with their relative for which the home does not charge. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 15 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): The home has a satisfactory complaints system with evidence from service users comments that they feel their views are listened to and acted upon. Staff have been 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: There have been no formal complaints received. A report following a visit from Shropshire Partners in Care and two anonymous concerns received at the Commission were discussed with the manager who took on board the issues raised. Service users comments were that they would be happy to talk to Matron or the Owners about any concerns they would have. The manager is to undertake POVA training soon. Staff files showed that adult protection had been addressed at induction and on going training. Staff spoken with confirmed that this has occurred. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 16 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): The standard of décor within this home is very good with evidence of improvement through maintenance and future planning. The home, therefore, presents as a homely and comfortable environment for service users. The ancillary input into this home is very good providing service users with a clean and hygienic place to live. EVIDENCE: The standard of hygiene and cleanliness in the home is excellent. Service users praised the level of domestic input and there were no odours in any part of the premises. Rooms entered into were personalised according to the occupant’s wishes. Equipment is in place to meet the varying needs of service users within the categories the home is registered for. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 17 Service users commented that they liked their own space and to spend time in their room. One in particular said that “they didn’t think they could find a better place”. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 18 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): The home employes an enthusiastic workforce that works positively with service users to improve their whole quality of life. The home’s procedures provide a safe framework for the recruitment of staff which is followed consistently in order to protect service users. Staff are provided with training relevant to their job roles to ensure that service users assessed needs are addressed and that they are not put at risk EVIDENCE: Three staff spoken to were very positive about the support from senior management. They are supported to undertake NVQ and a variety of other training. The pre-inspection information detailed planned training is to focus on induction and manual handling updates. The home employes 8 NVQ2 staff. The home has not and will not achieve the 50 ratio within 2005. Staff are well trained the manager has developed staff portfolios. The national minimum standards refer to staff training portfolios and evidence that induction; training, supervision and appraisals are carried out. This was all recorded in the staff files sampled. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 19 4 staff recruitment files were seen of recent employees, one registered nurse and three care assistants. The three overseas care assistants had started before a criminal records bureau check and POVA 1st check had been received. This was explained as an oversight as it was thought to be the responsibility of the supplying agency who had carried them out. It was confirmed that these would be done. All other checks were in place that demonstrated the home’s vetting procedures were thorough. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 20 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): Staff are appropriately supervised which has a positive impact on the standard and consistency of care provided within the home. The manager has an understanding of the direction in which the home is going to improve. The directors have plans of how this improvement will be resourced and managed so that service users will be assured that the home has a viable future. EVIDENCE: The manager has completed the registered managers award and her hours are supernumerary in the home. The manager and owners set the tone and style of the home in terms of its efficiency, probity, concern for service users and staff and its relationships with the outside world. Good management can have a major impact on the way care is delivered and the National Minimum Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 21 Standards that are achieved or exceeded. Mrs Thomas and the Proprietors’ drive and enthusiasm and evidence at this inspection have clearly demonstrated this. Supervision takes place during the working shift and on a formal one to one basis. There has been a commitment to this process to ensure that training, when provided, the care planning process and key working all come together to improve outcomes for service users. Although supervision has started formally this month, it is suggested that a matrix which simply records the date of supervision and signed off by both supervisor and supervisee is maintained overall for monitoring purposes. The pre inspection questionnaire detailed the maintenance checks that are carried out such as fire, hot water, electrical testing etc. A sample of these was examined and all were in order. The regulation 26 reports that are sent to the CSCI each month provide the Commission with the management’s overview of the conduct of the home. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 22 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 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X 3 X 3 3 3 Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP1 OP28 Regulation 6 18(1)(c) Requirement Timescale for action 01/12/05 3 OP33 7 A service user guide must be provided. The home must provide an 31/12/05 action plan as to how it intends to increase its levels of care staff trained to NVQ2 to 50 The owner must commence NVQ 31/12/06 level 4 in care and management in compliance with the conditions of registration 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 2 3 4 Refer to Standard OP1 OP7 OP11 OP30 Good Practice Recommendations To streamline the statement of purpose so that it is more reader friendly. To review the care plans for service users regarding their wishes to retire and get up. To implement the Liverpool Care Pathway in end of life care The manager should maintain a central staff training DS0000062189.V256356.R01.S.doc Version 5.0 Page 24 Hillcrest Manor Nursing Home record and produce a training and supervision matrix to monitor the provision of each. Hillcrest Manor Nursing Home DS0000062189.V256356.R01.S.doc Version 5.0 Page 25 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. 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