CARE HOMES FOR OLDER PEOPLE
Hillcrest Manor Nursing Home Reabrook Minsterley Shrewsbury, Shropshire SY5 0DL Lead Inspector
Ann Stubbs Unannounced 4 May 2005 11:00
th 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 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 E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 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 with Nursing 38 Category(ies) of 38 x Old age, not falling within any other registration, with number category (OP) of places Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 provisiona nd 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 14:00-20:00 20:00-08:00 2 RNs 2 RNs 1 RN 6 Care Assistants 6 Care Assistants 3 Care Assistants 2. That the goodwill advice of the Fire Authority as per inspection 5th August 2004 be implemented within 3 months of this registration. 3. That the required Regulation 26 visits are conducted for 12 months with a relevant experienced professional, not associated with the running of the home. 4. To review the Statement of Purpose and Service Users Guide within the first 12 months of registration. 5. The Mrs Rai undertake NVQ4 in management and care within two years registration. Date of last inspection 20th January 2005 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. The manor house has undergone extensive restoration to its former state with high ceilings, cornice, ceiling roses and furnishings to compliment the style of the building. Hillcrest Manor is registered with the Commission for Social Care Inspection to provide nursing care to 38 service users. As from 1st December 2004 the home came under the ownership of Kelly Residential Ltd with Mrs Rai as the Responsible Individual. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken to assess the homes progress on meeting requirements made at previous inspections of the service and to ensure compliance with the conditions of registration. In addition the inspection measured the home’s continuing performance against a number of key standards that had previously been met. Standards not assessed on this occasion were assessed at previous inspections and will be covered again later this year. The judgements given throughout this report were informed by the examination of relevant documentation, discussions with 8 of the 22 residents 7 staff members, the management team and the owner and also through observations made during the three hour period of the inspection. What the service does well: What has improved since the last inspection?
Since acquiring the home the owners have made good progress and have introduced a new management structure and systems. Many of the outstanding requirements previously made have been met in full or are in hand.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 6 The registered manager is now supernumerary and has a clearly defined role she is assisted by a deputy manager and an administrator. A number of additional qualified nurses have been employed recently and the home is currently recruiting overseas carers to ensure that staffing levels are maintained. Improved assessment and care planning documentation has been agreed with senior staff and is being introduced for new residents. Staff training in the use of the new documentation is planned. Meanwhile the current care plans now contain the required additional information and those seen had been updated to reflect changing needs and had been agreed with the resident or their relatives if appropriate. The home has started a review of the Statement of Purpose and the Service User Guide and it is anticipated that these documents will be completed within the agreed timescale. The management team has developed a residents and relatives’ satisfaction questionnaire that will be sent out over the coming month and the owner, Mrs Rai, has commenced monthly quality monitoring visits with the support of her adviser copies of her reports have been received by CSCI. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 7 The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 standard(s) 1,3 and 4 Prospective residents are able to make an informed choice on the suitability of the service from information given verbally but do not yet have access to an updated service user guide. The assessment process covers all potential care needs but as the assessment tool has only recently been introduced further evidence of its effective use will be required at future inspections. The home is able to meet the needs of residents requiring personal care and who have a physical illness but does not currently provide care for people who develop symptoms of dementia or behavioural difficulties. EVIDENCE: The manager and her deputy confirmed that they have commenced a review of the statement of purpose and service user guide and expect that the new documents will be available within the agreed timescale. New residents have access to the documents produced by the former owners and are given verbal information relating to the new owners.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 10 The home has introduced an assessment tool developed by the Royal College of Nursing and the assessments of three recently admitted residents were examined and all aspects of potential physical and psychological need had been commented on. However a resident admitted on the previous day, who had been assessed using the newly introduced tool, exhibited unexpected challenging behaviour during the night and the home had concluded that it could not provide appropriate care. The resident concerned stated that he did not want to stay at Hillcrest Manor and wished to go home. The home had informed the care manager of the difficulties and had requested a further assessment; the resident’s condition had also been discussed with his doctor. A regulation 26 report to CSCI indicated that a former resident had been moved to another home when she became disruptive following bereavement. The management team felt that this was in the best interests of the other residents. 8 other people seen on the day confirmed that they are happy with the service they receive and that their needs are being met. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 standard(s) 7,8 and 9 All residents have individual care plans that reflect assessed needs and the new documentation being introduced will improve the care planning process. Resident’s health care needs are closely monitored and appropriate referrals made for specialist opinion when required. The home has improved recording, administration and storage procedures for resident’s medication and has updated policies and procedures giving clear guidelines for staff. EVIDENCE: The home has installed a new storage facility for residents’ medicines; the medication for individual residents is stored in individual boxes, which were found to be well ordered. Refrigerator temperatures had been recorded and were within the recommended range. Medication in the drugs trolley was again stored individually and identification photographs were fixed to residents’ storage boxes. Multi dose preparations had been dated at the time of opening and a number of MAR charts were examined and had been properly completed. A qualified nurse was administering medication at the time of the inspection and was observed to be following the homes procedure. Policy and procedure documentation has been updated and staff are aware of what is required.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 12 The home has recently concluded a disciplinary action against a staff member who did not adhere to the set procedure resulting in the nurses referral to the General Nursing Council. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 standard(s) 12 and 15 Optional outings and in house activities are arranged that are appropriate to the interests and abilities of the current group of residents. Residents are offered an aperitif before meals and the food served is nutritious and varied. EVIDENCE: The activities coordinator has again increased her hours and now works 30 to 35 hours per week. Forthcoming events were posted in the entrance hallway, as were photographs of special events that had taken place. Records were seen to contain details of residents’ interests and hobbies and all activities undertaken were recorded for participating residents. The kitchen records were examined and the cook operates a rotational menu system. The cook on duty had completed a catering course and a food hygiene update. Lunch was served during the inspection and the food looked appetising and was well presented. The main dining room has been redecorated and the stained carpet is being replaced shortly. 6 residents were enjoying a pre-lunch sherry and expressed appreciation of the food served and were also appreciative of the new décor in the main dining room.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 14 Mrs Rai stated that the stained carpet in the dining room was to be replaced shortly. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 standard(s) 16 and 18 Complaints of any kind are dealt with promptly and vulnerable people are protected from abuse. EVIDENCE: The complaints procedure is displayed prominently in the entrance hallway and new residents and their relatives/representatives have access to a copy. The home’s complaints log was examined and found to contain one minor complaint that had been dealt with promptly and appropriately by the management team. Two residents, when asked, were aware of how to make a complaint should they wish to Policies and procedures have been updated and a new staff training video has been obtained and updates are due to be delivered during May2005. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 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 standard(s) 19,25 and 26 Hillcrest Manor provides a warm and comfortable environment, which is clean and nicely decorated. A previously identified safety issue is in hand. EVIDENCE: A full tour of the building was not undertaken but all public rooms, the kitchen a number of shared toilet facilities and four bedrooms were found to be clean and tidy. Several rooms had been redecorated and refurbished to a high standard and the owner gave details of the on going programme of improvements. Which will include replacing the guards on a number of storage radiators Stained carpet throughout the home is due to be replaced over the coming month. One of the two cleaners on duty said she was happy with her work schedule and as a long standing employee exhibited great pride in her work. Six residents expressed their approval of the redecoration of the dining room and were happy with the way the home is maintained generally Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Resident’s needs are effectively met by qualified nurses and experienced carers who have received additional training appropriate to their role. The home’s proposed induction programme for new care staff is thorough but as yet untried and will be assessed at the next inspection. EVIDENCE: Staff rotas were examined and indicated that minimum staffing levels have been consistently maintained. The manager assesses dependency levels on a daily basis and adjusts staffing levels and ratios if required. During the inspection staff were observed to answer call bells and requests for assistance promptly. Housekeeping and catering staff are also employed and although the head cook was away her duties had been successfully covered. In addition to recruiting additional qualified nurses the activities co-ordinator has increased her hours worked and the owner has employed a full time administrator, her effectiveness being much in evidence in the way in which files are maintained. The files of 3 new staff members were examined and CRB disclosures had been obtained. The homes own policy states that one of the two references given must be from the last or current employer, however, a newly appointed qualified nurse commenced her duties before a reference from her current employer had been received. The nurse had requested that her employer was not approached before interview and the home did not follow this up following employment although all other checks including PIN status had been made.
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 18 Individual training needs have been identified as part of the newly introduced yearly appraisals and a number of staff members have completed additional training in the care of dying people and in supporting bereaved relatives. Mandatory training courses have either been completed or have been arranged but while copies of relevant training certificates are kept on individual files, there is no effective means of identifying when updates are required. Following discussions with the manager and the owner it was agreed that the administrator would establish a computer held training record and the manager would formulate a staff-training plan. 8 of the 15 carers have completed NVQ2, 3 of the 8 have also done NVQ3 and a further 2 carers are undertaking NVQ 2 The home has recently obtained an improved induction programme for care staff and plans to introduce it when the overseas staff commence employment. Qualified nurses also receive a documented induction Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36 and 38 The manager is qualified and experienced in the care of older people. She has the confidence of the staff group and the support of the new owner and manages the home effectively for the benefit of residents. Two conditions of registration relating to management are currently not being met as Mrs Rai has been unable to undertake the required NVQ level 4 in care and management and her quality monitoring visits (Regulation 26 visits) have not been overseen by a suitably experienced person. The safety of residents and staff is assured through risk assessment and adherence to the home’s policies and procedures. EVIDENCE: The manager, Mrs Thomas, is qualified and has many years experience in managing care and since the sale of the home has undertaken a full range of management duties. The manager is now supernumerary and a deputy
Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 20 manager has been appointed. Good rapport was observed between the residents the owner and the nursing/care team. The owner appeared to know the residents personally and the residents in turn responded positively to both Mrs Rai and Mrs Thomas. Residents are consulted personally regarding their views on how the home is run and the deputy manager has now developed a quality assurance questionnaire that is to be distributed during May (blank copies available). Mrs Rai has not yet commenced NVQ level4 in care and management this is understandable given that her priority has been to establish a new management team, introduce new management systems and oversee the refurbishment programme. She is at the present time very much ‘hands on’ and spends approximately 4 full days per week at Hillcrest Manor this involves a lengthy commute from her home. However she is aware that attaining the relevant NVQ’s is a condition of her continued registration and she has made a commitment to identify a suitable course within the next 2 months. Mrs Rai has submitted monthly regulation 26 reports and she is now aware that Mr Kelly must accompany her during the visits in addition to giving advice. All care and nursing staff have had an appraisal with the manager and the minutes of monthly staff meetings were examined. Individual risk assessments were seen in the residents records and the home’s health and safety policy is available to staff who receive the appropriate training. Co2 fire extinguishers have been purchased and the manager and the administrator have had additional fire safety training. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 2 x x 3 x 3 Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 22 yes 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 op3 Regulation 6 Requirement Timescale for action 1st Dec 2005 1 month 3. 4. op7 op25 5. op33 6. op33 Tbe statement of purpose and service user guide must be updated 14(1)(a) Service user assessments must effectively cover all areas of need identified in NMS 3 subsection 3.3 15(1)(2)( The care plans for all service a) users must comply with NMS 7 sub-sections 7.2 and 7.6 13(4)(a)(c Storage radiators must be fully ) guarded as stated in the plans for refurbishment and ground floor extension 26 Regulation 26 visits must be conducted with a relevant experienced professional, not associated with the running of the home, for a period of 12 months from 1st 1st Dec 2004 7 the owner must commence NVQ level 4 in care and management in compliance with the conditions of registration 2months 2 months Monthly until 1st Dec. 2005 2 months 7. Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 23 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 30 Good Practice Recommendations The manager should maintain a central staff training record Hillcrest Manor Nursing Home E56 S62189 Hillcrest Manor V222426 UI 260405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 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
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