Inspection on 16/08/05 for Hillcroft (Carnforth) Nursing Home

This inspection was carried out on 16th August 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

Hillcroft (Carnforth) Nursing... 23/05/07

Hillcroft (Carnforth) Nursing... 23/01/06

Hillcroft (Carnforth) Nursing... 23/02/05

Hillcroft (Carnforth) Nursing... 03/08/04

Hillcroft (Carnforth) Nursing... 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hillcroft (Carnforth) Nursing Home North Road Carnforth Lancashire LA5 9LU Lead Inspector Joy Howson-Booth Announced 16 August 2005 10:00am 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. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hillcroft (Carnforth) Nursing Home Address North Road Carnforth Lancashire LA5 9LU 01524 734433 01524 720050 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) Hillcroft (Carnforth) Limited Mrs Frances Clare Turner CRH Care Home 66 Category(ies) of DE Dementia 38 OP Old Age 28 registration, with number of places Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home should at all times employ a suitably qualified and experienced manager who is registered with the CSCI Date of last inspection 23rd February 2005 Brief Description of the Service: Hillcroft (Carnforth) Limited is the largest of the three homes operated within the Hillcroft group of homes and is situated in the small town of Carnforth, approximately 8 miles north of Lancaster. The home is registered for 66 people of either sex who require either general nursing or nursing with specialist dementia care. The home is situated in its own grounds and is built over three floors. Each floor has its own name – Elm, Oak and Ash and a dedicated team of staff for each floor. The main entrance and top floor of the home accommodate administration, offices and visitors lounge.Although the home is reasonably close to local shops and amenities, because of the nursing needs of the residents, there would be few people who could access these independently. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced so the General Manager, manager of the home, staff, residents and relatives were aware of the visit. The inspection lasted for most of the day and included looking at care pathways, other documents and talking with the manager and staff on duty. A small number of residents were talked with although staff were also observed at work and interacting with the residents. The inspection was carried out against the National Minimum Standards for Older People. Because of the needs and capacity of the residents at the home, only a small number were able to express an opinion over the care provided. The direct observations of staff provided a good opportunity and showed that residents were treated with dignity and respect and the relationships with staff were very positive. Residents spoken with said they felt well looked after. A number of relatives returned comment cards which were positive about the care provided. These comments included “the care is second to none – I have to agree – the home is very well maintained, staff are very friendly and cazring and keep me well informed re Dad’s care and physical and medical condition” and “I retain a very high opinion that I have of the level of care given to my relative who has now been a resident for two years”. Three relatives were spoken with who were also very positive in their comments about the care provided. The home is split over four floors, the top floor housing the administration and offices and separate units (Oak, Ash and Elm) which are on the three floors below. Observations of residents confirmed they looked comfortable and relaxed in their own environment, with a range of comfortable seating. What the service does well: Both the General Manager and the Home’s manager are committed to making sure that the needs of the residents are met and the standard of care and the home is kept at a high level. The Home’s manager works in a positive way and acts on advice given by the inspector for the home. A good example of this is when concerns were raised at the inspection over written information by one member of staff – the home’s manager has confirmed this was dealt with promptly. There is an ongoing commitment to provide training to everyone who works at the home, with the home employing a named person called the Clinical Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 6 Supervisor to make sure all staff get a range of training to do their work better. A number of staff have achieved National Vocational Qualification Levels II and III and staff are continuing to do these qualifications which are recommended by the Commission for Social Care Inspection. Relatives of residents were very positive about the management of the home and the care provided. One relative spoke of his enjoyment at having his Golden Wedding party organised by the home and celebrated there, along with family and friends being invited. There is an ongoing redecoration and refurbishment programme which means that the home is clean and tidy and provides an excellent environment for people to live in. This home began the relatives support group by recognising that a number of relatives were interested in the care provided to their residents, and provided this practical way so that people could meet informally. This support group meetings on a 3 monthly basis. As mentioned in this report, this group not only provides support to others who may be finding it difficult to accept their relatives have dementia or are now needing the care provided by the home, but also provides advice and information. The company pays for a place for the group to meet, along with food and drink. What has improved since the last inspection? What they could do better: Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 7 Overall, the care provided at the home was confirmed by both residents and relatives as being very good indeed. From this inspection it is recommended that the range of social and other activities in the home need to be developed further to ensure the residents who have dementia have meaningful and stimulating activities to do. The manager must make sure that information and guidance provided to staff in the care pathways is understood and followed, particularly over recording of difficult behaviours and how residents should be cared for when they are unhappy or upset. Advice was given that when bed rails are to be used a consent form should be completed and signed by relatives as part of the home’s formal risk assessment process. As well as this, when specialist seating like bean bags or specialist chairs are to be used, the manager must make sure that residents safety is maintained. Advice was given that pureed foods could be presented to the residents in a more positive style. Locks on residents doors need to make sure the resident’s privacy is kept but also makes sure that staff can access the room in an emergency. 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. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 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 Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 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) 3 and 6 The system for assessment of prospective residents in the home is very comprehensive and provides excellent information to enable a judgement to be made as to whether the home can meet identified needs. EVIDENCE: The company has recently introduced a new assessment and care planning system called “Care Pathways”. This means that following the initial enquiry from either Social Worker, Health professional or relative the manager will undertake a person visit to meet the prospective resident and complete a “care menu”. The care menu is in the format of a comprehensive list of identified needs, including – Leisure/Social, Mobilising, Elimination, Personal Hygiene/Dressing, Eating/Drinking, Skin Care, Physical Health, Communication, Sleep, Mental Health, Personal Safety and Pain Control. Each of these major areas is then Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 10 subdivided into specific needs relating to the main area and covers identified need, desired outcome and nursing intervention. This system not only provides a method of prompting for assessment but means that individual and specific needs can be added in as needed. In addition to this there is evidence of healthcare professional and Social Services assessments. Where a resident has been admitted from the specialist assessment hospital there is the arrangement for the residents place to be kept open for 12 weeks. Support and guidance is available from the specialist consultant and, before a final decision to discharge is taken, a review of the placement is made to ensure the resident has settled and the home is able to meet the identified needs. Care Pathways for recently admitted residents were seen and it was confirmed that the manager of the home also undertakes an initial assessment menu which includes a dependency score, administration and financial information, nurse admission sheet. It is from this initial information that a care pathway menu is completed and an initial care pathway plan put in place. This home does not provide an intermediate care facility. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 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 10 The are comprehensive and clear care planning systems in place which means the needs are of the residents are met in a consistent, professional and caring manner. The staff have a good understanding of the residents needs and provide care in a way that protects the residents privacy and dignity. EVIDENCE: As mentioned previously, a new care pathway system has been introduced into the home and, following the completion of a care menu at the time of assessment, a care pathway will be set up for the new resident. Care pathways have also been introduced for existing residents. The system means that identified needs in the care menu are transferred into a working document or care pathway. Either monthly or as residents needs change, this system enables any changes to be immediately incorporated into a new care pathway document . For example, should a resident experience a chest infection then the nurse in charge will indicate this needs to be incorporated. A new care pathway will Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 12 then be produced to ensure the chest infection and desired outcome is included, along with the nursing intervention required to meet this. A number of care plans were examined in detail (case tracked) and the documentation evidenced that the information is comprehensive and the new care pathways system is working well. Discussions with staff on duty confirmed that they felt this was an excellent system and provided them with clear information over care needs and how these are to be met. Discussions over specific care needs confirmed that these are clearly understood and followed, with good communication in place to ensure any changes are notified and addressed. Advice was provided by the inspectors that monitoring of the care pathways should take place to ensure that staff fully understand and follow any instructions written. For example, if a record needs to be kept of any behaviours that challenge – despite this being recorded on a number of resident’s care pathways there was no evidence of this recording taking place. In another example, one resident’s care pathway stated that if she became verbally aggressive then carers must approach her in a calm and gentle manner. However, when reading this resident’s daily care notes it was apparent that one member of staff had not used this approach. The possibility of developing individual behaviour management plans for residents was discussed. Such plans would include directions to staff in how to approach particular residents when displaying certain problematic behaviours. The development of such plans would provide further protection to those residents who have complex behavioural needs. In addition to the main care pathway separate information is maintained for specific nursing interventions – fluid balance, pressure care, etc. In discussion, one relative told the inspector that he felt his wife’s physical care needs were very well met at the home. Another relative told the inspector how pleased she was with her husband’s care. She explained that ongoing problems her husband had experienced with his legs, had now been resolved after his admission to Hillcroft. Discussion with those residents who were able to do so confirmed that they feel well cared for and they are able to continue with their day to day routines. Discussions with staff on duty and observations confirmed that the home maintains the privacy and dignity of residents and, through discussion, staff understand what this means on a practical level. The inspectors were concerned about some of the terminology used in residents’ care records and felt that such terminology compromised the dignity of the residents. For example, when writing about a resident with a learning disability staff had referred to her ‘coming to play.’ Another staff member had referred to ‘telling off’ another resident in her daily records. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 13 Two residents completed comment cards and confirmed that they liked living at Hillcroft (Carnforth), felt well cared for, were treated well by the staff and their privacy is respected. Two visiting relatives who were spoken with stated they were very happy with the care provided to their relatives, with both qualified and care staff doing their utmost to make sure the care was excellent. They also confirmed that they are kept aware of any changes, are consulted by the care staff and have confidence that their relatives were receiving the best care they could have. A number of comment cards were received which also confirmed this – “his care is second to none – I have to agree – the home is very well maintained, staff are very friendly and caring and keep me well informed re Dad’s care and his physical and medical condition” another comment card stated “I retain a very high opinion that I have of the level of care given to my relative who has now been a resident for two years“ Comment cards received from other relatives included the following comments – “I can’t speak highly enough of the standard of care my relatives receive”, “we are very pleased with the level of care Dad has received – we have never had any cause for concern that he is not getting the best care”. Another comment card stated “my relative likes being as independent as possible, even if this takes time and staff wait for her rather than having everything done for her”. All the comment cards received confirmed that relatives/friends are able to visit their relatives in private and are kept informed of important matters affecting their care. Unfortuantely, no comment cards were received from external healthcare professionals or GP’s. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 14 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, 13 and 15 Activities within the home are an area for development so that residents individual lifestyles, preferences, etc., can be met and they can receive social stimulation within the home. There are no restrictions for families and friends visiting the home which means the residents benefit from seeing familiar faces when they want. Arrangements and planning to provide good nutritional food are excellent which means the residents are provided with high quality food to ensure healthy living. EVIDENCE: Social activities are currently being reviewed with a number of staff due to attend a specialist course which will enable them to identify suitable activities and develop this as an area. As with the other homes within the Hillcroft group, staff again confirmed that they provide some activities in the afternoon and recognised the difficulties in identifying appropriate activities due to the needs of the residents. Staff confirmed a training course to look at activities has been organised with an external trainer and were looking forward to developing this within the home. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 15 All residents have a recreational therapy sheet which indicates a personal profile and their interests. A weekly report is completed but many state “as plan” which is not helpful in identifying what activities have taken place at any one time. For the residents case tracked the activities were limited. For one resident the recreational therapy plan was written in 2003 which would indicate there is a need to review the activities provided. The manager has confirmed that the staff who are to attend the training course for activities will be developing activities within the home in the future. One of the comment cards received from a resident stated that the home did not provide suitable activities for them to do. The inspectors were concerned about some of the terminology used in residents’ care records and felt that such terminology compromised the dignity of the residents. For example, when writing about a resident with a learning disability staff had referred to her ‘coming to play.’ Discussions with staff and visiting relatives, along with comment cards received, confirmed that relatives/friends are able to visit at any time, are made to feel welcome in the home and they can visit in private. One relative confirmed he visits daily and is always made most welcome. Another relative spoken with confirmed that she is always made welcome and are encouraged to have a meal with the resident they are visiting, if they wish to do so. Of particular mention is the clear pleasure enjoyed by one relative who had a Golden Wedding celebration organised at the home. This involved a buffet tea and other family and friends attended too. This was related with clear enjoyment and has provided a positive memory for the relative concerned. As with the other homes in the Hillcroft group, the home has now had the input of the Head Chef who has revised all the menus to provide an excellent standard of food. The menus are organised over a four week rota. On each day there is the provision for a range of breakfasts – from full English breakfast to porridge, prunes, eggs, etc. At lunchtime, there are a range of main courses on offer – with two main courses and specialist diets (soft, vegetarian, diabetic) being catered for. For example, turkey casserole, baked ham in orange sauce, soft option being minced turkey, vegetarian option being a burger, all served with green beans macedoine, lyonaise potatoes. This is followed by sticky toffee pudding or fruit pie. For the evening meal again there are a range of choices, a sample of the menu is as follows: – soup option, cheese and potato pasty or scrambled egg and ham with baked beans and new potatoes. In addition, bbeans on toast, assorted sandwiches followed by turkey salad. For sweet there is either peach Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 16 flan or fruit cocktail. In addition, there is fresh fruit, yoghurt or a cheese board on offer. All the food is home made. The chef on duty was spoken with who again confirmed that communication is very good within the home and again he feels very much part of the team. On admission, a nutritional form is completed so that he knows about individual likes and dislikes, etc. and he will be informed if there are changes to any residents which means they may need a more specialist diet. In discussion with the inspectors, the head chef demonstrated a good understanding of catering for residents with special dietary needs. In addition, the head chef had a good knowledge of individual residents and any special dietary needs that they had. The head chef is currently looking at the provision of soft diets and how this can be further improved. A contact for this was given and the Chef felt this would be helpful. In discussion, a number of relatives and staff commented that they felt the food at the home had greatly improved recently. In particular, comments were made about the choices available to residents and how these were much improved. . Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 17 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 The home has a satisfactory complaints system in place with evidence that views and concerns are listened to and acted upon. EVIDENCE: There is a formal complaints procedure and this is included in information provided to prospective residents and/or their family members. Because of the needs of most of the residents in the home, it is unlikely they would be able to use this complaint system and are reliant on their relatives and staff to ensure their care. All the relatives consulted by the inspectors said that they were very confident that any complaints or concerns they had would be properly investigated All but one of the comment cards received confirmed that the relatives/friends knew the home’s complaints procedure. The two residents who completed a comment card confirmed they knew who to speak to if they were unhappy about any aspect of their care. The complaints book was seen and evidenced a complaint which had been appropriately dealt with in a timely and sensitive manner by the General Manager. The manager confirmed that this complaint and follow up actions are to be clarified to staff at the next staff meeting. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 18 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) None of the standards were assessed in this section during this inspection EVIDENCE: Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 19 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) 30 There is a clear training programme for all staff which provides staff with information, skills and training to meet the range of both care and support needs within the home. EVIDENCE: Discussions took place with the Clinical Supervisor at the Hillcroft (Caton Green) home when the programme for the training of staff was discussed in great depth. The findings below were recorded at this previous inspection but for Hillcroft (Carnforth) are as follows. Over the last couple of years, the company decided to have a dedicated training organiser to identify, organise, access funding and personally provide training to the number of staff who work at the home. This person has the title of Clinical Supervisor. Discussions with the Clinical Supervisor confirmed that there is a comprehensive training programme in place for the staff who work at this home. All new staff receive a three full-day induction provided at this home as this is the main administration site. This is carried out prior to commencing work. This is the TOPSS Induction as recognised by the Commission for Social Care Inspection. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 20 All existing staff, both care and ancillary, access a range of courses, both inhouse and from external providers. Training for care staff includes – mandatory training, update training, TOPSS foundation training, National Vocational Training and specialist courses – challenging behaviour, death and dying, effective communication, pressure care, care of ageing skin, abuse and needs of service users. At present at Hillcroft Carnforth there are 8 people who are doing National Vocational Qualification (NVQ) Level II and 3 people doing NVQ Level III. Update training is also provided for qualified nursing staff at the home and includes – dressing and bandages update, continence care, dementia care, controlled drugs procedure update and supervision training. Training provided for ancillary staff includes –National Certificate in Further Education, food hygiene, healthy eating, National Vocational Qualification in cleaning and support services, infection control and health and safety. There are full training records for all staff which are maintained by the Clinical Supervisor. It was confirmed that there is a working relationship with the local college who will provide a yearly needs analysis for training. Monitoring of both the training and those who access the training is carried out by the Clinical Supervisor who confirmed some staff are counselled if there is no clear progress evidenced. This high level of training commitment provided to staff is excellent and is something that should be continued. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 21 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 and 38 The residents live in a home that is very well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The manager of the home has been in place for several years and has a range of qualifications and experience which enables her to manage the home effectively. Through discussions with staff and relatives the manager has their full confidence to manage the home. Because of the needs of the residents at the home, formal residents meetings are not an option. However, the home has very close links with relatives and has its own support group. The support group is made up of both current relatives and relatives of people no longer at the home and provides both a support, information and social function. The group meets on a 3 monthly basis, with input from both one of the Directors, the General Manager and the manager of the home. There is a financial cost to these meetings which is met Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 22 wholly by the company. Discussions with a visiting relative confirmed that these meetings are valuable to him and provide him with an opportunity to meet with like minded relatives, obtain and give information and to make sure “new relatives” are given support and help from someone who has experience in what it is like to see a loved one with dementia or nursing needs go into a care home. As in the other homes within the Hillcroft group, the health and safety of the home is managed by the manager with the support of the Housekeeper. The housekeeper has responsibility over the domestic, laundry and handyman and ensures the cleanliness and maintenance of the home. Regular update meetings with the manager take place. There is an ongoing programme for redecoration and refurbishment of the home, with new bedding and curtains and some recarpeting being a current priority. The home has a non-lifting policy in place which has necessitated the purchase of a number of new hoists. The pre-inspection questionnaire also confirmed that regular safety checks are carried out in the home. There are arrangements in place for the safe disposal of clinical waste. Safe working practices and health and safety training is provided to all staff, both care and ancillary and this has been evidenced via training records. Discussion took place over a resident choosing or a decision being made to keep their room door open. Advice was given that it would be safer to have the door installed with an approved fire stop which would release the fire door should the fire alarm be activated. This would mean that the safety of the resident is maintained as the fire door would then shut automatically. The manager has previously confirmed that she is aware of the relevant legislation which must be complied with. Risk assessments are carried out for working practices. Risk assessments are also carried out as part of the care pathways planning – initially at the point of assessment by the manager and from then on by the qualified staff in the home. For one resident who was case tracked a consent form for the use of bed rails was not in evidence. Advice was provided to the manager over the use of the bean bags in one unit. In addition, the manager was made aware that the residents on one unit did not appear to be being supervised adequately as two staff were attending to one resident in their room and no other staff were visible in the lounges for sometime. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 23 There are procedures in place for recording of accidents and these are monitored by the manager and General Manager on a monthly basis. However, some errors were noted for example, the same accident being recorded as 11.15am and 11.15 pm. The inspectors recommended that carers be reminded of the importance of recording accurate information in records such as these. Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x x x 3 Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 25 no 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations The area of activities to continue to develop to ensure the residents accommodated are offered appropriate and tailored activities which provide them with stimulation and meaning Procedures should be put in place to make sure staff understand and follow any specific instructions or guidance in the care pathways, particularly for behaviour monitoring or dealing with residents who are exhibiting behaviours that are challenging Pureed food may be better presented in individual stylised portions Fire door stops should be investigated for use within the home, espcially when a resident prefers to have their door open at night Protocols should be put in place for the use of bean bags and bucket chairs in the home Consent forms for cot sides should be obtained and signed as part of the risk assessment The current penny locks should be replaced by a more apprpriate facility that enables residents privacy to be F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 26 2. OP7 3. 4. 5. 6. 7. OP15 OP38 OP38 OP38 OP24 Hillcroft (Carnforth) Nursing Home 8. 9. 10. OP30 OP10 OP7 11. OP38 maintained but also ensures access in an emergency Continue with the National Vocational Qualification training Staff should be made aware that terminology about residents should not compromise their dignity Behavioural Management strategies in the care pathways may be more useful if individualised and provide directions to staff in how to approach the particular resident when displaying problematic or challenging behaviours. This would provide further protection to those residents who have complex needs. Staff should be reminded to record accurate and full information on accident records Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Hillcroft (Carnforth) Nursing Home F57 F09 S6164 Hillcroft (Carnforth) V234265 160805 Stage 4.doc Version 1.40 Page 28 - 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. 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