CARE HOMES FOR OLDER PEOPLE
Hillcroft (Carnforth) Nursing Home North Road Carnforth Lancashire LA5 9LU Lead Inspector
Mrs Joy Howson-Booth Unannounced Inspection 23rd January 2006 10:00 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 Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hillcroft (Carnforth) Nursing Home Address North Road Carnforth Lancashire LA5 9LU 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) 01524 734433 01524 720050 Hillcroft (Carnforth) Limited Mrs Frances Clare Turner Care Home 66 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (28) of places Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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 NCSC. 16th August 2005 Date of last inspection 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 DS0000006164.V278748.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced so the registered manager and staff at the home were not aware of the inspection. The purpose of this inspection was to assess the service against the key National Minimum Standards, which remain outstanding and also review actions taken following the recommendations made in the previous inspection report. A number of residents were spoken with, along with two visitors to the home. Observations were also made of the care staff and it was noted that interactions were respectful and positive. Both qualified and care staff on duty were also spoken with. A selection of documents held by the home were examined, including care pathways, medication records, staff files and financial records. Feedback received from residents indicated that they felt very well looked after at the home and were very well cared for by the staff. Relatives spoken with both commented that they were very satisfied with the care provided to their relatives and felt the home was well maintained, pleasant, clean and tidy. 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 again confirmed they looked comfortable and relaxed in their own environment. What the service does well:
The Company, General Manager and Registered Manager take very seriously their responsibilities to the residents and are consciously looking to make improvements as needed. There is a continuous and ongoing improvement programme, which works alongside a formal quality assurance system, to ensure both the care and environment are maintained to a high level. The home is very well maintained and provides a comfortable and homely environment for the residents. There is an ongoing commitment to developing the service with support and training provided to all levels of staff. Support is also provided to relatives by means of a support group. The company recognised 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 now need
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 6 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?
There were no requirements made in the last inspection report, although a number of recommendations for good practice were made. At this inspection, the General Manager confirmed actions taken over these, as follows: There is now a dedicated Occupational Therapist who organises the activities, etc., for the home. All staff now have a paid quarter-hour handover at the start/end of each shift. This provides an opportunity for the care needs of each resident to be clarified, along with any changes. The suggestion that moulds could be used for pureed foods has been looked into but appears cost prohibitive. The cook is looking to develop the idea but is ensuring each different part of the meal is pureed separately. The company is looking to purchase fire door stops for those residents who wish to have their doors open at night. Protocols for the use of beanbags and consent forms for cot sides are now contained in the care files for the residents concerned. Penny-locks are being phased out as part of the refurbishment programme for the home. The company have employed 8 dedicated staff to provide holiday and sickness cover in the homes. A staff bulletin has been introduced to aid communication to the staff who work for the Hillcroft homes. A new full-time Clinical Supervisor has been appointed to organise and provide training for all levels of staff in the homes. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 7 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. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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 Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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): Standard 3 was assessed and met at a previous inspection The home does not provide an intermediate care facility EVIDENCE: Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Standards 7, 8 and 10 were assessed and met at a previous inspection Systems are in place to ensure medication is safely administered to residents by people who are qualified to do so. EVIDENCE: A selection of medication records, stocks and controlled drugs were examined and found to be accurately maintained and safely stored. The qualified nurses spoken with confirmed that only qualified nurses deal with medication. Residents who were able to do so said their medication was administered correctly and on time. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 11 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): Standards 12, 13 and 15 were assessed and met at a previous inspection. As much as they are able, residents exercise choice and control over their lives. EVIDENCE: Those residents who were able to do so confirmed that they are able to exercise choice and control over their lives. It is recognised that many residents at Hillcroft (Carnforth) are needing a high level of nursing input. To address individual changes there is a quarter-hour handover at the start of each shift when any adjustments to care are informed to staff, this is particularly important when individual choices may be outweighed by nursing interventions. For example, a resident who may prefer to remain in bed but to avoid a deterioration in their health need to be encouraged to get out of bed. Residents are free to remain in their own rooms and to access the communal areas as they choose or are able to do so. Staff spoken with also had a good understanding of the importance of choices and making sure residents had as much control over their lives as was possible. Staff also felt it was very important to obtain as much information as
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 12 possible on residents’ lifestyles and social histories and evidence of this was seen on the social history forms completed by relatives. The care pathways in place also informed staff as to choices for individual residents. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 13 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): 18 Standard 16 was assessed and met at a previous inspection There are good systems in place, and training provided, to ensure that residents are protected from abuse. EVIDENCE: The home has a comprehensive vulnerable adult abuse procedure which has been used, when needed, in the past. Any incidences or concerns are passed to the Registered Manager who is responsible for taking the appropriate action. An overview and monitoring of concerns or complaints is carried out by the General Manager as part of the home’s quality monitoring process and who would also deal with any formal appeals, if needed. The Commission has clear evidence that the General Manager is proactive in her adult protection responsibilities. Discussions with the Training Manager confirmed that adult abuse awareness is covered both in the home’s own induction as well as in other training. Discussions with both qualified and care staff on duty confirmed that there is a good understanding of what may constitute abuse and the steps to take should any concerns be raised in this regard. Examination of one care pathway indicated an area where a resident had had to be restrained whilst in a wheelchair. Evidence indicated this decision had
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 14 been made as part of a multi-disciplinary team and was included in the care pathway. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: The home is very well maintained, with a programme of maintenance and redecoration ongoing. During this inspection, it was noted that re-carpeting and refurbishment was taking place on one of the floors. There is a secure garden which is accessible by residents, although this is generally with staff support. There is a dedicated housekeeper and maintenance section to ensure any requirements made by the fire department and environmental health are addressed promptly. There are no CCTV cameras in use in the home.
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 16 From touring the three floors of the home, it was seen that the home is kept to a high standard, with all furnishing and fittings being domestic in character and all areas in the home clean and tidy. There is a dedicated laundry for washing which is separate to the cooking and other areas of the home. It has previously been confirmed that all the requirements for the washing of foul laundry and disinfection standards are met. There are policies and procedures in place for the control of infection, as well as procedures should a serious outbreak occur. Discussions with staff during this inspection confirmed there is a good understanding of infection control. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 The level and calibre of staff is very good. Residents are cared for by staff who are qualified, competent and dedicated. Staff are properly vetted before taking up employment meaning that only people who are suitable work with vulnerable people do so. EVIDENCE: Staffing rotas were seen and evidenced that the staffing levels are maintained to an appropriate level. Discussions with staff on duty and with two visiting relatives confirmed that they feel there is always sufficient staff on duty. One resident said that there was always staff about to help him and he never had to wait for someone to come when he called, in fact sometimes two people turn up! On each floor there is a qualified nurse on duty at all times, along with care staff. There is a dedicated full-time ‘Care Supervisor’ on duty whose role is to organise the staffing levels at all the three Hillcroft homes, dealing with sickness and holidays and ensuring there is sufficient staff on duty. More recently, the Hillcroft group has employed 8 experienced people who are a dedicated holiday/sickness bank of staff used within the four homes to cover as required. These people are required to be experienced to a higher level of competence, for example, auxiliary nurses or trained National Vocational
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 18 Qualification Level III as a minimum. In addition, there is a dedicated Clinical Supervisor who organises and provides training to staff. To ensure staff get to know about changes to care needs, all staff now have a paid quarter-hour handover period. This provides an opportunity for qualified and care staff to get together to discuss any changes or specific instructions which have come about since their last shift. Staff spoken with felt this was very good and enabled them to get to know what was going on. The General Manager has introduced a ‘Staff Bulletin’ for all the staff within the four homes and includes information on Company news; training available; welcome for new staff; congratulations on training completed; and any other pertinent information. Four files were seen for new staff and, although actual photographs were awaited, all contained the information required under the regulations. A slight alteration to the reference request form was advised. For one file, although two references had been obtained there was no official reference from the prospective employee’s previous employer. The circumstances around this were discussed but the General Manager is to remind the home’s managers of the requirement to obtain a reference from the last employer. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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 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): 33 and 35 Residents and their relatives feel listened to The financial arrangements in place ensure that residents’ finances are safeguarded. Systems are in place to ensure the service is monitored and developed to the benefit of the residents EVIDENCE: 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
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 20 manager of the home. There is a financial cost to these meetings which is met wholly by the company. Discussions with a visiting relative during a previous inspection 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. The General Manager confirmed that a good number of relatives attended the support group for the Christmas meeting. Discussions with two visiting relatives during this inspection confirmed that they were very happy indeed with the care provided by the staff at the home; that they were made welcome at any time; the communication by staff was excellent and they were able to obtain information and to give feedback at any time. Residents who were able to do so also confirmed that they feel listened to and were able to talk to staff who took any concerns seriously. Comment was made by a resident that the registered manager regularly comes onto the unit to speak with residents. Discussion with the Company’s administrator confirmed that there are exacting and significant financial procedures in place to ensure the resident’s financial interests are protected. Examination of financial files evidenced that each resident has their own financial file into which copies of invoices, payments, contracts, etc., are kept. Residents can choose to have their own account into which money is paid. The home will make payments on behalf of individual residents and at the end of each month an invoice is raised and either presented to relatives or paid from this individual account. The Administrator confirmed that any large expenditures have to be authorised and receipts, etc., are sent out to relatives for their information. Minor expenditures on behalf of residents have to be receipted and presented to the finance department. Computer records are maintained of charges and payments and the Administrator also confirmed these are backed-up on a daily basis. A selection of accounts were examined and the information presented was seen to be exact. The Administrator also stated that for some residents monitoring of payments into accounts and appropriate action takes place as needed. The Administrator is the named person who will act as an appointee, if required. The General Manager confirmed that the existing quality assurance systems remain in place which include external and internal auditing, the use of ‘noncompliance forms’ which are used to identify issues so that appropriate action can be taken. Feedback is also sought from residents, relatives and external
Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 21 healthcare professionals. The registered provider also visits and tours the home on a weekly basis and, in addition to this, monthly reports are sent to the Commission by the General Manager. Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 4 X 3 X X X Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 OP29 Good Practice Recommendations The General Manager to amend the reference request form so that the referee can state their relationship to the person they are giving the reference about. A reference should be obtained from the person’s last employer Hillcroft (Carnforth) Nursing Home DS0000006164.V278748.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection North Lancashire Area Office 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
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