Inspection on 23/05/07 for Hillcroft (Carnforth) Nursing Home

This inspection was carried out on 23rd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

Hillcroft (Carnforth) Nursing... 16/08/05

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 Mrs Joy Howson-Booth Unannounced Inspection 23rd May 2007 09:30 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.V334731.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 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 Corris 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.V334731.R01.S.doc Version 5.2 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. 23rd January 2006 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. The current range of fees are from £520.00 per week and are according to assessed needs. Further details over fees can be obtained from the registered manager of the home. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit and was unannounced so the registered providers, registered manager, staff and residents were not aware of the visit. The inspector for the service carried out the site visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. As well as the site visit, judgements have been made about the service based on information supplied by the registered manager. Comment cards were made available to residents, their relatives and GP surgeries. 11 responses were received from relatives who were very satisfied with the service provided. 1 response was received from a healthcare professional which again expressed their satisfaction with the service provided. The site visit took place over one day and included taking time to sit and speak with residents, spending time observing staff on duty performing the day-today care tasks, speaking with staff, speaking with four relatives/visitors to the home. As well as this, a selection of documents were examined. The home’s registered manager was available during the inspection to answer questions and provide additional information. The inspector looked around parts of the home, including communal rooms, a small number of personal rooms, bathrooms and toilets to see first hand if the home was a comfortable, clean and safe for people to live in. Additional information was also supplied from a pre-inspection questionnaire completed by the registered manager. The site visit was positive with everyone welcoming, friendly and co-operative during the visit. What the service does well: Hillcroft (Carnforth) provides a pleasant and homely environment which has a relaxed and friendly atmosphere. As with the other homes in the Hillcroft group, the registered manager and staff at Hillcroft (Carnforth) try hard to make sure equal care is given to the residents, considering their individual choices and preferences, and giving equal support to all, irrespective of their race, gender, disability, sexuality, age religion or beliefs. Comments include – “I have been impressed with the level of care throughout the 18 months since my relative was admitted”; “facilities and efficient management are excellent. However my chief praise is for the quality of care – and my admiration for the cheerfulness and friendliness of nursing and care staff in the difficult work of a Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 6 dementia unit is boundless”; “and” no concerns. Hillcroft is a first class company with first class caring and well trained staff”. When asked what the home does well, the following comments were made by relatives - “arranging special events and bringing families and residents together – e.g. bonfire night, comic relief fundraising, cub scouts coming in to do a cake and coffee afternoon, Xmas meals. Also special treats for residents – manicures”; “staff genuinely care about residents”; “provides care and love well above that called for in their terms of reference”; “looks after individuals as people not just a number. Shows care and affection to all the residents (however difficult)”; “very caring”; “there are non better than Hillcroft staff. They nurse my relative look after her as if she is family”; “as far as I have experienced. The new or younger members of staff are very compassionate, caring and obliging towards residents, our relative and ourselves. The experienced staff are excellent. All residents are treated as individuals and with respect. Their dignity and safety is promoted at all times”; “we don’t think they can improve, as long as the standards are maintained. The home is always spotlessly clean and well maintained. Nothing ever appears to be too much trouble for anybody. Whether its management, carers, cleaners, kitchen staff, or maintenance man. They all appear to be dedicated to care of the elderly” and “thank you for doing such a splendid job which in turn gives me complete peace of mind”. During the site visit, a number of residents were seen and a small number spoken with. All appeared to be well cared for and content. People spoken with all said they felt well cared for and the staff were very good. One person said “I am extremely well looked after” and continued “I have never had anything to complain about but if I did, given how the staff care, it would be sorted out straight away”. A number of genuine and caring interactions between residents and the staff were seen, with each person being treated as an individual and given the time and attention needed. The registered manager works at the home on a full-time basis which gives an opportunity to talk with the residents and pick up immediately on any concerns or issues. Staff confirmed that the registered manager is a visible presence on a daily basis and is approachable and supportive. Individual comments from relatives include - “the matron and her staff are very efficient and always willing to help in any way they can”; “very well run, excellent food, consistent and attentive care” and “if all the care homes were run as well as Hillcroft (Carnforth) there would be no need for inspectors”. There is equal consideration given to all prospective employees, with both male and female staff, including staff from overseas being employed. Training and development programmes are offered to all members of staff. The home employs a number of qualified nurses to undertake formal nursing care and are supported by a range of care staff. Information from the home stated that 70 of the care staff are trained to National Vocational Qualifications (NVQ) Level II. This means that residents are cared for by suitably qualified and Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 7 experienced staff. The carers were friendly and understood the personal needs of the residents. Whilst all the residents have a range of differing care needs, they are encouraged to maintain their lifestyles as much as they are able to do so. Visitors to the home are always made welcome and are able to visit at any time. Individual comments include – “all the staff from the matron to receptionists act in a very sympathetic and caring manner not just with my relative but also their families, especially when dealing with (another) elderly and frail relative”; “always there for the relatives to talk to, and supportive when needed”; Four relatives/visitors were spoken with who confirmed they were very satisfied with the care provided. Information supplied by the home confirms that there are a range of policies and procedures which ensure the residents are provided with the care they need and respects their rights irrespective of their race, gender, disability, sexuality, age, religion or beliefs. The home is well maintained and homely with communal rooms being accessible to the residents. Each unit is self-contained on one level, although there is a passenger lift within the home. There are a range of aids and adaptations for use within the home to help maintain residents’ independence and dignity. The small number of personal rooms seen during this site visit were well maintained and homely. Residents are also encouraged to bring in treasured personal items to personalise their rooms. Communal rooms are well maintained and provide a homely and comfortable environment for the residents to use. From talking with the residents and staff on duty it is clear all work hard to ensure the home is maintained to a high standard and the registered manager is approachable for any ideas and suggestions that would improve the service. What has improved since the last inspection? The home continues with its ongoing programme for redecoration and refurbishment of individual rooms. A number of hospital beds have been purchased to assist with those people who are less mobile. A consultant dietician has been employed to assess the nutritional input of the residents. This is being done with the involvement and support of the head chef who is also keen to make sure people have a very good diet and enjoy the food his team make. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 8 Training of staff in the home continues with staff being supported to attend and complete a range of training according to their needs. 70 of care staff are now trained to National Vocational Qualification Level II and the home is aiming to have 72 of staff trained to NVQ Level II by the end of 2007. The home has introduced the Liverpool Care Pathway (end of life care) system for people whose health is deteriorating. Full details on this system can be found in the main report within the Health and Personal Care Section (Standard 11). Management systems (which look at how the home is being run) have been brought in so that there improvements can be made when needed. What they could do better: Two requirements and four recommendations have previously been made regarding the administration and recording of medications in the home. These were made following a pharmacist inspection earlier this year. At this inspection, the registered manager confirmed that these are being addressed. However, confirmation is required that the requirements have now been addressed. No requirements have been made at this site visit. A small number of recommendations have also been made which can be found at the end of this report and include individual comments discussed with the registered manager. These issues were raised as general points and the people who raised them were not identified. These include : “change of staff sometimes a problem, e.g. individual preferences may not be known by new staff” – the registered manager confirmed she was aware of this issue. Advice given that if the care pathways were more person centred they would include preferences of each individual resident so staff should be better informed. “with the current problem of hospital and care home infections I feel hand washing facilities for relatives and staff should be available both at the main entrance and on each unit” – the registered manager confirmed that such facilities have been installed in another of the Hillcroft homes and she is in discussion with the general manager over installing these at the Hillcroft (Carnforth) home. “more mailshots to families to tell them of special events/activities coming up” – this has been highlighted as wanted at other Hillcroft inspections and the general manager has already confirmed she is looking at ways of producing a newsletter for relatives. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 9 The registered manager welcomed these comments and feedback as a way of hearing first hand about the service she manages. The registered manager confirmed that she is very happy to speak with relatives and welcome the opportunity to talk about any concerns at all. 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. The summary of this inspection report can be made available in other formats on request. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 10 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.V334731.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The system for assessment of prospective people in the home is very comprehensive and enables a judgement to be made as to whether the home can meet identified needs. EVIDENCE: The home (in line with the four other homes in the company) has a care plan system called “Care Pathways”. This means that following the initial enquiry from either Social Worker, Health professional or relative the manager or the head of nursing undertake a person visit to meet the prospective resident and complete a “care menu”. It is from this initial information that a care pathway menu is completed and an initial care pathway plan put in place. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 12 The care menu is in the format of a comprehensive list of identified needs, which outlines the individual person’s needs and how staff are to meet these. Advice was given that the pre-admission assessment form could be more person centred and detailed information gained could then be transferred onto the care pathway. For example, information supplied by relatives (our relative likes a night light on) could be included in the care pathways so that these are personalised and recognise individual preferences. 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 people 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. There is also in place an admissions procedure which outlines for staff how people who are admitted to the home need to be given time, information and made to feel comfortable. The home also involves relatives in the move and works hard to keep them involved. The General Manager advised that the Statement of Purpose and Service User Guide are being reviewed to ensure both documents have all the required information. The General Manager also confirmed that following a needs assessment, all prospective people are provided with a letter offering them a place, along with their designated room and fees. Once this has been accepted a formal pack is then sent out which includes the Service User Guide, Terms and Conditions/Contract (if private) and any other information (e.g. information about the relatives support group) thought useful. Comment cards received confirmed that contracts are provided by the home. This home does not provide an intermediate care facility Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 10 and 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. An excellent quality of care is provided to the people which means their health and personal care needs are met and people are treated with dignity and respect. EVIDENCE: The care pathway system is used in this 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. All the residents have their own care pathway which is reviewed, either monthly or as needs change. This system enables any changes to be immediately incorporated into a new care pathway document. The five care pathways examined evidenced that there is good written information which provide all levels of staff with the individual people’ needs and how these are to be met, including specialist monitoring charts. The care Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 14 pathways also include risk assessments and the outcome of these. It was not possible to view consent forms for the use of bed rails as no separate documents now exist and the registered manager was advised that this should be reviewed. The registered manager was also advised that some care pathways had not been changed as residents’ needs had changed. Some of the care pathways have somewhat general information, for example, “monitor triggers” but there is no evidence of why, what these may be or whether any monitoring has taken place. Some care pathways provided evidence that the resident (or their representatives) had been involved in their care pathway plan. Daily records are also kept, although it was again mentioned to the registered manager that “care as pathway” is not detailed enough and may be insufficient should any specific questions be raised. There was good evidence of healthcare monitoring and intervention by GPs, Consultants, etc. One healthcare professional comment card was received in respect of this service. Comments include that the ‘care service always seeks advice and acts upon it to manage and improve individuals healthcare needs’ and ‘individuals’ healthcare needs are always met by the care service’. On healthcare professional commented – “I am very happy with the home and quality of care the staff give”. Information supplied by the home indicates that a full range of healthcare professionals are used, some on request but others on a regular basis. A small number of residents were also spoken with. From these discussions and from comment cards received all expressed their satisfaction over the care provided by the staff at the home. Residents who are able to do so and relatives all confirmed that staff listen and act on what is being said, they always receive the care and support they need and they receive the medical support they wish. Individual comments from relatives include – “I refer any small queries to the nursing staff who deal sympathetically with them. We work as a team for the benefit of my relative”; “I have been impressed with the level of care throughout the 18 months since my relative was admitted”; “my relative had to go to hospital recently and care home staff phoned us as soon as they had called for ambulance”; “our family is really pleased our relative is here as she is getting such loving care”; “there are non better than Hillcroft staff. They nurse my relative look after her as if she is family” and “the nursing care is very good. If there is a problem with any health issue it is dealt with right away”. One resident spoken with commented “I am extremely well looked after” and confirmed that her healthcare needs are addressed promptly. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 15 A selection of both qualified and care staff were spoken to about individual care needs and all were well informed and had a very good understanding of the care needed by each of the people case tracked. Discussions with staff also confirmed they were well aware of individual preferences and how people wish to be supported. The care pathways also include information to ensure people dignity and privacy are maintained and include “ensure dignity and self respect” and “minimise distress and maintain independence”. One care pathway examined noted that “personal care to be performed by the same sex carer only”. The home has policies and procedures for people who are dying and when death occurs. Qualified staff at the home have been trained in Liverpool Care Pathways (which ensures that an intensive multi-disciplinary care input is provided (including the resident, their relatives and their own GP) when death is close so that unnecessary interventions are stopped and only the necessary (e.g. pain relief) interventions take place. This ensures that the resident is provided with their chosen level of input, according to their personal and religious preferences, which is dignified and pain free. Relatives are welcomed and supported by the manager and staff during these circumstances and are able to spend as much time as they wish with their relative. Four visiting relatives/friends were spoken with and all expressed their satisfaction over the care provided to their relative/friends. Medication was not assessed on this occasion as this was done in depth by the pharmacist inspector at an earlier site visit (January 2007). The registered manager confirmed that the Hillcroft group of homes is addressing all the requirements and recommendations. The registered manager was advised that allergies noted in assessment information should also be included in the care pathways. Currently this information is noted on the Medication Administration Sheet (MARs) but to include as a standing item on an individuals’ care pathway notes would help to reduce the risk of a resident being given medication they are allergic to. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities, social contact and meals are good which means the people are provided with a good quality of lifestyle EVIDENCE: Due to the needs of the people at Hillcroft (Carnforth) only a small number of people were able to make comment on their daily activities. However, those people who were able to do so confirmed that they are able to follow their own routines and preferred activities. Individual routines are generally found at the time of assessment and following admission, although it was suggested that the information sought could be more person centred. The majority of comment cards completed by relatives confirmed that the service supports people to live the life they choose, although recognising that the abilities of their relatives are now very diminished. Individual comments regarding activities and lifestyles include – “my relative cannot “choose” but the support is excellent “; “arranging special events and bringing families and residents together – e.g. bonfire night, comic relief fundraising, cub scouts coming in to do a cake and coffee afternoon, Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 17 Xmas meals. Also special treats for residents – manicures” ; “looks after individuals as people not just a number”; “The care and compassion that our relative receives is second to none. Their individual needs in every aspect have always been met”; “home always supports people to live the life they choose – “I observe that people are not only supported but encouraged to do so”. Examination of care pathways noted that more information could be included so that staff are clear as to what routines and preferences would be enjoyed. The care pathways examined contain the generally statement “follow recreational therapy plan” which is too general and each individual person should have something specific on their care pathway which staff can then follow. Whilst each unit has staff identified to provide recreational therapy, there is a need for some creative ideas to be brought in which are specific for people who have dementia and also activities for people who are at the later stages of their dementia (e.g. SONAS). It would also be helpful to identify more 1 to 1 activities that could be based on what the people had enjoyed doing. Recreational therapy records examined were too general over activities provided. Information supplied by the home indicates that the following activities are provided : one to one activities, games, craft, speciality food tasting afternoons, mobile library, visiting entertainers, weekly visit from PAT dog. Due to the needs of the residents, general community activities are not accessed, although residents are supported on a one to one basis and one resident has two hours individual funding. One resident spoken with told me about visiting local shops in Carnforth and was looking forward to a shopping trip to buy some new dresses. Generally, activities for those people who are able to self determine are well managed and respected. However, activities for those people in the later stages of their dementia require more thought and planning to ensure appropriate social stimulation is offered to everyone. Relatives also confirmed they are kept in contact and are provided with information as needed. Comments included – “communication is excellent”; “we are always informed immediately” and “all the staff from the matron to receptionists act in a very sympathetic and caring manner not just with my relative but also their family especially when dealing with (another) elderly and frail relative”. As with the other homes in the Hillcroft group, this home continues to have 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. Hillcroft is Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 18 able to meet the needs of special diets, although diets on religious or cultural grounds would need to be ascertained at the point of assessment. Menus supplied by the home confirm that there is an excellent range of food provided, with special diets being catered for. The general manager stated that the Hillcroft group has recently employed the services of a dietician. There are a number of choices available at each meal. People spoken with confirmed they were very satisfied with the food provided and if they wished for something different this would be provided. A member of staff was observed giving one resident her lunch – this was done in a caring and kindly way, talking with the resident and making sure it was a social occasion and a pleasant experience with the meal being given in an unhurried way. This carer was spoken with who stated that she felt that lunchtimes were particularly important for the people who were unable to leave their rooms and made sure these people were given time an attention. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Concerns can be voiced and staff are trained in safeguarding adults which means that people are protected. EVIDENCE: Information supplied by the home indicated there has been one complaint received regarding this service. This was discussed with the registered manager who outlined the complaint and the actions taken to address it. The complaint has been dealt with appropriately. The commission has not received any complaints or concerns regarding this home. The complaints procedure remains the same and is also contained in information provided by the home. A copy of the complaints procedure is also on display in the main reception area, along with a survey form which relatives and visitors are encouraged to complete. There is ongoing monitoring from the general manager who would ensure that any complaints are fully investigated and recorded and used as a basis to improve the service. One person spoken with commented – I have never had anything to complain about but if I did, given how the staff care, it would be sorted out straight away”. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 20 Comment cards received from relatives and people spoken with all indicated that they knew who to talk to if they were unhappy about any aspect of their care. Individual comments include – “can not think of nor have I experienced any persistent problems. Minor transient matters are attended to as they arise”; “I refer any small queries to the nursing staff who deal sympathetically with them. We work as a team for the benefit of my relative” and “I know how to make a complaint – but I have never needed to!”. One healthcare professional survey form indicated that the home has “always responded appropriately if any concerns have been raised”. As one of the Hillcroft group of homes, there are robust procedures in place for recognising and responding to any safeguarding adult concern. Previous discussions with the Hillcroft group’s training manager confirmed that safeguarding adults is covered in both the home’s own 3 day induction programme and through other training. Safeguarding adults is also covered within the TOPSS and NVQ training programmes. Information supplied by the training co-ordinator indicates that (since the last inspection) 7 staff have completed a specific course in managing people who have challenging behaviour and 8 have completed a specific course in adult abuse awareness. The home has had one safeguarding adults referral since the last inspection, which was handled appropriately. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager confirmed that there have been no changes to the environment since the last inspection, other than ongoing redecoration and repair, as necessary. Although not all areas of the home were viewed, communal areas and some individual rooms were seen. The home continues to maintain a high standard of facilities, with individual rooms being clean, well maintained and providing a comfortable private space for the residents. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 22 Individual rooms have been personalised with treasured possessions to make them familiar and homely. There are a small number of shared rooms on the lower floor. Generally residents do not have a choice of room but discussion will take place as needed. People spoken with confirmed that they are very happy with their rooms, the communal areas and the home is clean, warm and comfortable for them to feel at home. No concerns were raised over the cleanliness of the home. One comment card included – “the home is always spotlessly clean and well maintained”. There is a secure and pleasant garden area which can be accessed, although it 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. Staff spoken with confirmed that any repairs, etc., are done promptly. There is an infection control policy and procedure in place and training records evidenced that staff have accessed infection control training. One relative comment card stated – “with the current problem of hospital and care home infections I feel hand washing facilities for relatives and staff should be available both at the main entrance and on each unit.” This was discussed with the registered manager who confirmed such a system is in place in another of the Hillcroft homes and is intending to speak with the General Manager to install similar systems at Carnforth. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The level and calibre of staff is generally good. Residents are safeguarded as their care is provided by a staff team who are vetted, qualified and competent. EVIDENCE: A selection of staff files were examined for staff appointed since the last inspection – these were found to contain all the required information as outlined in the regulations. The home has a formal recruitment procedure in place. The home’s equal opportunities policy is reflected in their employment as there are both male and female staff, aged over 18, including overseas carers working at the home. Information from the home confirmed that only two shifts in the last eight weeks have used agency or bank staff which means that residents are cared for by staff who are familiar to them and know their needs. The Hillcroft group have a dedicated Clinical Supervisor who organises training, including a formal 3 day induction training programme for new staff. More Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 24 recently the Hillcroft group have set up a dedicated training room at their Lancaster home to enable staff to undertake their training courses in a more formal setting. In addition, a range of other in-house training and external training courses are accessed as training needs dictate. Staff spoken with confirmed they have accessed a range of training, as outlined above, dependent on their experience and time with the home. Information supplied by the home confirmed that currently 70 of care staff hold NVQ II or above, with 2 care staff currently doing NVQ Level II. Staff spoken with confirmed that training is ongoing and spoke about what they had learned during the training and how they were putting this into practice when looking after the people who live at the home. Comments from those residents who are able to do so and from relatives indicate that staff are experienced and skilled to meet their needs, and there are usually sufficient staff on duty. It was noted that people and staff felt that staffing levels are generally good with holiday and expected absences are covered by the dedicated relief staff who work, as needed, in the four homes. Individual comments include – “they have a happy group of staff, from the top right down to the cleaners. If the staff are happy it shows in the way they care for people”; “However my chief praise is for the quality of care – and my admiration for the cheerfulness and friendliness of nursing and care staff in the difficult work of a dementia unit is boundless”; “staff genuinely care about residents”; “as far as I have experienced, the new or younger members of staff are very compassionate, caring and obliging towards residents, our relative and ourselves. The experienced staff are excellent. All residents are treated as individuals and with respect. Their dignity and safety is promoted at all times” and “nothing ever appears to be too much trouble for anybody. Whether its management, carers, cleaners, kitchen staff, or maintenance man. They all appear to be dedicated to care of the elderly”. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents live in a home that is well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The manager of the home has been in post for a number of years and is registered with the commission. She has a wide range of experience in management and is also a registered nurse and since registration has demonstrated her competency. Comments received both from the comment cards and also from speaking with residents who are able to comment and staff all confirm that the manager is very approachable, competent and deals Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 26 with issues immediately. The registered manager has clear responsibilities and is not in charge of any other home, although provides relief management cover for the other three homes on a rota basis with the other managers. Comments included – ““if all the care homes were run as well as Hillcroft (Carnforth) there would be no need for inspectors”; “facilities and efficient management are excellent”; “all the staff from the matron to receptionists act in a very sympathetic and caring manner”; “thank you for doing such a splendid job which in turn gives me complete peace of mind” and “the matron and her staff are very efficient and always willing to help in any way they can”. Staff spoken with confirmed that the registered manager is in evidence and is available to speak with if they have any concerns or questions. As with the other homes in the Hillcroft group, this home has a flourishing relatives 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 wholly by the company. Meetings are well attended. The General Manager confirmed that the quality assurance systems in place continue to be used to review and improve services and include external and internal auditing, the use of ‘non-compliance forms’ which are used to identify issues so that appropriate action can be taken. The home has just received the ISO quality award for a further 3 years. Feedback is also sought from residents, relatives and external healthcare professionals. Both the general manager and the registered provider visit the home on a very regular basis. From previous inspections it is noted that, because of the needs of the residents at the home, formal residents meetings are not an option. However, people who were able to say confirmed that they feel listened to. The two Requirements and Recommendations 1-4 made in this report relate to the Pharmacist Inspection earlier in the year. Discussions with the registered manager confirmed that the Hillcroft group of homes are currently liaising with an external Pharmacist to ensure all the requirements and recommendations are met. It was confirmed that regular meetings take place between trained staff, care staff, handovers at the start of each shift, matron’s meetings, quality meetings. Information supplied by the home confirmed that there are the full range of policies and procedures which are located in both the registered manager’s office and in the nurse’s station on each of the three floors. Policies and procedures are reviewed in line with the quality assurance requirements by the general manager. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 27 The general manager confirmed at a previous inspection that all new residents are provided with a breakdown of their individual fees, along with what the home provides, as required in the Care Homes Regulations 2001. A letter giving full details over the home’s Terms and Conditions is sent when an offer of a place at a Hillcroft home is made. This letter gives information over what is supplied, facilities, responsibilities for fees and any arrangements for any additional fees, e.g. for sundry items. This is in addition to the Individual Service Agreement sent by Social Services. A general statement regarding this is included in the home’s Service User Guide The registered manager has previously confirmed that no monies are held for people in the home. For those people who do not handle their own financial affairs these are managed by solicitors, families or via the resident’s own account which is where expenditure (hairdressing, personal items, etc.) are refunded from. All expenditure is receipted and audited. The system for financial management for people who use services within the Hillcroft homes is, as follows : 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. At a previous inspection 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. At this site visit, the administrator confirmed that the financial systems previously inspected remain in place. A selection of these financial records were seen for a selection of people at all four Hillcroft homes and these appeared accurate and up to date. Information supplied by the registered manager confirmed that regular maintenance and servicing takes place on equipment and facilities within the home. Discussions with staff confirmed that regular maintenance takes place, with prompt action being taken if any issues are raised. The registered manager confirmed the home has a fire assessment in place and information supplied stated that the last fire drill was held in February 2007. The accident forms were seen and all appeared accurately completed and followed through. The general manager has previously confirmed the home has received the new bed rail guidance from MHRA, with new hospital style beds being installed. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 28 Information supplied by the Clinical supervisor confirmed that Skills for Care (TOPSS) induction and foundation training is accessed for new staff. Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 29 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 3 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 3 x 3 Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The registered manager must ensure an accurate record of receipt is made for all medicines kept in the home. This is essential to show that medicines have been administered correctly. (This was not assessed at this site visit – confirmation is still required that this requirement has been met previous timescale of 22/02/07 not met) Timescale for action 23/05/07 2. OP9 13(2) The registered manager must 23/05/07 ensure an accurate record of medicines administration is made with particular reference to creams and nutritional supplements. (This was not assessed at this site visit – confirmation is still required that this requirement has been met previous timescale of 22/02/07 not met) Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations All handwritten medicines records should be doublechecked and counter signed. Patient information leaflets should be consulted for all medicines kept in the home to ensure medicines are given at the correct time of day and are stored at the correct temperature. Protocols should be developed for when required and variable dose medicines to ensure they are administered correctly. A review of all medicines administration is recommended to ensure they are being given at the correct time. Care plans should be more person centred and provide information over individual preferences, wishes, interests, etc. Care pathways should be updated as needs change Care pathways should provide information over allergies and could be a standing item at the head of the care pathway sheet Staff at the home could develop activities for the people with dementia – for example SONAS – further information can be obtained from specialist websites/contacts Consideration should be given to the provision of antibacterial hand gel available on entering/leaving the home Napkins for use when eating should be put on at the time the meal is going to be given and not in advance as this does not respect the dignity of the residents 2. OP9 3. OP9 4. OP9 5. 6. 7. 8. 9. 10. OP7 OP7 OP7 OP12 OP26 OP10 Hillcroft (Carnforth) Nursing Home DS0000006164.V334731.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000006164.V334731.R01.S.doc Version 5.2 Page 33 - 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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