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Inspection on 01/05/07 for Hillcroft (Caton Green) Nursing Home

Also see our care home review for Hillcroft (Caton Green) Nursing Home for more information

This inspection was carried out on 1st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Hillcroft (Caton Green) Nursing Home Caton Green Road Brookhouse Lancaster Lancashire LA2 9JH Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 1st 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 (Caton Green) Nursing Home DS0000006141.V332530.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 (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcroft (Caton Green) Nursing Home Address Caton Green Road Brookhouse Lancaster Lancashire LA2 9JH 01524 770334 01524 771472 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) Hillcroft (Caton Green) Limited Mrs Valerie O`Connor Care Home 35 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (16) of places Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered within the Commission for Social Care Inspection.. The home is registered for a maximum of 35 service users to include up to 19 service users in the category DE (dementia) and up to 16 people in the category OP (older persons 65 and over) 14th February 2006 Date of last inspection Brief Description of the Service: Hillcroft (Caton Green) Limited is the second smallest of the four homes operating within the Hillcroft Limited group of homes and is situated near to the small village of Caton, approximately 10 miles north of Lancaster. The home is a detached dwelling, built in a Victorian style, originally used as a maternity home but its use was changed to that of a nursing home in more recent times. The home is situated in its own quite extensive grounds and is built over two floors. Additional accommodation has been built on. The home has two main areas - The Manor and The Croft. The home is reasonably close to local shops and amenities in the nearby village but, because of the needs of the residents, there would be very 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 (Caton Green) Nursing Home DS0000006141.V332530.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 people who use the service were not aware of the visit. The site visit was carried out by the inspector for the service. 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 people who use the service, their relatives and GP surgeries. 2 responses were received from people who use the service, all satisfied with the care provided. 14 responses were received from relatives who also were generally very satisfied with the service provided. Some individual issues raised in comment cards were discussed with the registered manager who welcomed these as an opportunity to further improving the service. 2 comment cards were received from healthcare professionals – both satisfied with the care provided by the home and one commented “one of the better homes I visit”. The site visit took place over one day and included taking time to sit and speak with people who use the service, spending time observing staff on duty performing the day-to-day care tasks and speaking with staff. As well as this, a selection of documents were examined. The home’s registered manager and general manager made themselves 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. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 6 What the service does well: Hillcroft (Caton Green) is set within its own grounds in the countryside near to the small village of Brookhouse and provides a pleasant and homely environment with a relaxed and friendly atmosphere. As with the other homes in the Hillcroft group, the registered manager and staff at Hillcroft (Caton Green) try hard to make sure equal care is given to the people who use the service, considering their individual choices and preferences, and giving equal support to all, irrespective of their race, gender, disability, sexuality, age religion or beliefs. A number of specific comments from people who use the service and from their relatives have been included in the body of this report. However, when asked what the service does well, relatives made the following specific comments – “everything” “my relative is very well looked after and their needs well catered for” “attend to individual needs of the resident and their family. Show an interest. Show they care” “they do all they can do which is make my relative comfortable” “provides care with sensitivity and is aware of this patient’s needs!” “good food, kept clean, room clean, friendly” “as a family we are made to feel very welcome. We are very impressed by the way all the staff speak so well to our relative” “provides security and reassurance as well as day to day care” “it values residents and tries to allow them to make choices where possible. Staff are courteous and caring. My relative is clean, well fed and generally content. I am very grateful for the support they give me” “very well in the care given. We are very grateful for all the care given at Hillcroft” “my relative is unable to take responsibility for personal hygiene. They are always clean and tidy” “keeps a fairly happy atmosphere and provides good meals. Very caring generally” “high standard of furnishings and decoration. Visitors lounge where residents can have some privacy with their visitors” “Caton Green is an excellent nursing home. I cannot speak highly enough of the staff. It is a centre of excellence”. During the site visit, a number of people who use the service were seen and spoken with and all appeared to be well cared for and content. People who were able to do so all said they felt well cared for and the staff were very good. A number of genuine and caring interactions between people who use the Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 7 service 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 people who use the service and pick up immediately on any concerns or issues. A relative commented “we are especially impressed with two members of staff – Jackie (receptionist) and Val (matron). Both of them sets the high standard at first meeting, which has continued on each of our visits. We are made to feel very welcome”. Each of the homes within the Hillcroft group have their own 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 6 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. These are seen by relatives as positive and comments included – “at Hillcroft we are invited every 6 months to a meal, which gives us opportunity to voice any concerns or ways for them to improve their care” and “the M.D. meets us all over a buffet 2x per year and invites criticism and comment”. 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. This means that people who use the service are cared for by suitably qualified and experienced staff. Whilst all the people who use the service 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 – “we keep in touch with our relative and Hillcroft”, “my relative has Alzheimer’s – the staff inform me directly” and “I usually visit my relative daily”; “no restrictions on visiting”. Information supplied by the home confirms that there are a range of policies and procedures which ensure people who use the service 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 very well maintained and homely with communal rooms being accessible to the people who use the service. Both The Croft and The Manor have their own passenger lifts so that the people who use the service can access their rooms at any time. There are a range of aids and adaptations for use within the home to help maintain people who use the service’ independence and dignity. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 8 The small number of personal rooms seen during this site visit were well maintained and homely. People who use the service 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 people who use the service to use. From talking with the people who use the service 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? What they could do better: Only one requirement has been made and this is to ensure medication is better organised and given out correctly within the home, as follows : • Medicines must always be administered as prescribed failure to do so can seriously affect the health and well being of the residents. DS0000006141.V332530.R01.S.doc Version 5.2 Page 9 Hillcroft (Caton Green) Nursing Home A number of recommendations have also been made which can be found at the end of this report and include : • • • • Records of administration of creams need to be improved to show that they are being used as prescribed. The medicines audit should be reviewed and updated ensuring it is targeted at all key medicines handling issues. Daily records should not just record “care as pathway” as this lacks detail about the actual care provided. Deployment of foreign staff should be considered so that people whose first language is not English can be supported to communicate with people who use the service and their relatives As part of this quality assurance system it is recommended that spot checks are carried out on day-to-day care tasks, e.g. medication administration • Some individual comments and suggestions to improve the service made on relatives’ comment cards were discussed with the general manager and registered manager. These issues were raised as general points and the people who raised them were not identified. These included : “Laundry” – the registered manager confirmed that there had been some problems with the laundry but these had now been sorted out. She could see no reason why white clothing should not remain white and colours not faded. “More mental and physical motivation is needed”. The registered manager confirmed that all people who come to the home are asked about their lifestyles and preferred activities and, if they are not able to provide this information, family members are asked to complete a social history giving this information. It was also confirmed that some members of staff have completed an activities course. This is an area that the home needs to continue to develop, particularly in light of the people who use the service being more dependent on staff for social and physical stimulation. “more staff” – the registered manager is aware that the home must be staffed according to the needs of the people who live there and the staffing rotas indicate a good level of staffing. In addition, there is a dedicated bank of relief staff which are used in the home to cover planned absences and holidays. “difficulties in communicating with some overseas staff” – the general manager confirmed that all staff who are considered for employment have to successfully pass a written test on their comprehension and written and spoken English set by the Home Office. As noted above, it is recommended that the registered manager continue to review staffing rotas so that people whose first Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 10 language is not English can be supported to communicate with people who use the service and their relatives. “perhaps a short update or report of any changes” – the general manager is considering a newsletter to be issued to relatives so that changes/moves/ forthcoming events/relatives meetings dates, etc. can be better communicated. Both the general manager and the registered manager welcomed these comments as a way of hearing first hand about the service. Both confirmed that they are very happy and welcome the opportunity to talk with relatives 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 (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 11 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 (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 12 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 People who use the service experience excellent outcomes in this area. 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 will undertake a personal 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 (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 13 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 subdivided into specific needs relating to the main area and covers identified need, desired outcome and nursing intervention. Advice was given that the pre-admission assessment form could be more person centred, for example, where bathing is assessed the timings, frequency and any individual preferences or routines could also be noted. This system not only provides a method of prompting for assessment but also 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 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. From examination of two assessments for recently admitted people, it was confirmed that the Care Pathways assessment information was carried out by the registered manager. 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. Individual comments included “I was kept informed at every stage” and “we find Hillcroft provides us with excellent care and good communication”. A relative comment card also stated “We are especially impressed with two members of staff – Jackie (receptionist) and Val (matron). Both of them sets the high standard at first meeting, which has continued on each of our visits. We are made to feel very welcome”. The General Manager has previously 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 an 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. However, because of the needs of the people who are accommodated in this home it is usually their relatives or named social worker who act as advocates for the people to be moved. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 14 The home does not offer intermediate care facilities. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 15 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, 9, 10 and 11 People who use the service experience good outcome in this area. This judgement has been made using available evidence including a visit to this service. A quality of care is provided to the people which means their health and personal care needs are generally met and people are treated with dignity and respect. Medication systems are generally satisfactory but some practices have the potential to place people at risk. EVIDENCE: Five care pathways were examined and 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. The care pathways also include risk assessments and the outcome of these – for example the use of bed rails. There was evidence of reviews. Daily records are also kept, although it was again mentioned to the registered manager that “care as pathway” is not Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 16 detailed enough about the day-to-day care and may be insufficient should any specific questions be raised. There was good evidence of healthcare monitoring and intervention by GPs, Consultants, etc. Two healthcare professional comment cards were received in respect of this service. Both indicated 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 specific comment – “generally one of the better homes I visit” was made by a healthcare professional. Information supplied by the home indicates that a full range of healthcare professionals are used, some on request but others on a regular basis. The home promotes equality by treating people as individuals and ensuring that diversity needs such as impaired mobility and functional are appropriately met. The care pathways also include information about individual preferences and choices and the importance of ensuring dignity and privacy are maintained. Staff observed were seen to care for the people with kindness, care and respect. Some care pathways provided evidence that the resident (or their representatives) had been involved in their care pathway plan. A small number of people who use the service 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. People who use the service 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. Other relatives spoken with directly were positive about the care provided – “my relative has been quite poorly but they have been looked after exceedingly well”; “I am very pleased with the care my relative is getting – he is very happy”; “(at a previous home) I was told my relative couldn’t walk – however the staff take the time to walk with her to the loo now”; “my relative is very happy there. He has come on a bundle. They’ve been so kind - he was poorly and it took them a bit to find out what was wrong but they got the GP involved. They’ve been endlessly kind to my relative” and “the standard of care is excellent …… I feel confident that my relative (who is very poorly) is being looked after in the best possible way”; “my relative is unable to take responsibility for personal hygiene. They are always clean and tidy (clothes always clean, hair clean and cut regularly, nails always clean and short)”. Comments from one relative stated that their relative is not offered choices. This was discussed with the registered manager who felt that staff do offer choices but is to remind staff to do so. Medication records and stocks were examined, two qualified nurses were spoken with and a medication administration round observed. Generally medications are being administered properly, although several anomalies on Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 17 the medication records and an incident of poor practice were observed. It was also of serious concern that one person’s medication was not being given at the ‘correct’ time. The registered manager was advised that signatures should be clear as two signatures appeared to correspond with codes which may cause confusion. Failure to give medicines as prescribed can seriously affect the health and well being of residents Advice has previously been given to the general manager (at a recent inspection to another of the Hillcroft homes) on how to improve their general medicines handling procedures (including their ordering and recording systems) and their audits on medicines to help ensure all medicines are being given to residents correctly.. Medicines are stored securely within the home. Access is normally restricted to qualified nurses this ensures they are not mishandled. Procedures are in place to treat minor ailments, a small number of nonprescribed (homely remedies) medicines are available and appropriate consent has been obtained. This helps ensure minor ailments such as headaches are promptly treated. At this inspection the general manager confirmed that steps have been taken to begin to address the previous issues raised and the issues raised from this inspection will also be dealt with under their revised medication procedures once in place. Whilst this was not formally assessed, 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. The general manager confirmed that the Hillcroft homes have all now their own syringe driver for use to ensure pain relief is always available. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 18 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): Standards 12, 13, 14 and 15 People who use the service experience good outcomes in this area. 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: Discussions with people who use the service confirmed that individual routines can be followed and they are happy with the activities currently on offer. 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 people who use the service and their relatives confirmed that the service supports people to live the life they choose. Records examined evidenced that activities are provided and recorded, along with whether the person enjoyed that activity or not. Information supplied by the home indicates that the following activities are provided : mobile library, TV/Video entertainment, church choir singers, singer/entertainer, hand and Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 19 nail care, hand massage, music therapy, games, jigsaws and use of the extensive gardens, weather permitting. People are also supported to take part in home visits, social outings, outings with families. Staff also use personal care time to talk with the people who use the service. In addition, a priest and/or minister visits the home on a regular basis, providing communion and religious support to residents as needed. At the time of this inspection visit, some people were sat outside enjoying the warm sunshine and in the afternoon a number of people were enjoying an ‘olde time’ music and dancing session. Comment cards supplied from people who use the service and people spoken with all indicated that generally there is a satisfaction with the activities provided, although some comment cards did express concern that sometimes “there is little or no stimulation for some residents” and “because there are very few English speaking staff at present my relative is receiving less stimulus than previously and seems more withdrawn” and “I am concerned my relative is not being motivated mentally or physically.” Generally, activities for those people who are able to self determine are well managed. However, activities for those people in the later stages of their dementia require thought and planning to ensure social stimulation is offered to everyone, regardless of their presenting needs. Time was also spent observing staff in their day-to-day care tasks. This took place on The Manor. Some good care practices were observed along with areas for development. Other observations were also noted and all were discussed with the registered manager at the end of the inspection. Staff spoken with all appear committed to trying to meet individual needs and preferences and see family members as a way of better getting to know individual residents wishes. Comment cards general indicated that people were usually supported to live the life they choose, although one comment card stated – “my relative is sometimes frustrated in making choices. For example, in what to wear. These decisions are sometimes made for my relative because of a time factor”. Another comment card stated the home “tries to allow them to make choices where possible”. People who use the service were able to confirm that they are able to maintain contact with their family. Individual comment cards from relatives and relatives spoken with also confirmed this. Comments included – “we are made to feel very welcome”, “we keep in touch with our relative and Hillcroft”, “my relative has Alzheimer’s – the staff inform me directly”, “I usually visit my relative daily”. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 20 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. 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. It was observed that special diets that had been pureed were mixed together. The registered manager is to speak with the chef regarding this as previous discussions with the chef have confirmed the importance of providing different textures and tastes to people on special diets. Hillcroft is 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. Discussions with the people who use the service and from comment cards received all confirmed that they enjoy the food provided. Individual comments include “the food is very good indeed, sometimes we get too much to eat”. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 21 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): Standard 16 and 18 People who use the service experience excellent outcomes in this area. 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. The commission received notification of this complaint but has not received any other complaints direct. 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. 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. Comment cards received and people who use the service spoken with all indicated that they knew who to talk to if they were unhappy about any aspect of their care. Individual comments from relatives included – “my family have no complaints whatsoever with his care”; “I have NEVER had any concern. I am very confident in the home” and “we have a good relationship with the management team and would feel able to raise any issues we were concerned Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 22 about. We haven’t needed to but are confident that if that was needed it would be sympathetically dealt with”. Two healthcare professional survey forms 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) 4 staff have completed a specific course in managing people who have challenging behaviour and 3 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 (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 23 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 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: The registered manager confirmed that the requirements on the last inspection report have now been addressed. Although not all areas of the home were viewed, communal areas and some rooms were seen. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 24 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 people who use the service. Individual rooms have been personalised with treasured possessions to make them familiar and homely. Generally people who use the service do not have a choice of room but discussion will take place as needed. People who were able to do so 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. Comments from relatives included “the home is kept in excellent order”; “high standard of furnishings and decoration. Visitors lounge where residents can have some privacy with their visitors”. There is a secure and very pleasant garden which is accessible by people, 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. There is an infection control policy and procedure in place and training records evidenced that staff have accessed infection control training. One comment card stated that a strong odour had been noticed on arrival at the home and is in evidence sometimes in the dining room on The Manor. This comment was discussed with the registered manager who confirmed that the housekeeping staff work hard to make sure no unpleasant odours linger. There were no odours present at the time of the inspection and a number of time-release air fresheners were seen in use in the home. This is something that should be monitored. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 25 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The level and calibre of staff is generally good. People who use the service are safeguarded as their care is provided by a staff team who are vetted, qualified and competent. EVIDENCE: Staff files were examined for all the new staff 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 (as with the other homes in the group) which include a formal interview, two references, CRB/POVA checks being carried out and a formal induction, including access to TOPSS induction. It was confirmed during the site visit that CRB disclosures have been obtained for all staff. Concern was expressed in some comment cards about difficulties in communicating with some overseas staff. These comments were discussed with the general manager and registered manager who confirmed that all overseas staff have to pass a written test according to Home Office standards to confirm their understanding, use of written and spoken English. Only overseas staff who have passed this test are considered for employment. The Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 26 comments made by some relatives is something that the registered manager should consider when recruiting further staff and when organising staffing rotas. Information from the home confirmed that only two shifts in the last eight weeks have used agency or bank staff which means that people who use the service are generally cared for by familiar people. The Hillcroft group have a Clinical Supervisor who organises training, including a formal 3 day induction training programme for all new staff. More recently, the Hillcroft group has set up a dedicated training room at their Lancaster home to enable staff to undertake their training courses in a more formal setting. A comprehensive range of in-house training and external training courses are accessed as training needs dictate. Information supplied by the Clinical Supervisor confirmed that a range of training courses have been attended by staff at the home, with a range of future training planned. Staff files examined evidenced ongoing training with copies of certificates. Information supplied by the home confirmed that currently 73 of care staff hold NVQ II or above, with 4 care staff currently doing NVQ Level II. Staff spoken with confirmed that training is ongoing and that they are enjoying doing the NVQ training courses. Comments from both people who use the service 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. A small number of comment cards indicated that they felt more staff are required. Individual comments include – “some of the foreign staff are excellent”; “mostly the staff are terrific”; “excellent staff both nursing and domestic”; “the staff certainly take good care of my relative”; “the staff are attentive and respond quickly to requests”; “my relative has been a resident of Caton Green for a very long time. Over the years they have been very well looked after”. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 27 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 People who use the service experience excellent outcomes in this area. 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 couple of years and is registered with the commission. She has a range of experience in management and is also a registered nurse and since registration continues to demonstrate her ability to manage the home well. Comments received both from the comment cards and also from speaking with people who use the service and staff all confirm that the manager is approachable, competent and deals with issues immediately. The registered manager has clear Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 28 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 – “we are especially impressed with two members of staff – Jackie (receptionist) and Val (Matron). Both of them sets the high standard at first meeting, which has continued on each of our visits.” 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. Positive comments were made by a couple of relatives about these meetings who clearly enjoy the opportunity provide feedback directly to the managing director and general manager “at Hillcroft we are invited every 6 months to a meal, which gives us opportunity to voice any concerns or ways for them to improve their care” and “the M.D. meets us all over a buffet 2x per year and invites criticism and comment”. 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. Comment cards received from relatives also confirmed that staff listen and act on what they are saying. As part of this quality assurance system it is recommended that more spot checks are carried out, for example, over medication records. 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. In addition, the registered manager meets with the night staff on a weekly basis. Information supplied by the home confirmed that there are the full range of policies and procedures which are located in the nurses’ office. Policies and procedures are reviewed in line with the quality assurance requirements by the general manager. 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 29 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 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 exact 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. Computer records are maintained of charges and payments and these are backed-up on a daily basis. 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. At a previous inspection it was seen through examination of a selection of records evidenced that the Hillcroft group maintain exacting and significant financial procedures to ensure the resident’s financial interests are protected. These will be examined again for the people at Hillcroft Caton Green during the Hillcroft Carnforth inspection. 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 general manager confirmed that a fire risk assessment has been carried out 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 30 has received the new bed rail guidance from MHRA, with new hospital style beds being installed. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 31 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 3 8 3 9 2 10 3 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 3 17 X 18 3 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 Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 32 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. 1. Standard OP9 Regulation 13(2) Requirement Medicines must be administered and accurately recorded as prescribed to ensure the health and well being of the people who use the service is maintained Timescale for action 31/05/07 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 Records of administration of external medicines such as creams need to be improved to show that they are being used as prescribed. The medicines audit should be reviewed and updated ensuring it is targeted at all key medicines handling issues. Daily records recording “care as pathway” lack detail about the actual care provided – records should be clear about care provided. The registered manager should continue to review the DS0000006141.V332530.R01.S.doc Version 5.2 Page 33 2. 3. 4. OP9 OP7 OP27 Hillcroft (Caton Green) Nursing Home deployment of foreign staff so that people whose first language is not English can be supported to communicate with people who use the service and their relatives. 5. OP33 As part of this quality assurance system it is recommended that spot checks are carried out on day to day care tasks, e.g. medication administration. Hillcroft (Caton Green) Nursing Home DS0000006141.V332530.R01.S.doc Version 5.2 Page 34 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. 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