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Inspection on 11/08/05 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 11th August 2005.

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 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

Both the General Manager and the individual home`s manager are committed to making sure that the needs of the residents are met and the standard of care and the home is kept at a high level. There is an ongoing commitment to provide training to everyone who works at the home, with the home employing a named person called the Clinical Supervisor to make sure all staff get a range of training to do their work better. A number of staff have achieved National Vocational Qualification Levels II and III and staff are continuing to do these qualifications which are recommended by the Commission for Social Care Inspection. There is an ongoing redecoration and refurbishment programme which means that the home is clean and tidy and provides an excellent place for the people to live in. The home has used the interest a number of relatives have in the care that is provided by the home by starting a support group which meets on a twice yearly basis. As mentioned in this report, this group not only provides support to others who may be finding it difficult to accept their relatives have dementia or are now needing the care provided by the home, but also provides advice and information. The company pays for a place for the group to meet, along with food and drink. From talking with the manager and the staff on duty they know the residents at the home very well. Staff confirmed they were asked for their input into the care given to make sure the care is given as needed by each individual resident.

What has improved since the last inspection?

What the care home could do better:

Overall, the care provided at the home was confirmed by both residents and relatives as being very good indeed. From this inspection it is recommended that the range of social and other activities in the home need to be developed further to ensure the residents who have dementia have meaningful and stimulating activities to do. Some comment cards from relatives indicated that they were not aware of the home`s complaints procedure. This is something that the manager of the home can look at. When specific aids like a monitoring alarm are used in the home, the home needs to make sure that these are used with a regard to the residents privacy and dignity, with clear instructions over the use contained in the care pathway. A prompt or agenda sheet may be useful for supervision of staff to make sure all the relevant areas are discussed. The risk of falling could be reduced by instructing staff to make sure there are no trailing loops from lifting slings on the floor. The new manager in post is currently being registered with the Commission for Social Care Inspection and is aware that she needs to obtain the Registered Managers Award by 2007.

CARE HOMES FOR OLDER PEOPLE Hillcroft (Caton Green) Nursing Home Caton Green Road Brookhouse Lancaster, Lancashire LA2 9JH Lead Inspector Joy Howson-Booth Announced 11 August 2005 10:00am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hillcroft (Caton Green) Nursing Home Address Caton Green, Brookhouse, Lancaster, Lancashire, LA2 9JH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01524 770334 01524 771472 Hillcroft (Caton Green) Limited CRH Care Home 35 Category(ies) of DE Dementia 19 OP Old Age 16 registration, with number of places Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered within the Commission for Social Care Inspection. 2. The home is registered for a maximum of 35 service users in the category of DE(E) (Dementia over 65 years of age). Date of last inspection 25th February 2005 Brief Description of the Service: Hillcroft (Caton Green) Limited is the smallest of the three 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 registered for 35 people of either sex who require either general nursing or nursing with specialist dementia care. 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 service users, there would be very few people who could access these independently. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced so the General Manager, manager of the home, staff, residents and relatives were aware of the visit. The inspection lasted for most of the day and included looking at care pathways, other documents and talking with the manager and staff on duty. A small number of residents were talked with although staff were observed at work and interacting with the residents. The inspection was carried out against the National Minimum Standards for Older People. Because of the needs and capacity of the residents at the home, only a small number were able to express an opinion over the care provided. The direct observations of staff provided a good opportunity and showed that residents were treated with dignity and respect and the relationships with staff were very positive. Residents spoken with said they felt well looked after. A number of relatives returned comment cards which were positive about the care provided. These comments included “I can’t speak highly enough of the standard of care my parents receive”. Another comment card said “We have been very pleased with the level of care our Dad has received. We have never had any cause for concern that he is not getting the best care”. Two visiting relatives were spoken with who were also very positive in their comments about the care provided – “everything is wonderful and I would be told if I needed to know anything – which staff do all the time. I am amazed at the number of staff who are always around and are always very cheerful”. The home has two separate units – The Manor and The Croft – during this inspection both units were visited and staff on duty were spoken with. Observations of residents confirmed they looked comfortable and relaxed in their own environment, with a range of comfortable seating. What the service does well: Both the General Manager and the individual home’s manager are committed to making sure that the needs of the residents are met and the standard of care and the home is kept at a high level. There is an ongoing commitment to provide training to everyone who works at the home, with the home employing a named person called the Clinical Supervisor to make sure all staff get a range of training to do their work better. A number of staff have achieved National Vocational Qualification Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 6 Levels II and III and staff are continuing to do these qualifications which are recommended by the Commission for Social Care Inspection. There is an ongoing redecoration and refurbishment programme which means that the home is clean and tidy and provides an excellent place for the people to live in. The home has used the interest a number of relatives have in the care that is provided by the home by starting a support group which meets on a twice yearly basis. As mentioned in this report, this group not only provides support to others who may be finding it difficult to accept their relatives have dementia or are now needing the care provided by the home, but also provides advice and information. The company pays for a place for the group to meet, along with food and drink. From talking with the manager and the staff on duty they know the residents at the home very well. Staff confirmed they were asked for their input into the care given to make sure the care is given as needed by each individual resident. What has improved since the last inspection? Training of staff – current training includes a moving and handling update as the home now has a no lifting policy in place. A number of hoists for lifting residents have been purchased and bathrooms have been improved with higher/raised baths and additional bath aids being bought. A ‘stairmaster’ hoist has also been bought to help staff to move residents up and down stairs. A garden path has been put in the garden and is used by the residents to enjoy the gardens and walk around in the fresh air. Relatives have donated a wooden garden bench for residents to sit on. The care pathways (which detail individual resident’s care needs and how the staff at the home are to meet these) continue to develop with initial gremlins being ironed out. The home is looking to the local College to enable their care pathways to be officially recognised as a way of writing about care needs. The work of the relatively new Head Chef shows that the meal provision in the home is much better and with the range of meals on offer, the quality and quantity means that residents have much better meals to eat. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The system for assessment of prospective residents in the home is very comprehensive and provides excellent information to enable a judgement to be made as to whether the home can meet identified needs. EVIDENCE: The company has recently introduced a new assessment and care planning system called “Care Pathways”. This means that following the initial enquiry from either Social Worker, Health professional or relative the manager will undertake a person visit to meet the prospective resident and complete a “care menu”. The care menu is in the format of a comprehensive list of identified needs, including – Leisure/Social, Mobilising, Elimination, Personal Hygiene/Dressing, Eating/Drinking, Skin Care, Physical Health, Communication, Sleep, Mental Health, Personal Safety and Pain Control. Each of these major areas is then subdivided into specific needs relating to the main area and covers identified need, desired outcome and nursing intervention. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 10 This system not only provides a method of prompting for assessment but means that individual and specific needs can be added in as needed. In addition to this there is evidence of healthcare professional and Social Services assessments. Where a resident has been admitted from the specialist assessment hospital there is the arrangement for the residents place to be kept open for 12 weeks. Support and guidance is available from the specialist consultant and, before a final decision to discharge is taken, a review of the placement is made to ensure the resident has settled and the home is able to meet the identified needs. This home does not provide an intermediate care facility. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 The are comprehensive and clear care planning systems in place which means the needs are of the residents are met in a consistent, professional and caring manner. The staff have a good understanding of the residents needs and provide care in a way that protects the residents privacy and dignity. EVIDENCE: As mentioned previously, a new care pathway system has been introduced into the home and, following the completion of a care menu at the time of assessment, a care pathway will be set up for the new resident. Care pathways have also been introduced for existing residents. The system means that identified needs in the care menu are transferred into a working document or care pathway. Either monthly or as residents needs change, this system enables any changes to be immediately incorporated into a new care pathway document . For example, should a resident experience a chest infection then the nurse in charge will indicate this needs to be incorporated. A new care pathway will then be produced to ensure the chest infection and desired outcome is included, along with the nursing intervention required to meet this. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 12 A number of care plans were examined and the documentation evidenced that this system is working well. Discussions with staff on duty confirmed that they felt this was an excellent system and provided them with clear information over care needs and how these are to be met. Discussions over specific care needs confirmed that these are clearly understood and followed, with good communication in place to ensure any changes are notified and addressed. In addition to the main care pathway separate information is maintained for specific nursing interventions – fluid balance, pressure care, etc. Discussion with those residents who were able to do so confirmed that they feel well cared for and they are able to continue with their day to day routines. Discussions with staff on duty confirmed that the home maintains the privacy and dignity of residents and staff understand what this means on a practical level. One care pathway examined recorded that a monitoring device was being used. Advice was given that this may infringe the resident’s privacy and the use of such a system must be risk assessed and clear approval gained and protocols in place for its use. Two visiting relatives who were spoken with stated they were “thrilled with the home”. They stated that they were not involved in the care pathway planning but they were asked to be and chose not to be involved. They continued “everything is wonderful and I would be told if I needed to know anything – staff do this all the time”. Comment cards received from other relatives included the following comments – “I can’t speak highly enough of the standard of care my relatives receive”, “we are very pleased with the level of care Dad has received – we have never had any cause for concern that he is not getting the best care”. Another comment card stated “my relative likes being as independent as possible, even if this takes time and staff wait for her rather than having everything done for her”. All the comment cards received confirmed that relatives/friends are able to visit their relatives in private and are kept informed of important matters affecting their care. Comment cards received from General Practitioners’ all confirmed that the home communicates clearly and works in partnership, they are able to see their patients in private, the staff have a clear understanding of the care needs of residents and any specialist advice is incorporated into the residents care plan. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Activities within the home are an area for development so that residents individual lifestyles, preferences, etc., can be met and they can receive social stimulation within the home. There are no restrictions for families and friends visiting the home which means the residents benefit from seeing familiar faces when they want. Arrangements and planning to provide good nutritional food are excellent which means the residents are provided with high quality food to ensure healthy living. EVIDENCE: At present, relatives are asked to complete a personal history for the prospective resident so that the staff at the home are aware of the individual’s likes, dislikes, employment and social history which can then be incorporated into their care pathway. At present, staff provide Recreational Therapy (RT) during the afternoon but, due to the needs of the residents, this tends to be on 1 to 1 basis. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 14 Social activities are currently being reviewed with a number of staff due to attend a specialist course which will enable them to identify suitable activities and develop this as an area. Staff spoken confirmed that they provide some activities in the afternoon and recognised the difficulties in identifying appropriate activities due to the needs of the residents. Staff confirmed a training course to look at activities has been organised with an external trainer and were looking forward to developing this within the home. The need to develop the social activities within the home has been discussed in previous inspections. A comment card from a relative stated “stimulation is the biggest draw back”. Discussions with staff and relatives confirmed that they are able to visit at any time. Staff spoken with gave examples of how they enable the residents to have choice over their day to day life – for example, when dressing being offered a choice of clothing. As with the other homes in the Hillcroft group, the home has now had the input of the Head Chef who has revised all the menus to provide an excellent standard of food. The menus are organised over a four week rota. On each day there is the provision for a range of breakfasts – from full English breakfast to porridge, prunes, eggs, etc. At lunchtime, there are a range of main courses on offer – with two main courses and specialist diets (soft, vegetarian, diabetic) being catered for. A sample of the menu includes:- diced turkey in cream sauce or roast lamb (with broccoli, sliced carrots and boiled potatoes), cheese omelette. For the evening meal again there are a range of choices, including – soup option, Lancashire hot pot, spaghetti in sauce, vegetables and sauté potatoes, poached egg on toast, egg, salmon and corned beef sandwiches, egg salad; followed by mandarin cheese cake or chocolate éclair. In addition, there is fresh fruit, yoghurt or a cheeseboard on offer. All the food is home made. One resident spoken with about the food commented “we are fed to death – I’ve had to cut down because I am putting on weight”. Relatives spoken with said “mother is now putting on weight – that’s because the food is excellent”. Discussion with the Head Chef confirmed that he has accessed training courses, including Food Hygiene and this was evidenced by his training record. The Head Chef also confirmed that communication is very good within the home and he feels very much part of the team – On admission, a nutritional form is completed so that he knows about individual likes and dislikes, etc. and Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 15 he will be informed if there are changes to any residents which means they may need a more specialist diet. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system in place with evidence that views and concerns are listened to and acted upon. EVIDENCE: There is a formal complaints procedure and this is included in information provided to prospective residents and/or their family members. Because of the needs of the residents in the home, it is unlikely they would be able to use this complaint system and are reliant on their relatives and staff to ensure their care. No complaints have been received, either by the home or by the Commission for Social Care Inspection regarding this service. During this inspection, one resident commented on the doors that bang and how this is disturbing. This was brought to the attention of the General Manager and manager who are to address this issue. Comment cards received from relatives confirmed that some people were aware of the complaints procedure but others were not. One comment card indicated that they had had to make a complaint “some years ago but this was mentioned to the then Matron and the complaint was dealt with immediately.” Comment cards received from three General Practitioners all confirmed they have not received any complaints about the home. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards within this section were assessed during this inspection EVIDENCE: Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 There is a clear training programme for all staff which provides staff with information, skills and training to meet the range of both care and support needs within the home. EVIDENCE: Over the last couple of years, the company decided to have a dedicated training organiser to identify, organise, access funding and personally provide training to the number of staff who work at the home. This person has the title of Clinical Supervisor. Discussions with the Clinical Supervisor confirmed that there is a comprehensive training programme in place for the staff who work within the Hillcroft company. In relation to this home, the findings are as follows:All new staff receive a three full-day induction provided at the Carnforth home prior to commencing work. This is the TOPSS Induction as recognised by the Commission for Social Care Inspection. All existing staff, both care and ancillary, access a range of courses, both inhouse and from external providers. Training for care staff includes – mandatory training, update training, TOPSS foundation training, National Vocational Training and specialist courses – challenging behaviour, death and dying, effective communication, pressure care, care of ageing skin, abuse and needs of service users. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 19 At present at Hillcroft Caton Green 3 people who have completed National Vocational Qualification (NVQ) Level II, 1 person NVQ Level III. There are also 3 people doing NVQ Level II and 1 person doing NVQ Level III. Update training is also provided for qualified nursing staff at the home and includes – dressing and bandages update, continence care, dementia care, controlled drugs procedure update and supervision training. Training provided for ancillary staff includes –National Certificate in Further Education, food hygiene, healthy eating, National Vocational Qualification in cleaning and support services, infection control and health and safety. There are full training records for all staff which are maintained by the Clincial Supervisor. It was confirmed that there is a working relationship with the local college who will provide a yearly needs analysis for training. Monitoring of both the training and those who access the training is carried out by the Clinical Supervisor who confirmed some staff are counselled if there is no clear progress evidenced. This high level of training commitment provided to staff is excellent and is something that should be continued. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 38 The residents live in a home that is very well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The manager was appointed at Caton Green in February of this year and is a qualified nurse with a long history of experience in both community and residential settings. At present the manager is undergoing registration with the Commission. Discussions with staff confirmed that they felt the new manager had brought her own management style to the home but was always available for advice and guidance. It was also confirmed that the manager monitors the care provided by regular visits to both units. Discussions with relatives at the time of this inspection stated that they were very happy with the manager and very much appreciated her support during their relatives’ admission to the home. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 21 They said that they valued the time to sit and talk with the manager and to be shown around the home and to be reassured. Because of the needs of the residents at the home, formal residents meetings are not an option. It was observed, however, that the manager has her finger on the pulse of all the residents and from speaking with them in person and from weekly matron’s meetings with qualified staff maintains a clear picture of the care needed and provided. The home has very close links with relatives and has its own support group. The support group is made up of both current relatives and relatives of people no longer at the home and provides both a support, information and social function. The group meets on a twice yearly 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. Discussions with staff confirmed, as did records, that supervision is carried out. Supervision of qualified nurses comes directly from the manager of the home, the qualified nurses then supervise the care staff in the home. Supervision of the ancillary staff comes from the Housekeeper. It was advised that the supervision of staff may benefit from a prompt or agenda sheet so that staff are aware of what is to be discussed and all areas are covered. The health and safety of the home is managed by the manager with the support of the Housekeeper. The housekeeper has responsibility over the domestic, laundry and handyman and ensures the cleanliness and maintenance of the home. Regular update meetings with the manager take place. There is an ongoing programme for redecoration and a number of rooms have been totally refurbished. The pre-inspection questionnaire confirmed that two new bath hoists have been fitted and a bath position changed. The home has a non-lifting policy in place which has necessitated the purchase of a number of new hoists, including one specifically designed for use on stairs. In addition a ramp has now been replaced with a step. The pre-inspection questionnaire also confirmed that regular safety checks are carried out in the home. There are arrangements in place for the safe disposal of clinical waste. Safe working practices and health and safety training is provided to all staff, both care and ancillary and this has been evidenced via training records. The manager is aware of the relevant legislation which must be complied with. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 22 Risk assessments are carried out for working practices. Risk assessments are also carried out as part of the care pathways planning – initially at the point of assessment by the manager and from then on by the qualified staff in the home. During this inspection, it was observed that some of the sling hoists were left on the floor and may mean residents and staff may catch their feet and trip up. This was brought to the attention of the manager who is to ensure staff are made aware and address this potential hazard. There are procedures in place for recording of accidents and these are monitored by the manager and General Manager on a monthly basis. Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x 3 x 3 Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 12 Good Practice Recommendations The area of activities to continue to develop to ensure the residents accommodated are offered appropriate and tailored activities which provide them with stimulation and meaning To ensure that all relatives are aware of the homes complaints procedure The manager to obtain the Registered Managers Award The use of a monitoring device should be risk assessed and approval sought, along with a protocol for use put in place The supervision procedure may benefit from a prompt or agenda sheet to ensure all areas are covered Slings should not trail on the floor and thereby pose a trip hazard to residents and staff 2. 3. 4. 5. 6. 16 31 10 36 38 Hillcroft (Caton Green) Nursing Home F57 F09 S6141 Hillcroft (Caton Green) V187786 110805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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