CARE HOMES FOR OLDER PEOPLE
Hillcroft (Morecambe) Nursing Home Woodlands Morecambe Lancashire LA3 1LZ Lead Inspector
Mrs Joy Howson-Booth Unannounced Inspection 10:30 17 March 2006
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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 (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 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 (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hillcroft (Morecambe) Nursing Home Address Woodlands Morecambe Lancashire LA3 1LZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01524 858599 01524 858699 Hillcroft Limited Ms Gillian Duffy Care Home 54 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (30) of places Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The service may accommodate 2 named people under 65 years of age within a maximum of 54 service users. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 54 service users to include Up to 30 service users in the category OP (older persons 65and over) Up to 24 service users in the category DE (dementia) 24th August 2005 Date of last inspection Brief Description of the Service: Hillcroft Nursing Home (Morecambe) Limited is registered to provide residential and nursing care to up to 54 people of either sex. This home is one of a group of four homes, all operated by the Hillcroft Company, which has a Board of Directors who are reported to by the General Manager. The General Manager oversees the four nursing homes, each having their own named Registered Manager, registered with the Commission for Social Care Inspection. Hillcroft (Morecambe) is situated in a quiet residential area in the west end of Morecambe and is reasonably close to local shops and amenities. The home is built over two floors, with two separate units - one for those people who require nursing care and the other for those people who require more specialist dementia care. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced so the registered manager and staff at the home were not aware of the inspection. The purpose of this inspection was to assess the service against the key National Minimum Standards, which remain outstanding. A small number of residents were spoken with, although only three were able to express a verbally their view of the home. Residents were seen to be relaxed and comfortable and the care staff were respectful and kind in their dealings with them. Both qualified and care staff on duty were also spoken with. A selection of documents held by the home were examined, including medication records and staff files. The home was toured and found to be well maintained, pleasant and providing a comfortable environment for the residents to live in. A number of rooms had been personalised with familiar and treasured possessions. Comment cards were left at the home but none were received at the time of publication of this report. What the service does well:
Both the General Manager and the Home’s manager continue to be committed to ensuring 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 redecoration and refurbishment programme which means that the home is clean and tidy and provides an excellent environment for people to live in. Minor maintenance issues raised in this report will be dealt with promptly. The home continues to hold relatives’ support groups which take place on a 3 monthly basis and are funded by the company. As mentioned in previous reports, this group not only provides support to others who may be finding it difficult to accept their relatives are needing residential care but also provides advice, information and a social event. Medication is safely administered within the home by the qualified staff on duty. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 6 Training is provided to staff on adult abuse awareness and, from discussions with staff, all are aware of who to talk to should any concerns be raised. Staffing within the home is generally to a good level with staff commenting that they are able to care for the residents without feeling hurried or not having the opportunity to give the residents some quality one to one time. Finances are appropriately and safely managed with the systems that are in place. What has improved since the last inspection?
A new dedicated Clinical Supervisor has been appointed to work full time organising and providing training to all levels of staff. Staffing is now organised centrally by a dedicated full-time ‘Care Supervisor’ whose role is to organise the staffing levels at all the four Hillcroft homes, dealing with sickness and holidays and ensuring there is sufficient staff on duty. More recently, the Hillcroft group has employed 8 experienced people who are a dedicated holiday/sickness bank of staff used within the four homes to cover as required. These people are required to be experienced to a higher level of competence, for example, auxiliary nurses or trained National Vocational Qualification Level III as a minimum. In addition, there is a dedicated Clinical Supervisor who organises and provides training to staff. Staffing is now centrally organised by the company. To ensure staff get to know about changes to care needs, all staff now have a paid quarter-hour handover period. This provides an opportunity for qualified and care staff to get together to discuss any changes or specific instructions which have come about since their last shift. Staff spoken with felt this was very good and enabled them to get to know what was going on. The registered manager feels that the new staffing arrangements are very good and ensure staffing levels are maintained. In addition, staff are now attending courses together, passing on knowledge and information and the fact that staff now work across the four homes means that there is a much more feeling of ‘working together’ The General Manager has introduced a ‘Staff Bulletin’ for all the staff within the four homes and includes information on Company news; training available; welcome for new staff; congratulations on training completed; and any other pertinent information. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 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 (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were assessed and met at the previous inspection EVIDENCE: Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Standards 7, 8 and 10 were assessed and met at the previous inspection Systems are in place to ensure medication is safely administered to residents by people who are qualified to do so. EVIDENCE: Medication records and stocks were examined during this inspection and found to be accurately maintained. A selection of controlled drugs records were also examined and were accurate and up to date. All drugs, including controlled drugs were securely stored in a clean and tidy environment. Medication records included photographs of the individual residents on their records to assist with administration. There are no residents who have responsibility for their own medication at the home. Medication is only administered by the qualified staff on duty.
Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 11 Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were assessed and met at the previous inspection EVIDENCE: Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Standard 16 was assessed and met at the previous inspection There are good systems in place, and training provided, to ensure that residents are protected from abuse. EVIDENCE: The company has a formal adult abuse procedure which is contained in their policies and procedures file. This is available for staff to use. Discussions with the dedicated Training Manager for the Hillcroft group whilst at the Hillcroft (Carnforth) home confirmed that adult abuse awareness is covered both in the home’s own induction as well as in other training. There is also an ongoing training programme for all staff. Some staff spoken with have not yet had the formal, specialist adult abuse awareness training but confirmed abuse awareness was covered within their induction. Staff spoken with were very clear about what would constitute abuse and are aware of who to contact should they have concerns. Any incidences or concerns would be passed to the Registered Manager who is responsible for taking the appropriate action. An overview and monitoring of incidents and accidents is also carried out by the General Manager. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. Minor repairs were noted which will be addressed promptly. EVIDENCE: Overall the home provides a homely and pleasant environment for the residents to live in, with a number of residents bringing in treasured personal items to make their rooms more homely and familiar. The home was clean and tidy and there were no offensive odours in evidence. There is a ongoing programme for maintenance and repair, although the registered manager was made aware of the following observations that need to be addressed, as follows : Door handles in Rooms 26, 30 and 41 need repair/replacing
Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 15 Some easy chairs in the upstairs lounge are looking grubby and would benefit from professional cleaning The leather arms on one chair in the upstairs lounge are cracked and may be uncomfortable for the residents who use it The carpet in the upstairs lounge had a gap which would pose a risk of tripping to both residents and staff – a separate letter has been sent regarding this and the registered manager assured this would be dealt with promptly. In addition, the registered manager was made aware that a number of medicine pots, medicine syringe (no needle) and teaspoons were drying on the radiator in the upstairs bathroom. From the previous inspections the following is noted : 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 a separate laundry for washing which is separate to the cooking and other areas of the home. It has previously been confirmed that all the requirements for the washing of foul laundry and disinfection standards are being met. There are policies and procedures in place for the control of infection, as well as procedures should a serious outbreak occur. Discussions with staff during this inspection confirmed there is a good understanding of infection control. Domestic staff confirmed their understanding of infection control and also the fact that they are currently undertaking National Vocational Qualification training specifically for their role. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 The level and calibre of staff is generally good. Residents are cared for by staff who are qualified, competent and dedicated. Staff are properly vetted before taking up employment meaning that only people who are suitable work with vulnerable people do so. EVIDENCE: The Company has appointed a dedicated full-time ‘Care Supervisor’ on duty whose role is to organise the staffing levels at all the four Hillcroft homes, dealing with sickness and holidays and ensuring there is sufficient staff on duty. More recently, the Hillcroft group has employed 8 experienced people who are a dedicated holiday/sickness bank of staff used within the four homes to cover as required. These people are required to be experienced to a higher level of competence, for example, auxiliary nurses or trained National Vocational Qualification Level III as a minimum. In addition, there is a dedicated Clinical Supervisor who organises and provides training to staff. To ensure staff get to know about changes to care needs, all staff now have a paid quarter-hour handover period. This provides an opportunity for qualified and care staff to get together to discuss any changes or specific instructions which have come about since their last shift. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 17 Discussions with staff on duty confirmed that they feel there are sufficient staff on duty to care for the residents and the new holiday cover staff has proved to be very helpful. Comment was made that staffing at night was less satisfactory, stating that there was insufficient staff on duty for the number and needs of the residents accommodated. This was discussed with the registered manager who felt that the issue may be the deployment of staff on duty rather than actual staff numbers as there have been no reductions to staffing levels. The registered manager is to look into the concerns raised, discuss staffing with the staff on duty at nights and take whatever action is needed. Staff felt that they were well supported, both by the company and by each other within the teams. Staff commented that the registered manager provided guidance and support and managed the home very well. Staff files for staff employed since the last inspection were examined and found to contain all the required checks. Only one new member of care staff has been recruited since the last inspection and, from examining their personnel file, all the required checks have been carried out prior to appointment. Criminal Record Bureau disclosure forms have been obtained for all current staff and these were seen during this inspection. The General Manager has introduced a ‘Staff Bulletin’ for all the staff and includes information on Company news; training available; welcome for new staff; congratulations on training completed; and any other pertinent information. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Standard 38 was assessed and met at the last inspection The financial arrangements in place ensure that residents’ finances are safeguarded. Systems are in place to ensure the service is monitored and developed to the benefit of the residents. Residents feel listened to. EVIDENCE: 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, 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
Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 19 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. The registered manager confirmed that these support meetings continue to take place. Three residents who were able to do so also confirmed that they feel listened to and were able to talk to staff who took any concerns seriously and were very happy with the care provided. Other residents on both units were observed and were seen to be relaxed and comfortable in their environment. Overall financial administration takes place at the Company’s Carnforth home where it was confirmed all four homes in the Hillcroft group follow the same financial procedures. Through talking with the Company’s administrator it was confirmed that there are exacting and significant financial procedures in place to ensure the resident’s financial interests at all the four homes are protected. Residents can choose to have their own account into which money is paid. The home will make payments on behalf of individual residents and at the end of each month an invoice is raised and either presented to relatives or paid from this individual account. The Administrator confirmed that any large expenditures have to be authorised and receipts, etc., are sent out to relatives for their information. Minor expenditures on behalf of residents have to be receipted and presented to the finance department. Computer records are maintained of charges and payments and the Administrator also confirmed these are backed-up on a daily basis. A selection of accounts were examined and the information presented was seen to be exact. The Administrator also stated that for some residents monitoring of payments into accounts and appropriate action takes place as needed. The Administrator is the named person who will act as an appointee, if required. The General Manager has also confirmed that the existing quality assurance systems remain in place which include external and internal auditing, the use of ‘non-compliance forms’ which are used to identify issues so that appropriate action can be taken. Feedback is also sought from residents, relatives and external healthcare professionals. The registered provider also visits and tours the home on a weekly basis and, in addition to this, monthly reports are sent to the Commission by the General Manager. Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP27 OP19 OP18 Good Practice Recommendations The night staff deployment to be assessed to ensure that there are sufficient staff on duty in each of the units to meet the residents needs The minor repairs noted in this report to be addressed promptly Abuse awareness training should be provided to those staff who have not undertaken this training and refresher training to longer-serving employees Hillcroft (Morecambe) Nursing Home DS0000006142.V269867.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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