Inspection on 25/04/07 for Hillcroft (Morecambe) Nursing Home

This inspection was carried out on 25th April 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.

Other inspections for this house

Hillcroft (Morecambe) Nursing... 17/03/06

Hillcroft (Morecambe) Nursing... 24/08/05

Hillcroft (Morecambe) Nursing... 22/02/05

Hillcroft (Morecambe) Nursing... 26/07/04

Hillcroft (Morecambe) Nursing... 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillcroft (Morecambe) Nursing Home Woodlands Morecambe Lancashire LA3 1LZ Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 25th April 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 (Morecambe) Nursing Home DS0000006142.V330890.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 (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 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 gillduffy@hillcroftnursinghomes.co.uk 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.V330890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 1 service user over 55 years of age 17th March 2006 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 is 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. 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 (Morecambe) Nursing Home DS0000006142.V330890.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 and a specialist Pharmacist Inspector. 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. 6 responses were received from people who use the service, all satisfied with the care provided. 7 responses were received from relatives who also were generally 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. No responses were received from GP’s. 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, speaking with staff, speaking with three relatives/visitors to the home. 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. What the service does well: Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 6 Hillcroft (Morecambe) provides a pleasant and homely environment which has a relaxed and friendly atmosphere. As with the other homes in the Hillcroft group, the registered manager and staff at Hillcroft (Morecambe) 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. Comments include – “There is a warm friendly atmosphere and excellent staff”; “some exceptional members of staff who take time to talk to my relative”; “sensitivity to the home being the residents’ home, welcoming of visitors, responding to concerns”; “friendly and homely atmosphere, genuine care and concern when resident unwell. Clean healthy environment, try hard to stimulate people who use the service and involve them. Excellent cuisine and varied menu”; “at all times when I have visited the senior staff have conducted themselves in a most professional yet kindly and quiet way. Other staff are happy keen and most patient. All make themselves available”; “if more homes were like Hillcroft there wouldn’t be a problem”. 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 spoken with all said they felt well cared for and the staff were very good. One person said “I have no grumbles at all”. A number of genuine and caring interactions between people who use the 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. Individual comments regarding the registered manager include – “when I speak to the matron she responds”; “matron very effective in communications and advice”; “matron’s door is always open”. There is equal consideration given to all prospective employees, with both male and female staff, including staff from overseas being employed. Training and development programmes are offered to all members of staff. The home employs a number of qualified nurses to undertake formal nursing care and are supported by a range of care staff. Information from the home stated that 76 of the care staff are trained to National Vocational Qualifications (NVQ) Level II. This means that people who use the service are cared for by suitably qualified and experienced staff. The carers were friendly and understood the personal needs of each resident. 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 – “There is a warm friendly atmosphere and excellent staff. I feel welcome and receive caring support from the staff”; “there is a general ethos of kindness and respect towards residents and their Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 7 families and friends”. Three relatives/visitors were spoken with who confirmed they were very satisfied with the care provided. Information supplied by the home confirms that there are a range of policies and procedures which ensure 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 well maintained and homely with communal rooms being accessible to the people who use the service. For the bedrooms upstairs there is a passenger lift for the people who use the service to use. There are a range of aids and adaptations for use within the home to help maintain people who use the service’ independence and dignity. 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? The home continues with its ongoing programme for redecoration and refurbishment of individual rooms. A number of hospital beds have been purchased to assist with those people who are less mobile. A number of timed air fresheners are also being installed in the communal areas. A consultant dietician has been employed to assess the nutritional input of the people who use the service. This is being done with the involvement and support of the head chef who is also keen to make sure people have a very good diet and enjoy the food his team make. Comments include – “the food and drinks are excellent. The actual dishes coming out of the kitchen match the description on the board!” and “the meals seem lovely”. Comments from people who use the service all said how much they enjoyed the food. A couple of suggestions are noted later in this report summary. Training of staff in the home continues with staff being supported to attend and complete a range of training according to their needs. 76 of care staff are now trained to National Vocational Qualification Level II and the home is aiming to have 90 of staff trained to NVQ Level II by the end of 2007. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 8 The home has introduced the Liverpool Care Pathway (end of life care) system for people whose health is deteriorating. Full details on this system can be found in the main report within the Health and Personal Care Section (Standard 11). Management systems (which look at how the home is being run) have been brought in so that there improvements can be made when needed. What they could do better: 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. The timing of medicines administration should be reviewed to ensure they are given at a time that is right and convenient to residents. Giving medicines at the wrong time of day can affect the way they work and in some cases increase the chances of side effects. Records of administration of external medicines such as creams need to be improved to show that they are being used as prescribed. Systems/paperwork should be developed to ensure medicines that are prescribed as when required are given consistently and correctly. A number of recommendations have also been made which can be found at the end of this report and include individual comments 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 include : “Some carers seem young” – the registered manager noted that some staff are younger but are learning and have undertaken both basic in-house training and have either completed or are doing National Vocational Qualification training. The registered manager addresses the use of younger staff by making sure they are always on a shift with a qualified nurse and other experienced staff. It was also noted that some staff are older than they look! “Sometimes there is a shortage of care staff” – the registered manager confirmed that there is a dedicated bank of relief staff which are used in the home to cover planned absences and holidays. However, there are occasions when staff ring in at short notice and cover is not always possible to find. However, the registered manager monitors all absences and takes appropriate actions as needed. “Shortage of staff at mealtimes/meals being left to go cold” – lunchtime for one group of people who need additional support was observed and there were Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 9 sufficient staff to meet the needs with no one being hurried or rushed. Meals for people were kept hot in a warming cupboard. Discussions with staff on the unit for people with dementia expressed concern that there is a need for an additional pair of hands in an evening. Both these comments were passed onto the registered manager who intends to speak with the staff on both units and will review staffing levels if needed. “Perhaps a little more heating, sometimes my relative feels cold” – the registered manager confirmed that she was not aware of any areas that were not up to the required temperature. However she is to speak with the maintenance team to have areas checked out and will monitor. Discussions with staff all confirmed they were aware that people who use services could get cold whilst sitting and use blankets to make sure people are not cold. The use of blankets was seen during the site visit. Comments from people who use the service noted that the meal names. For example, people said they didn’t know what Chicken Chasseur is. People who use the service said that staff do try to explain but sometimes staff don’t know. This comment was passed onto the chef during the site visit. Also, whilst there is a four-week rota for meals, meals are served on the same day each week. These comments were passed onto the general manager and registered manager who are to speak with the chef to see how this can be addressed. Both the general manager and the registered manager welcomed these comments as a way of hearing first hand. 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 (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3 and 6 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 or the head of nursing undertake a person visit to meet the prospective resident and complete a “care menu”. It is from this initial information that a care pathway menu is completed and an initial care pathway plan put in place. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 12 The care menu is in the format of a comprehensive list of identified needs, which outlined the individual person’s needs and how staff are to meet these. Advice was given that the pre-admission assessment form could be more person centred, for example, where bathing is assessed the timings, frequency and any individual preferences or routines could also be noted. In addition to this there is evidence of healthcare professional and Social Services assessments. Where a resident has been admitted from the specialist assessment hospital there is the arrangement for the people place to be kept open for 12 weeks. Support and guidance is available from the specialist consultant and, before a final decision to discharge is taken, a review of the placement is made to ensure the resident has settled and the home is able to meet the identified needs. There is also in place an admissions procedure which outlines for staff how people who are admitted to the home need to be given time, information and made to feel comfortable. The home also involves relatives in the move and works hard to keep them involved. One comment made by a relative – “my first contact with staff in the home was shortly after my (relative) moved into the home. The members of staff I met immediately gave me so much information about how he was and how he was coping with the move – this was very reassuring”. The General Manager advised that the Statement of Purpose and Service User Guide are being reviewed to ensure both documents have all the required information. The General Manager also confirmed that following a needs assessment, all prospective people are provided with a letter offering them a place, along with their designated room and fees. Once this has been accepted a formal pack is then sent out which includes the Service User Guide, Terms and Conditions/Contract (if private) and any other information (e.g. information about the relatives support group) thought useful. Comment cards received confirmed that contracts are provided by the home. This home does not provide an intermediate care facility Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 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. 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: Six care pathways were examined evidenced that there is good written information which provide all levels of staff with the individual people’ needs and how these are to be met. The care pathways also include risk assessments and the outcome of these – for example the use of bed rails. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 14 There was evidence of reviews (as mentioned earlier). Advice was given that some areas within the care pathway could be more detailed. 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. There was good evidence of healthcare monitoring and intervention by GPs, Consultants, Specialists, Chiropodists, etc. Unfortunately no GP comment cards were received about this service. An in-depth inspection of the medication systems in the home was undertaken by a Pharmacist Inspector. As well as examining medication records and stocks, the pharmacist inspector spoke with two nurses and three care staff. His inspection findings are as follows : Records of medicines receipt, administration and disposal are made that can show whether medicines are being given correctly to residents. The pharmacist inspector identified several mistakes when completing these records particularly the receipt of medicines when new residents are admitted to the home, the disposal of medicines when medicines have been discontinued and the recording of external preparations such as creams. Incomplete records could lead to mistakes when giving medicines. Records of medicines administration showed discrepancies that indicate not all medicines are administered as prescribed particularly short courses of treatment such as antibiotics. Numerous medicines were not being given at the correct time in relation to food, this can affect the way they work and can cause increased side effects. Nursing staff should always check medicines information before giving them to make sure they are given at the right time. Advice was given to managers at the end of the visit 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. Failure to give medicines as prescribed can seriously affect the health and well being of residents. Numerous examples of medicines prescribed as “when required” were identified. Records did not show nursing staff taking a consistent approach when administering them to residents, details of how and when to given these medicines should be written in the residents’ care plans or in the medicines records to ensure nursing staff give them correctly. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 15 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. The general manager advised that the concerns would be addressed promptly and input and advice of Boots’ Pharmacists are currently being organised. One area of concern raised through a comment card was that staff did not appear to understand dementia care. Discussions with the registered manager confirmed that nearly all the staff have undertaken dementia awareness training and, from discussions with staff on duty, there appears to be a good knowledge and understanding of care needs. Staff were asked about the specific needs of the individual people who were case tracked and they knew about their individual needs, recent conditions and changes to care. People who use the service were also spoken with, including the people who had been case tracked. 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, one person said they only have to ask and the GP is called. Individual comments from both people who use the service and from their relatives include – “I am always kept up to date”; “friendly and homely atmosphere. Genuine care and concern when a resident is unwell”; “all the staff make themselves available to “chat” about my relative” 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. Three visiting relatives/friends were spoken with and all expressed their satisfaction over the care provided to their relative/friends. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 and their relatives confirmed that individual routines can be followed and these are ascertained at the time of the assessment and following admission. People who use the service and their relatives also confirmed that they are free to visit as often as they wish and at any time. Records examined evidenced that activities are provided and recorded, along with whether the resident enjoyed the activity or not. Information supplied by the home indicates that the following activities are provided : mobile library, talking newspapers/books, music therapy, massage therapy, arts and crafts and games. Some staff have attended an activities course although feedback comments from staff indicate this remains an area for development. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 17 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 expressed concern that sometimes there is little or no stimulation. Some people spoken with said they would like to be able to go out more, although all agreed that the garden area is an excellent resource and used frequently when the weather is good. Staff spoken with all demonstrated they try hard to ensure people’s preferences are met and individual choices are given on a daily basis. 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. People spoken with made suggestions over meals which were passed onto both the registered manager and the head chef. Menus supplied by the home confirm that there is an excellent range of food provided, with special diets being catered for. The general manager stated that the Hillcroft group has recently employed the services of a dietician. There are a number of choices available at each meal. People who use the service confirmed that alternatives are provided – one person said “if I don’t like the meal then I tell the staff and I will get an alternative”. A number of comment cards from relatives made very positive comments about the food – “the food and drinks are excellent. The actual dishes coming out of the kitchen match the description on the board!”. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 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 have been no complaints received regarding this service. The commission has not received any complaints about this service either. The complaints procedure remains the same and is also contained in the Service User Guide and other 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 include – “Sister is always in evidence and Matron’s door is always open”, “when I speak with the matron she responds” and “matron is very effective in communications and advice”. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 19 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 formal foundation and National Vocational Qualification training programmes. The home has had three safeguarding adults referrals since the last inspection, these have been handled appropriately by the home’s registered manager. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 20 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: Although not all areas of the home were viewed, communal areas and some rooms were seen. The home continues to maintain a high standard of facilities, with individual rooms being spacious and clean. 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. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 21 One comment card raised concern over the heating in the home. This was discussed with the registered manager and, at the time of the inspection, the home was warm. However, the registered manager is to monitor and ask the maintenance man to check to make sure all areas of the home are warm. From discussions with staff they are aware that older people may feel the cold and confirmed blankets are available and used when needed. 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. Minor repairs noted at the previous inspection have been attended to. There is an infection control policy and procedure in place and training records evidenced that staff have accessed infection control training. There were no odours present at the time of the inspection. During the inspection the housekeeper was assessing rooms to have pump air fresheners installed. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 22 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 very 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 which evidenced that all the required checks are carried out prior to commencement of employment. The registered manager confirmed that only staff who have the necessary interest and skills in working with vulnerable people are employed. The home’s equal opportunities policy is reflected in their employment as there are both male and female staff, aged between 18 and 65, including overseas carers working at the home. The Hillcroft group have a dedicated Clinical Supervisor who organises a formal 3 day induction training programme for new staff which is held at the main Carnforth home. In addition, other in-house training and accesses external Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 23 training courses as training needs dictate. Information supplied by the Clinical Supervisor confirmed that a range of training courses have been attended by staff at this home within the group, with a range of future training planned. A new member of staff was spoken with who confirmed that they had followed the recruitment procedure, had attended the 3 day induction programme and had enrolled to begin the National Vocational Qualification (NVQ) level II training. Staff spoken with confirmed they have accessed a range of training, as outlined above, dependent on their experience and time with the home. Information supplied by the home confirmed that currently 76 of care staff hold NVQ II or above, with 6 care staff currently doing NVQ Level II. Comments from both people who use the serviced and from relatives indicate that staff are experienced and skilled to meet their needs, and there are usually sufficient staff on duty. Staff spoken with confirmed that staffing levels have improved since the last inspection, particularly as there is now a dedicated bank of relief staff who cover holiday and expected absences. One comment card noted that additional staff might be needed at lunchtimes. Observations at lunchtime noted that there is a two sitting meal in place so that people can eat in an unhurried way. People observed were seen to be supported appropriately by staff and no one was rushed or hurried. However, staff on the unit for people with dementia felt that an additional pair of hands would be very useful in an evening when a number of people were needing a lot of support. Both these comments were discussed with the registered manager who agreed to discuss further with staff to see if any additional staff are needed. Comment cards and people spoken included the following comments “I usually receive the care and support I need unless they are short staffed”; “staff are very patient and caring towards my relative.” “There are some young staff in the team who are gaining skills and experience but appear to have minimum requirements.” “At all times when I have visited the senior staff have conducted themselves in a most professional yet kindly and quiet way. Other staff are happy, keen and most patient”. Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 24 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 people who use the service 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 several years and is registered with the commission. She has a wealth of experience in management and is also a registered nurse and since registration has demonstrated her competency on many occasions. 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 well respected, supportive and deals with issues Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 25 immediately. The registered manager has clear responsibilities and is not in charge of any other home, although provides relief management cover for the other three homes on a rota basis with the other managers. 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 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. Meetings are well attended. The General Manager confirmed that the quality assurance systems in place continue to be used to review and improve services and include external and internal auditing, the use of ‘non-compliance forms’ which are used to identify issues so that appropriate action can be taken. The home has recently renewed its ISO quality assurance award. Feedback is also sought from people who use the service, 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 people who use the service at the home, formal people who use the service meetings are not an option. However, people who were able to say confirmed that they feel listened to. Comment cards received from people also confirmed that staff listen and act on what they are saying. 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 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 or family members. People at Hillcroft have their own “resident accounts” which is where expenditure (hairdressing, personal items, etc.) are charged. All expenditure is receipted and audited. 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 Hillcroft Morecambe at the Hillcroft Carnforth inspection. Information supplied by the registered manager confirmed that regular maintenance and servicing takes place on equipment and facilities within the Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 26 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 Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 1 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 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 (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 28 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 24/05/07 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. Paperwork relating to medicines prescribed as “when required” should be improved to ensure they are given to residents correctly. Patient information leaflets for all medicines kept in the home should be used to ensure medicines are administered correctly at the right time. All handwritten medicines records should be double checked by DS0000006142.V330890.R01.S.doc Version 5.2 Page 29 2 OP9 3 OP9 4 OP9 Hillcroft (Morecambe) Nursing Home two staff and counter signed to help ensure they are accurate. 5 6 7 OP9 OP27 OP15 The medicines audit should be reviewed and updated ensuring it is targeted at all key medicines handling issues. 8 OP25 Staffing levels should be reviewed at lunchtimes and on the unit for people with dementia to ensure they are sufficient to meet needs Meal choices should be varied so that the same meal is not provided on the same day. Meals should be described so that people who use the services know what they are being offered Heating within the home should be monitored to ensure people who use the services are warm Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillcroft (Morecambe) Nursing Home DS0000006142.V330890.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!