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Inspection on 18/02/08 for Hillcroft Nursing Home

Also see our care home review for Hillcroft Nursing Home for more information

This inspection was carried out on 18th February 2008.

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

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

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

The home is small and friendly with just twenty three residents. The single large lounge/dining room/ conservatory enables the majority of residents to feel part of life at the home and able to see staff for the majority of the time. Feedback from people who live at the home and their relatives was positive. Residents say, "Its home from home". Visitors said "they are very good here". Residents have an assessment of their needs before they come to live there so that the home has information about them. The home has medication policies and procedures that are safe and promotes and maintains residents health and wellbeing. The home provides home cooked food that is tasty and nutritious with a choice available at each mealtime.

What has improved since the last inspection?

The home has had several specialist profiling beds, new bed rails and bumpers to aid residents comfort and protect them from the risk of accident. There has been some improvement in care planning with the initial assessment of need that is person centred and reflects peoples needs will as its developed provide a good base for staff to develop care planning. The Manager and a trained nurse have undertaken training to enable them to teach and assess staff moving and handling practices. Residents now have new moving and handling risk assessments are now more detailed. There are now more social activities available such as cooking, gardening and a lady who visits every Monday and undertake a variety of activities with residents.

What the care home could do better:

Care records must be more detailed and reflect all residents individual needs, choices and capabilities and provide staff with comprehensive instructions how their needs should be met. There is a need to undertake required actions including referral to adult protection for any unexplained injury as well as allegations or suspicion of abuse. If required actions are undertaken of any sign of potential abuse then there will be greater assurance that residents will be protected from harm. The continued refurbishment and decoration of the home with the replacement of furniture will make the home a more pleasant and comfortable place to live. There is also a need to provide appropriate storage for wheelchairs to improve access around the home. There is a need to look at stimulation for those residents who spend all or the majority of time in their bedrooms to give them an increased quality of life. There is a need to review the sufficiency of staff as the number of people who live at the home with dementia and constantly wander particularly at night has increased. The recruitment of staff at the home has not been undertaken either safely or appropriately to meet the regulations for some time and this remains the situation. The appropriate and safe recruitment of staff will mean that the risk of people who are unsuitable to work with vulnerable people will be reduced. It is acknowledged that some required changes have been undertaken but other requirements remain unmet and this continues to put residents at risk. The failure to undertake required actions has lead to the need for statutory requirement notices which could have been avoided if required actions had been taken. The management team need to ensure that they solicit advice and take the advice that is given is act upon it to enable care and practice at the home to be developed and improved and give confidence that high quality care is consistently provided.

CARE HOMES FOR OLDER PEOPLE Hillcroft Nursing Home 135 High Street Wordsley Stourbridge West Midlands DY8 5QS Lead Inspector Mrs Amanda Hennessy Unannounced Inspection 18th February 2008 09:15 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 Nursing Home DS0000004878.V360101.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 Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcroft Nursing Home Address 135 High Street Wordsley Stourbridge West Midlands DY8 5QS 01384 271317 01384 271112 christinedalwood@hotmail.com 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) Mr. Jayantilal James Bhikhabhai Patel Mrs. Kailash Jayantilal Patel Mrs Christine Dalwood Care Home 28 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (28) of places Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 28 OP and up to 10 DE(E) Service Users to include up to 28 OP and up to 10 DE(E) Date of last inspection 4th September 2007 Brief Description of the Service: Hillcroft Nursing Home is situated in a residential area of Wordsley close to a main bus route, shops and other local facilities. The home has been converted from a traditional domestic dwelling and extended for its present purpose a care home providing nursing care to a maximum of 28 residents in the category of old age, many of whom have complex needs and require a high level of care. Ten of these 28 places can be allocated at any one time to older people who have a diagnosis of dementia. Hillcroft, as stated, is registered to provide nursing care and therefore has a registered nurse on duty at all times. The home is on two floors. The ground floor housing the lounge, dining area, conservatory, kitchen, laundry rooms, office, a number of bedrooms, toilets and an assisted bathroom. The home has an attractive garden to the rear and car parking space to the side. The home offers ramped access, has a passenger lift, hoisting equipment and other aids and adaptations to enhance, safety, accessibility and independence. For information about fees that the home charges you are advised to contact the Home Manager. Additional costs include hairdressing and private chiropody which can be provided within the home for an additional fee. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out in one day by an Inspector and an Expert by Experience. The inspection commenced at 9:15 am and the home/provider did not know we were coming. The manager was present throughout the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection by the homes manager which was sent to us; on the day of the inspection a tour of the building was undertaken, records and documents were examined in relation to the management of the home, discussion with the manager and care staff plus visitors and residents. Some residents were unable to communicate their views verbally to the inspector so direct and indirect observation was used to inform the inspection process. Three residents who live in the home were ‘case tracked’ this involves establishing individuals experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experience of people who use the service There was also another visit to the home on the 18/1/08 to assess compliance with longstanding requirements in relation to care planning, recruitment and selection and the use and risk assessment of bedrails. As a result of this visit statutory requirements notices have been served on the home requiring that specific improvements are made. A copy of the letter to the Home’s proprietor detailing the findings of the inspection on the 18/1/08 is available from CSCI on request. Five of the previous nine requirements have been addressed.; One new requirement and fourteen good practice recommendations were made as a result of this inspection. The inspectors would like to thank the residents, relatives, management and staff for their hospitality throughout this inspection. The quality rating for this service is 0 stars. The means the people who use this service experience poor quality outcomes. What the service does well: Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 6 The home is small and friendly with just twenty three residents. The single large lounge/dining room/ conservatory enables the majority of residents to feel part of life at the home and able to see staff for the majority of the time. Feedback from people who live at the home and their relatives was positive. Residents say, “Its home from home”. Visitors said “they are very good here”. Residents have an assessment of their needs before they come to live there so that the home has information about them. The home has medication policies and procedures that are safe and promotes and maintains residents health and wellbeing. The home provides home cooked food that is tasty and nutritious with a choice available at each mealtime. What has improved since the last inspection? What they could do better: Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 7 Care records must be more detailed and reflect all residents individual needs, choices and capabilities and provide staff with comprehensive instructions how their needs should be met. There is a need to undertake required actions including referral to adult protection for any unexplained injury as well as allegations or suspicion of abuse. If required actions are undertaken of any sign of potential abuse then there will be greater assurance that residents will be protected from harm. The continued refurbishment and decoration of the home with the replacement of furniture will make the home a more pleasant and comfortable place to live. There is also a need to provide appropriate storage for wheelchairs to improve access around the home. There is a need to look at stimulation for those residents who spend all or the majority of time in their bedrooms to give them an increased quality of life. There is a need to review the sufficiency of staff as the number of people who live at the home with dementia and constantly wander particularly at night has increased. The recruitment of staff at the home has not been undertaken either safely or appropriately to meet the regulations for some time and this remains the situation. The appropriate and safe recruitment of staff will mean that the risk of people who are unsuitable to work with vulnerable people will be reduced. It is acknowledged that some required changes have been undertaken but other requirements remain unmet and this continues to put residents at risk. The failure to undertake required actions has lead to the need for statutory requirement notices which could have been avoided if required actions had been taken. The management team need to ensure that they solicit advice and take the advice that is given is act upon it to enable care and practice at the home to be developed and improved and give confidence that high quality care is consistently provided. 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 Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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 Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information obtained about people wishing to live at the home is not comprehensive and may mean that their needs are not met. EVIDENCE: The home has both a statement of purpose and service user guide. The statement of purpose has recently been updated and is displayed in the entrance hall, it now includes photographs of residents undertaking activities such as the cake decorating. Copies of the service user guide were seen in several of the bedrooms visited. We did not see copies of either document in any other format such as large print, although the Manager did say that both documents are available in large print. Information about the range of fees that are payable was not included in either document and therefore do not give potential residents required information to enable them to make an informed judgement about the home and this information should be included. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 10 No copies of resident’s contracts were seen in any of the files that we looked at, this has also been the situation at previous inspections. The Manager told us that all contracts were being reviewed across the group of homes and she would ensure that a copy of the contract would be forwarded to the Commission for Social Care Inspection which has now been undertaken. There remains a need for a copy of the residents contract to be retained by the home as recommended previously. Resident’s needs are all assessed prior to them coming to live at the home. Previous inspection have highlighted that pre admission assessment have been incomplete. It was pleasing to see that there has been a considerable improvement in the assessments of those residents who have come to live in the home most recently. There were still however some omissions within those assessments of needs that we saw. One persons assessment included several comments“unable to assess”. Areas that were specified as unable to assess were foot care as it stated that the resident was asleep with the blankets tucked around them and whether they wore dentures. We did ask the Manager why the person’s family had not involved in the assessment as they would have been able to provide the majority of the missing information and the assessment would have been more accurate. The manager told us that she did speak to relatives and she included these comments in the care assessment when they come to live at the home. We did discuss the possibility of family members whenever possible being invited to be present when staff assess potential residents, the Manager confirmed that she would look at ways that she could do this more effectively. The manager also writes to the prospective residents and when necessary their family to confirm that the home is suitable to meet their needs. The home does not care for people requiring intermediate care. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning does not inadequate identify all peoples needs and fails to provide staff with sufficient instructions to meet residents needs and therefore does not provide assurance that people’s needs will be met. EVIDENCE: The content and sufficiency of care planning at the home has been inadequate since 2005. Omissions in care plans have meant that all residents needs have not been identified and that staff have not been provided with appropriate information about people’s needs and how they should be met. The home received a statutory requirement notice in relation to this matter following the inspection. Care planning at this inspection did show some improvements although again not all people’s needs were identified. We found that there is now a good initial assessment of people’s needs by the manager, drawn from the pre admission assessment. This assessment shows improved understanding of person centred Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 12 care and was individual to the resident, their needs, capabilities and choices. When we compared this to people’s care plans available not all their needs highlighted within the assessment had a plan of care, for example people who were incontinent and required assistance did not have a plan of care for their incontinence. One person was described as “will not keep a pad in” and the other person “will ask to go to the toilet” but this was not included within their plan of care. Another resident was described as being a “restless sleeper” in her long term assessment of her needs and required medicine to help her sleep but again there was no care plan to give staff instructions on her care at night. In addition care plans seen did not reflect choices such as time they preferred to go to bed and get up in the morning another care plan identified “daughter will purchase her chosen toiletries” but there was nothing to tell staff what her preferred toiletries were such as should staff use of bubble bath or not and if applicable which type of bubble bath she preferred. There was one comment seen “prefers a bath but knows that may be difficult and will have a shower”. It was not clear whether this was actually the persons choice or whether this was for the ease of staff. Care plans and care risk assessments are reviewed monthly although generally more information is needed to be included in the review to give assurance that any changes in care needs would be addressed. Care records did show that residents have appropriate access to other health professionals such as Doctors, Chiropodists, Opticians, Dentist and Speech and Language Therapists. The storage and administration of medicines at the home is undertaken by qualified nurses and is done both safely and appropriately. We observed staff to be respectful and polite to residents. Residents’ appearance was noted to be clean and tidy and they appeared well cared for. Toilet and bathroom doors were shut when in use and staff knocked on bedroom doors before entering. It was also noticed that staff paid particular importance to protecting knees and feet from injury whilst also protecting the residents dignity when they were being hoisted. Residents’ last wishes have started to be recorded usually by talking to their family about their wishes. A questionnaire is completed that includes the following: “Do I want resuscitation- yes or no” “Do I want surgery for a PEG- yes or no.” Those questionnaires we saw had been completed by family members although there was nothing to show that an assessment of the residents mental capacity had been undertaken and these decisions could and should be made by a third party as required by the Mental Capacity Act 2005. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are a variety of activities for people to take part in. Food is tasty and homemade and is enjoyed by the homes residents. Residents are able to maintain contact with their friends and families. EVIDENCE: The range of activities has been extended since the previous inspection. Cooking now takes place on a Wednesday morning which the Manager said had been particularly popular and gardening on a Thursday. A lady comes every Monday to undertake a variety of activities including crafts, singalong and reminiscence of people’s earlier life. Residents and their family’s all enjoyed the session that took place on the afternoon of the inspection. We were told that there is also Music to movement once a week. Music was played in the lounge during the morning whilst other residents chose to watch the television. We felt that not all residents would be able to see the television from where they were seated if they wished to. The home also have several caged birds that entertained and amused residents with their antics. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 14 During the morning of the visit one of the care staff was seen trying to alternate throwing coloured bean bags onto a mat with numbered areas for a residents whilst also assisting one or two of the other residents to go to the toilet. The disruption of the activity would have provided little enjoyment or fulfilment for those residents involved. There is a need to review staffing and their allocation to ensure that staff can continue to arrange activities without being disturbed. We did meet two people who spend all their time in bed in their rooms. The Manager told us that they have very poor or virtually no eyesight or hearing so TV and Radio would be of no benefit to them. We asked whether it was possible to bring them downstairs for some company and the manager said she would look into this further. Some people were seen to get up and have their breakfast just an hour before lunch although we were unable to ascertain if this was their choice although we have also previously seen this at previous inspection with other residents. Visitors are made welcome at the home and several visited during the day. There is a note on the door to request that people do not visit at mealtimes as this it can disrupt residents. The home has a four week menu. Since the previous inspection a choice of meal is now available at each mealtime. The Manager proudly told us that the chef prepares homemade soup daily and that they always use fresh fruit and vegetables. The day of the inspection the main meal choice was either chicken or sausage casserole with creamed potatoes, green beans and broccoli. There was creamed rice pudding or fruit flan for sweet or cheese and biscuits. We were invited to taste both the dinner and dessert choices and we found them to be very tasty. The cook confirmed that he provides a number of special diets. One of the rice puddings we tried is suitable for diabetics and we found it creamy and delicious. One lady having lunch told us that the food “is delicious” and then had three helpings of the rice pudding. The majority of residents chose to come to dining tables at lunchtime. Tables looked attractive with all required cutlery and cruets. A member of staff is employed to assist residents at breakfast and lunchtime five days a week. Two carers were feeding two residents but on the opposite table two ladies were trying to get up and walk away from the table throughout their meal without eating much at all. The two carers feeding had to keep getting up and down to try to encourage the two ladies who were restless to sit down whilst doing that they were also disrupting those people that they were feeding. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 15 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): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are appropriate arrangements in place for people to highlight concerns although there is a need to regard complaints as an opportunity to improve practice. There is an inconsistent approach to safeguarding people from potential abuse meaning that people may not be adequately protected from harm. EVIDENCE: There have been no new complaints about the home either directly to the home or to the Commission for Social Care Inspection (CSCI) since the previous inspection. The complaints procedure is displayed on the main notice board in the hall of the home and also included within the Welcome Pack and within the service user guide. Recent inspections have found that the Manager has been defensive about findings of the inspection and has been reluctant and slow to make improvements required. The lack of response to the requirements made by the Commission for Social Care Inspection does not provide confidence that that peoples concerns would be listened to and addressed. Previous inspections have highlighted a failure to reduce the risk of accident and subsequent injury and also report unexplained bruising to the appropriate agencies. CSCI are either not informed of all incidents that have affected the wellbeing of residents or there is a long delay before we are informed. Risk Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 16 assessments were previously inadequate with risks not identified making the risk assessment merely a paper exercise and of little value. A statutory requirement notice for the failure to appropriately assess for the use of bedrails was issued following findings of previous inspections. This inspection found that some improvements have been made in the protection of people who live at the home. Risk assessments for moving and handling of residents and the use of bedrails have been improved and the provision of new equipment has also meant that residents are now more protected from the risk of accident. The Manager informed us that all staff will undertake training in the Protection of Vulnerable which will include the management of challenging behaviour now as all statutory training had been completed. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, warm and homely with aids and adaptations for dependent people who live at the home although the refurbishment will approve this. EVIDENCE: The home is homely and clean but the décor is somewhat dated and is shabby in places. The home is in the middle of a refurbishment programme with the lounge being decorated at the time of the inspection, although this was also the situation at the visit on the 18/1/08 as the handyman is also continuing his other duties. The home has a large lounge shared with the dining area, and an open plan conservatory. It was pleasing to see that people’s chairs were arranged in small groups and not “all the chairs round the four walls” format. In some Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 18 areas of the lounge the chairs were close together and the reclined footrests were protruding into quite small spaces making movement around them a little hazardous for both staff and residents. The conservatory area is very light and airy, clean and comfortably furnished with a variety of styles of chairs. Several of the residents have little side tables with personal photos and trinkets on them which was lovely to see. The home has small garden and a balcony area off the conservatory. Current outside facilities provide limited opportunity for residents and particularly those with dementia to wander out into the garden. All bedrooms were found to be pleasant, clean and in most cases personalised with peoples treasured possessions such as photographs, pictures and ornaments. Toilets are situated throughout the home and again are accessible and have grab rails. There is an assisted shower room and bathroom with a bath that can be used by highly dependent people. The home has a variety of aids and adaptations throughout which are suitable for dependent people and a staff call system throughout the home. There has been a considerable investment in the provision of new equipment including electric “profiling” beds which residents can adjust the height, back and footrests to assist their comfort. We discussed with the Home Manager whether the home has facilities such as a bed/chair that would enable staff to bring downstairs the highly dependent residents that have been cared for in bed for several months and may improve the quality of their life. The home has very limited storage space for its wheelchairs and we observed that wheelchairs were placed outside three residents rooms meaning that these rooms could not be accessed. We advised that alternate storage should be found. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a need to review the sufficiency of staff at the home to ensure that people are adequately supervised and cared for. Recruitment practices at the home do not meet minimum standards and as a result put people at risk from unsuitable people working at the home. EVIDENCE: The home has a trained nurse on duty assisted by care staff on each shift. The home has employed someone to assist with the feeding of residents at breakfast and lunchtime since the previous inspection. Staff are very hardworking and we did not see them stop throughout the day that we spent at the home. We observed that some residents did not get up and have their breakfast until an hour before lunch. We also found that there is a high numbers of accidents at night particularly as the home has more residents with dementia who constantly wander. The home has 53 of its care staff with a care qualification (minimum of National Vocational Level 2). Staff recruitment at the home has been inadequate for some time which would mean that people who may be unsuitable to work with vulnerable people could do so. We found that staff are employed without the home first receiving two Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 20 written references and in some circumstances a criminal records check. CSCI sent a warning letter of possible enforcement following the previous inspection. A visit to the home in January found that recruitment processes were still inadequate and the home has since received a statutory requirement notice in respect of this. New staff do have an induction which the manager confirmed meets skills for care standards. Staff receive supervision but records seen show that it is not undertaken at the required frequency. Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are weaknesses in the management systems in the home which have resulted in residents not always being protected from harm. EVIDENCE: The manager has managed the home for several years is a qualified nurse and has the required management qualification to manage a home. It is disappointing that an experienced manager has failed to address longstanding requirements. The “improvement plan” that was submitted to CSCI by the Home Manager did not include any plans to make improvements to the home. The content of the “improvement plan” highlighted a lack of insight to the seriousness of the concerns and an unwillingness to implement required Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 22 changes. Discussions that we have had during inspections have also highlighted a lack of awareness of the content of the National Minimum standards and requirements of the regulatory framework. It is of particular disappointment that despite a letter informing her of the possibility of enforcement action following the visit on the 18/1/08, she has still employed new staff without required checks. The Home Manager did complete “An Annual Quality Assurance Assessment” (AQAA) that was sent to CSCI before the previous inspection. The AQAA contained only basic information and did not provide us with confidence that there was an awareness of how the service could improve upon current provision. The home is developing a quality assurance programme which includes the views of service users. The manager was advised to use the completion of the AQAA as a tool to develop a quality assurance framework. Staff do not manage residents money although small amounts of money can be kept for residents if required. The home has records of transactions made with receipts available to evidence the transactions. The Manager is aware of a need to ensure that receipts are given for all donations as concerns had been previously highlighted. There have been improvements implemented in the ways that residents are moved and handled and this is now undertaken more safety. There are now more comprehensive risk assessment for the use of bedrails and the moving and handling of residents. Statutory training is ongoing for all staff- although the majority of training is undertaken “in house” A sample of records in relation to servicing and checking of equipment were inspected at the previous inspection and were found to be up to date Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 2 3 2 x x x 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 2 x 2 Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered provider must ensure that each residents care plan reflect ALL of each residents needs. And includes the following; wound dressing regimes, nutritional care to include special dietary regimes. Management of any risks. Previous timescales of 01/07/05, 05/01/06 and 15/09/06, 30/9/07 and 18/01/08 were not met. The home has received a statutory requirement notice in relation to this requirement. 2. OP18 13(6) There must be suitable and appropriate arrangements in place that includes staff training to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. DS0000004878.V360101.R01.S.doc Timescale for action 18/02/08 31/03/08 Hillcroft Nursing Home Version 5.2 Page 25 Previous timescales of the 31/12/07 and 30/01/08 not met. 3 OP27 18(1)(a) Staffing levels must be reviewed to ensure that residents’ needs are consistently being meet thorough out the day on all houses. The registered provider and manager must obtain for each staff member all of the required documents detailed in Schedules 2 and 4 . A copy of each of these documents must be held on each staff members personal files. Previous timescales of 18.01.05, 01/07/05, 12/12/05, 21/09/07, 30/9/07 and 18/01/08 were not met. The home has received a statutory requirement notice in relation to this requirement. 5. OP37 37(1) Notification must be forwarded to the Commission of Social care and Inspection of any incident that has affected the health, safety or wellbeing of the service user at the care home. Timescale of the 30/9/07 and 18/01/08 Not met all incidents are not notified and when CSCI is notified there is a considerable delay notifying us of incidents that affect residents A warning letter of possible enforcement action has been sent to the home in relation Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 26 30/04/08 4. OP29 19(1)17(2 ) 18/02/08 18/02/08 to this requirement. 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 Refer to Standard OP1 OP2 Good Practice Recommendations The statement of purpose and service user guide should detail the fees that the home charges A signed copy of the terms and conditions of residency should be retained within the residents records. This is a previous good practice recommendation and was not met. 3 OP3 The prospective resident or whenever possible their representative should be actively involved in the preadmission assessment of the persons needs and this should be recorded. Residents last wishes in respect of death and dying should be explored and be recorded within their personal file. This is a previous good practice recommendation and was not fully met 5. OP12 There should be a record of peoples preferred leisure activities and their choice of daily life and routines such as getting up and going to bed. There is a review of those residents care who spend all their time in bed with only very minimal stimulation. It is recommended that the home obtain a copy of the Dept of Health guidance “Mental Capacity Act 2005 core training set” published July 2007 There should be only minimal disruption when residents are being fed. Staff should be made aware of the homes abuse policies and Dudley Council’s Adult Protection procedures. It is advised that staff sign and date when they have read these DS0000004878.V360101.R01.S.doc Version 5.2 Page 27 4. OP11 6 7 8 9. OP12 OP14 OP15 OP18 Hillcroft Nursing Home documents. This is an ongoing good practice recommendation. 10 11. OP22 OP30 The should be adequate and appropriate storage of wheelchairs. A thorough training needs assessment should be undertaken with a consequent training plan and an up to date training programme. This is an ongoing good practice recommendation. There should be an effective assurance system in place that includes quality checking systems and meets all elements detailed in standard 33. An acknowledgement and receipt must be given for all donations to the home. This is an ongoing good practice recommendation. 12. OP33 13. OP35 Hillcroft Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Nursing Home DS0000004878.V360101.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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