Inspection on 04/09/07 for Hillcroft Nursing Home

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Hillcroft Nursing Home 04/12/08

Hillcroft Nursing Home 20/05/08

Hillcroft Nursing Home 18/02/08

Hillcroft Nursing Home 21/08/06

Hillcroft Nursing Home 12/12/05

Hillcroft Nursing Home 06/06/05

Hillcroft Nursing Home 18/01/05

Hillcroft Nursing Home 20/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Hillcroft Nursing Home 135 High Street Wordsley Stourbridge West Midlands DY8 5QS Lead Inspector Mrs Amanda Hennessy Key Unannounced Inspection 4th September 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 Nursing Home DS0000004878.V346166.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.V346166.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.V346166.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 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. The charges for this home identified at the time of the inspection ranged from £ 369-525 per week. Additional costs include hairdressing and private chiropody which can be provided within the home for an additional fee. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection undertaken between 09.30 and 18.45 by two Inspectors without any prior notice. The inspection included a tour of the building, talking to service users, relatives, staff and the Manager, a review of records including information forwarded by the Manager before the inspection. Care records were reviewed as part of the “case tracking” of four people who live at the home, three staff files were also reviewed. A random selection of people who live at the home and their relatives were send surveys that asked about their life at the home and the care that they receive there. Five of the previous seventeen requirements have been addressed, a further nine requirements have been removed as they no longer applicable; Eleven new requirements and thirteen good practice recommendations were made as a result of this inspection. The home was given an immediate requirement to ensure that home has also appropriate moving and lifting and bedrail risk assessments when appropriate. A warning letter has also been sent as the home has not met requirements for the appropriate and safe recruitment and selection of staff or ensuring that all peoples needs are included within their plan of care. What the service does well: The home is small and friendly with just twenty four residents, enabling staff to get to know both residents and their visitors well. Feedback from people who live at the home and their relatives was positive. Residents say, “Staff are good”. Visitors said that “they take good care of my mother” and “they keep her clean, warm and well fed”. Residents have an assessment of their needs before they come to live there so that the home has required information about them. Staff are able to provide them with confirmation that the home will be suitable to meet their needs. The home has medication policies and procedures that safeguard its residents and promote their well being. The home provides home cooked food that is tasty and nutritious. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To enable this home to go forward there is a need for effective management and leadership that addresses poor practice, develops staff, improve communication and proactively solicit advice from other professionals and act upon it, to ensure that high quality care is consistently provided. Care records must be more detailed and reflect all residents individual needs and choices and give staff comprehensive instructions how their needs should be met. The manager must ensure that all staff are made aware of the existence and content of care records to ensure that they are aware of all care needs. Staff must ensure that residents choices are explored and met and not disregarded as it is felt that they are unable to understand. The home must be run for residents and not within a routine that is for staff convenience. There must be more social activities that are suitable for residents and which meet residents choice, needs and capabilities. A review of how meals are served and a choice of meal would help to make mealtimes more pleasurable. The continued refurbishment and decoration of the home with the replacement of furniture and bed linen will make the home a more pleasant and comfortable place to live. The Manager and staff require greater understanding and awareness of abuse and concerns relating to unexplained injuries. Required actions must be taken for any allegation or suspicion of abuse to give assurance that residents are protected from harm. Any complaints received must be fully investigated, an outcome and any required actions recorded to give assurance that people are listened to and any concerns comprehensively acted upon. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 7 There must be sufficient and appropriately skilled staff to meet the dependency and needs of residents. Currently residents may have to wait for care to be provided, or at mealtimes wait whilst other residents are fed during which time their meal may be cold. There is also a need for staff to receive all required statutory training, that is delivered by appropriate and credible training providers, as previous training has clearly not been effective. The home needs staff to have sufficient health and safety awareness to recognise and ensure that unsafe practice and equipment is identified and addressed. Required risk assessments must be available to give assurance that all identified risks are highlighted and appropriate actions are undertaken to minimise any risks to residents. 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.V346166.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.V346166.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. The lack of detailed assessments of residents needs and unavailability of terms and conditions of residency does not give total assurance of the completeness of information provided and that the home will be able to meet all residents needs. EVIDENCE: Prospective residents have an assessment of their needs before they come to live at the home but this appeared to be process driven rather than individualised. Information available about peoples individual needs was frequently found to be scant and did not give assurance that the home was aware of all their needs and that they would be met . The service has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides basic information about the service and the specialist care the home offers. The service user Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 10 guide is made available to individuals in a standard format with no alternative versions seen (such as large print) and is placed on the back of the door in each person’s room. The manager said that that either the resident or their families are provided with a contract of residency before their admission to the home. When the manager was asked for a copy of the contract she said: ‘They should all be on their file’, but no contracts were available within any of the files looked at. The home does not accommodate people requiring intermediate care and the Commission for Social Care Inspection has not been made aware of any plans to do so. Hillcroft Nursing Home DS0000004878.V346166.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): 7, 8, 9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their needs although records are not always accurate and would benefit from being more individualised and person centred. The moving and lifting of residents and how bedrails are used require improvement to ensure that residents are moved and lifted safely and are protected from harm. Policies and procedures in relation to medicines are generally appropriate but further improvement is required to give additional assurance that residents are safe guarded. EVIDENCE: People who live at the home have care plans to provide staff with instructions on their care needs. All residents care plans seen were all the same. The Manager explained that copies of care plans are printed off the computer. Those seen did not reflect peoples’ individual preferences and did not provide sufficient information about their care needs. Care plans were unclear and ill defined in outcomes, for example ‘refer if necessary ‘was recorded for some residents , but there was no description of when it may become necessary. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 12 There was no recording of any of the resident’s last wishes. The last inspection also noted that work was needed to be done to improve reflection of health issues, daily routine and recreational preferences in care planning and this is still the case. Care plans and care risk assessments had been recorded as being reviewed monthly although reviews indicated that there had been no change to the persons needs and did not always reflect the care to be given. Some care plans had remained the same for several years and one resident’s monthly care plan reviews recorded ‘no change’ after nearly a three year period. One residents care plan was found to be outdated, lacked necessary detail and failed to record risk. For example her risk of pressure sores had massively increased from 9 to 21 in a very short space of time, but there was nothing in the daily record to explain why this was the case, nor any entry in the care plan showing the increase in risk moving to a high level. She was now also being nursed in bed and the care plan also failed to reflect this. Two people had wounds that required dressings but there was no care plan detailing what dressing they required, or the frequency that that it should be or had been dressed and no record of any improvement to the wound. The Manager when asked about a wound to one residents hand and leg said that she was not aware of either wound. There was an entry in their care records that identified that their leg wound had been caused by the bed rails, yet the accident book had not been completed or did they have an risk assessment available for the use of bed rails which if available would have identified the risk to the person. Risk assessments for pressure sores and nutrition are available, although those seen were not always accurate. One resident’s had been assessed as low risk of skin damage but they had later developed excess fluid in their leg (oedema) following leg injury, however their risk level had not been reassessed and was recorded as it had been on all previous occasions and remained low. One resident had fluctuating weight, and had lost nearly a stone in weight but this was not identified in her care plan and there was no record of how staff may address this problem. There were no risk assessments available for moving and handling individual residents or for the use of bed rails when required for individual residents. As a result of insufficient information staff were seen to move residents both inappropriately and unsafely. Three residents had care instructions that identified that they must be moved with the use of a hoist and two members of staff, although staff were seen to move them by lifting them underarm which is a lifting techniques that have been identified to cause injury both to the person being moved and the person who is doing the lifting. When the manager was asked why staff were ignoring information on how one resident Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 13 should be moved she said:’ It’s because he has wet his sling, he pees all the time”. The home needs to ensure that risk assessments are available that staff comply with and there is sufficient equipment available to ensure that residents receive the required and appropriate care. People were seen to be moved in wheelchairs by staff without the footplates being put to use. The use of footplates reduces the risk of injury to that person. No records were seen to identify this as their choice. Two other residents were seen to be moved in wheel chairs that were tipped back by staff, this can be both distressing and disorientating to people. The member of staff when challenged said she had tipped the wheel chair backwards as the person would have come out the chair, if this is the situation a more safe system of moving this person is required. Again there was no record identifying this to be their choice yet these poor practices were not challenged by other staff. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident. The receipt of medicines received and administered is recorded, again recording is not always clear. For example on records seen for one resident stated that one or two tablets had to be given, and from the administration sheet it was not evident exactly how many tablets had been administered. There was a collection of controlled drugs which had not been disposed of and should have been. When the nurse was asked about this she stated that the disposal bin was too small, however she had ordered another. There was no evidence seen of any people administering their own medication. Medication systems consequently do not always follow good practice or safe practice guidelines. One residents care records did identify that all of her medication was to be administered covertly. There were no risk assessments in place for covert administration of medicines, nor any evidence that there had been consultation with the GP or the family. The manager said:’ The GP knows and got very cross when we asked him about this. He said we were the professionals and it was our job to get the medication in’. It some situations the covert or hidden administration of medicines may be unsafe and abusive practice and although it is recognised that some residents require essential medicines alternatives also need to be considered such as the use of liquid medicines that may be easy for the person to swallow. When there is no alternative to covert administration a risk assessment must be in place which is agreed by other professionals such as the GP, Pharmacist and the reasons for the covert administration explained to the person or their advocate. There were records to evidence that people who live at the home regular see other Health Professionals such as Doctors, Opticians, Dentists and Chiropodists. It was positive to see an Optician visiting a resident for some new glasses. Generally, the health care needs of residents are being addressed Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 14 but not always recorded in respect of GP involvement, and referrals to specialist nurses were not evident in one residents records reviewed. For example one resident had a problem with regular highly fluctuating blood sugars to serious levels, but there was no recent written evidence of the residents Doctor being contacted about this. The manager and nurse were asked about this. The manager said she did not always record the telephone conversations she had with the doctor, but he was involved and the nurse supported this. Staff were seen to be respectful to residents and polite. Residents appearance was noted to be tidy and clean and most men were shaven. Toilet and bathroom doors were shut when in use and staff knocked on bedroom doors before entering. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 15 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, 13,14,15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The limited range of activities in the home and contact with the local community means that residents have only limited stimulation. The lack of meal choice, poor feeding practices and lunch routine mean that mealtimes do not provide a conducive occasion for residents. EVIDENCE: There was no record of individual’s preferences for particular activities in those residents whose care records reviewed. An activities co–ordinator has not been appointed, as was advised at the last inspection. The Manager reported that activities are provided by staff on some days after 2pm in the afternoons. Activities included manicures and hairdressing with several residents having their hair done on the day of the visit. There was information available to evidence that people who live at the home were involved in the choice of activities available. Birthdays are celebrated and it was lovely to see trifles and other party food in the fridge, and a birthday cake for the birthday party on the day of the visit. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 16 There was only a limited record of resident’s preferred daily routines. Residents spent the majority of the day either asleep in bed or sitting in chairs. There were two televisions on in the lounge (which is open plan with the dining area) with different stations for most of the morning. There were two birds, one of whom whistled on and off for the first hour, after which it was moved. The atmosphere was consequently noisy. The televisions were on for the majority of the day and although one resident was asked which channel she would like to watch residents generally were not asked. It was pleasing to hear that visiting and contact with friends and family is encouraged and visitors said that they are made welcome when they visit. The home does have a menu which is nutritionally balanced and provides tasty home cooked food. The home does not offer a choice of meal. The Manager was asked why no choice was available. She responded: ‘It’s because of their dementia. It’s difficult to find out likes and dislikes. We ask the family if they have any and we wouldn’t give fish if they don’t like it’. A view to limit peoples choice due to their dementia is inappropriate and also limits the choice of all residents within the home. Lunch was served by care staff and for one late riser, this was ten minutes after his breakfast. Residents were wheeled to the table approximately one hour before lunch was actually served. One resident fell asleep with his head on the table and was in that position for 50 minutes. Several residents required assistance with eating and all available care staff were involved in assisting them. Two residents had had their meal placed in front of them for 20 minutes before any help was provided. At one point one member of care staff fed two people at the same time, and occasionally she fed a third. The pacing was poor, and technique used cumbersome and no fluid was offered whilst these residents were being fed. Lunch was not a particularly social event, although the manager did switch the televisions off and played some music. Tea or coffee was not offered after lunch, and one drink was provided at the start of the meal with none offered during lunch. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 17 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. The complaints procedure is not robust and outcomes are frequently not clear or evidenced giving no assurance that concerns are appropriately addressed. The lack of appropriate adult protection processes mean that people who live at the home are not adequately protected. EVIDENCE: A written complaints procedure is on display in the front entrance hall which assures that complainants will be responded to within 28 days. A complaints book evidenced that complaints were recorded, however the outcome of complaints was not clear and there was little evidence of how complaints were responded to. The home had received two recent complaints yet it was evident that issues highlighted had not been addressed and appropriate actions taken. Residents were not supplied with a complaints procedure in a format that could be understood. The procedure was on a notice on the wall by the front door when most residents were not ambulant or able to wheel themselves independently out of the lounge. Adult protection training and systems within the home are not effective, resulting in residents experiencing unexplained injuries. One recent complaint Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 18 highlighted unexplained bruising possibly to a residents hand but no adult protection referral to Dudley MBC had been undertaken. There was little recorded evidence to support that staff were aware of procedures or how to implement them. The manager had confirmed on a previous occasion that this is the process she would use if there was an allegation of abuse, but had chosen not to refer a recent allegation of physical abuse involving both a member of staff and a member of the resident in question’s family. Discussion about this with people who live at the home users was difficult due to their high levels of complex need. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 19 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 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 but the slow development of the refurbishment programme detracts from this and improvements are required to provide and safe and comfortable environment of people who live at the home. Procedures to minimise the risk of infection are generally satisfactory and the risk of cross infection to residents is minimised. EVIDENCE: The home is homely and clean but the décor is somewhat dated and is shabby in places. The manager said they were in the middle of a refurbishment programme and the net curtains were being replaced next week. Some bed linen was found to have holes in it. The manager said all bed linen was also about to be replaced, and she was ‘ordering new linen’. The home has a large Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 20 lounge shared with the dining area, and an open plan conservatory. The home has pleasant gardens and a balcony area off the conservatory. The Manager also told Inspectors that there was a plan to improve the bathing facilities for dependent people who require assistance and changes to the shower room and one existing bathroom will be undertaken shortly. The home has appropriate systems in place to minimise the risk of infection with availability of gloves, aprons and liquid hand gel. The kitchen was clean and well maintained. Food was up to date in the fridge and some of it was covered. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 21 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): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient staff and staff have not received sufficient training to support the people who use the service. Important National Minimum Standards are not being met and people who receive this service are not always safe as a result. EVIDENCE: Staffing levels were found to be insufficient to meets residents’ needs. Two residents did not have their breakfast until after 11.30 but it was not evident that this was their choice or a result of staff insufficiency. Lunch time was observed to be difficult with at least seven residents requiring feeding and staff were observed to hurry residents and as previously highlighted within this report to inappropriately feed more than one resident at the same time. There was some evidence of in-house induction for new staff . The manager was able to demonstrate that the ‘Skills for Care’ standards are available for use in the home but it was not evident that staff had completed this programme. In house training seems a little hit and miss and considering how staff were applying training learnt such as with moving and handling was weak. No training plan was evident although there was a chart of dates of completed Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 22 training. There was no record that staff had undertaken Adult Protection Training. The home has eleven of its twenty-one staff with National Vocational level two in care. A thorough training needs assessment is needed, a consequent training plan and an up to date training programme, in order to help staff improve the service that is offered to residents. Required checks including appropriate references and a criminal records checks are usually undertaken prior to a new member of staff commencing employment at the home as required. The previous inspection noted that generally, recruitment processes were seen satisfactory but there were shortfalls in gaining references. This inspection found that there were no references for one member of staff, however criminal records checks were available for all staff. The keeping and filing of staff records was found to be poor which was also highlighted at the previous inspection. A resident said “The home does everything well – I find the staff friendly and helpful and remember things”. Although observations made by the Inspectors highlighted a number of concerns about staff practice. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of effective management compromises the health, safety and welfare of residents and does not give assurance that home is run in their best interests. EVIDENCE: The manager is a registered nurse and has an appropriate management qualification. Leadership and communication at the home were found to be weak. Poor staff practice was not challenged and the manager consistently said that she was unaware of issues highlighted by Inspectors. Care records did not detail the care that residents were receiving and when the Manager was shown this she Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 24 said that she had left care records to the trained nurses and that they should know how to complete them. A handover discussion between one shift to another did not give key information about residents or the care that they required and as staff spoken to said that they relied on the “handover” this does not give assurance that staff are aware of and will be able to meet residents needs. The home is developing a quality assurance programme which includes the views of service users. It was clear however that the current programme is ineffective. There is no monitoring of care records which if undertaken would have identified that they were incomplete and were not reviewed appropriately. Accident records were also not always appropriately completed and followed up to give assurance particularly in the case of the bed rail risk injuries may have been avoided. There is also a need to explore residents preferences for alternative choices at mealtimes, as it is totally inappropriate not to offer them a choice as they have dementia as identified by the manager. 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, although receipts are not all kept together for that resident which may lead to confusion. Comments received highlighted that no receipts had been given for money that had been donated to the home for their residents/ staff, and there had been no explanation how this money would be used. The Manager confirmed that she did not given receipts or written acknowledgement of the donations and was advised that she must do so. There was some written evidence available to demonstrate that some staff receive regular one to one supervision sessions although this was not consistent. It was a concern that staff did not challenge or appear to recognise poor practice. The member of care staff seen to tip a residents back in a wheelchair, feed more than one resident at the same time and moved residents using unsafe lifts was a “Senior” carer and so should be have provided a good example to more junior staff which was not the situation. The home do not send required notifications of incidents that have affected the health, safety or wellbeing of the service user at the care home. Records identified that one service user is frequently aggressive to staff and other residents, two other residents had sustained injury due to their bedrails but the Commission for Social Care had not been informed of these incidents There were a number of health and safety concerns identified during the visit, and it was evident that the home had insufficient health and safety expertise to recognise and address unsafe practices. Concern was highlighted in relation to the lack of appropriate and key risk assessments such as moving and handling risk assessments and other unsafe equipment that the Inspector asked for immediate removal. Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 25 Required maintenance contracts are available and the home undertakes regular fire safety checks and hot water temperature testing . Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 26 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 1 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 1 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 1 x 1 Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 27 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. Hobbies, recreation and stimulation. Personal goals , wishes and choices, daily routines. (Timescale of 01/07/05, 05/01/06 and 15/09/06 not fully met). The home has been sent a warning letter of possible enforcement action as this requirement has not been addressed. 2 OP8 13(5) There must be suitable and appropriate arrangements to DS0000004878.V346166.R01.S.doc Timescale for action 30/09/07 14/09/07 Version 5.2 Page 28 Hillcroft Nursing Home provide a safe system for moving and handling service users.- This would include a requirement that all residents have an appropriate moving and handling risk assessment. This will give assurance that service users are moved safely and appropriately and protected from harm. The home was sent a letter of serious concerns highlighting this concern. 3. OP8 13(4) I, 15 All service users requiring bedrails must have an accurate and detailed risk assessment for their use. The home was sent a letter of serious concerns highlighting this concern. 4. OP8 13(4), 15 14/09/07 Footplates must be used when service users are moved in wheelchairs unless There is recorded information stating that this is the service users choice and this has been agreed with the homes insurance company and meets Health and Safety guidance. This is to ensure that residents are protected from the risk of injury The home was sent a letter of serious concerns highlighting this concern. 5 OP8 12(1)(a) The care home must be conducted so far as to promote and make proper provision for the health and welfare of service users. The care home must be conducted to ensure that service users receive the proper provision of care and when DS0000004878.V346166.R01.S.doc 14/09/07 30/09/07 6 OP8 12(1)(b) 30/09/07 Hillcroft Nursing Home Version 5.2 Page 29 7 OP9 13(2) 8 OP12 16(2)(m) and (n) 9 OP16 22 10 OP18 13(6) 11 OP27 18(1)(a) 12 OP29 19(1)17(2 ) appropriate treatment. Appropriate arrangements must be made for timely disposal of controlled drugs and a comprehensive record of the administration of all medicines at the home. Residents must be consulted about their social interests and make arrangements to ensure that they are consulted about the programme of activities available to ensure that it meets their needs, preferences and capabilities. There must be a comprehensive record of all complaints made about the home with a record of the investigation that has been undertaken and the outcome of the complaint that details actions to be undertaken. This will give assurance that people are listened to, their concerns investigated and appropriate actions undertaken as a result of concerns that have been highlighted. 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. The registered provider and manager must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 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 DS0000004878.V346166.R01.S.doc 30/09/07 31/10/07 31/10/07 31/12/07 30/09/07 30/09/07 Hillcroft Nursing Home Version 5.2 Page 30 documents must be held on each staff members personal files. (Timescales of 18.01.05, 01/07/05, 12/12/05 and 21/09/07 not fully met). No references were available for one member of staff, which was the same at the previous inspection. The home has been sent a warning letter of possible enforcement action as this requirement has not been fully addressed. 13 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. A record of any accident or incident affecting service user within the care home which is detrimental to the health or welfare of the service user must be made. The record should include the nature, date and time of the accident or incident, whether medical treatment was required and the name of the persons who were respectively in charge of the care home and supervising the service user. 30/09/07 14 OP38 17(1)(a) (schedule 3 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000004878.V346166.R01.S.doc Version 5.2 Page 31 Hillcroft Nursing Home 1 2 3 4 5 Standard OP1 OP2 OP9 OP11 OP12 The service user guide is available in alternative formats that are suitable for the residents such as large print. A signed copy of the terms and conditions of residency should be retained within the residents records. When a variable dose of medicine is prescribed there should be a record of the amount of medicine that has been administered. Residents last wishes in respect of death and dying should be explored and be recorded within their personal file. The registered provider and manager must explore and Staff should explore residents preferred leisure activities and their choice of daily life and routines such as getting up and going to bed. An appropriate meal choice should be available at each mealtime. 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 documents. The homes refurbishment plan should be sent to the Commission for Social Care Inspection. A thorough training needs assessment should be undertaken with a consequent training plan and an up to date training programme. There should be an effective assurance system in place that includes quality checking systems and meets all elements detailed in standard 33. All individual residents receipt should be kept together and filed numerically within their own records. An acknowledgement and receipt must be given for all donations to the home. Staff should receive at least six supervision sessions annually that are recorded. 6 7 OP15 OP18 8 9 OP19 OP30 10 11 12 13 OP33 OP35 OP35 OP36 Hillcroft Nursing Home DS0000004878.V346166.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Trading Estate Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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