CARE HOMES FOR OLDER PEOPLE
Hillsdon Nursing Home 37 Springfield Road Lower Parkstone Poole Dorset BH14 0LG Lead Inspector
Marjorie Richards Key Unannounced Inspection 5th September 2006 10:10 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 DS0000049686.V306351.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. DS0000049686.V306351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hillsdon Nursing Home Address 37 Springfield Road Lower Parkstone Poole Dorset BH14 0LG 01202 742753 01202 740114 hillsdon1@btconnect.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) Baselink Care Limited Mrs Alison Jane Thomas Care Home with Nursing 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places DS0000049686.V306351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Hillsdon Nursing Home is a large detached property, situated in a residential area of Parkstone. The home is not far from local shops and amenities. Although these are not easily accessible on foot, a local bus route serves Parkstone, Poole and Bournemouth. Limited car parking for visitors is available at the front of the home, with additional parking on nearby roads. Hillsdon Nursing Home is registered to provide care to a maximum of 21 persons over the age of 65 years who are in need of 24-hour nursing and personal care. Accommodation is provided on ground and first floor levels with bedrooms, a lounge, staff areas, (office and nurses station) kitchen and laundry on the ground floor and further bedrooms on the first floor. The home has seventeen bedrooms and four of these are for shared use. Five bedrooms have ensuite facilities. There are sufficient communal bathrooms, showers and toilets sited around the home in close proximity to bedrooms and the lounge. Access to the first floor is via a passenger lift and central stairway. The first floor has a divided level accessed by additional steps. A Stair-Matic stair climber is used to enable residents who need assistance to access this level. The registered persons have undertaken much redecoration and refurbishment of the property since they became registered in August 2003. At present, access to the large rear garden is being substantially improved; creating an attractive facility that will be available to all residents. Hillsdon Nursing Home provides 24-hour nursing and personal care, The current range of fees is £525 - £675 per week. This includes nursing and personal care on a 24-hour basis, all meals, drinks and snacks, as well as laundry and domestic services. Social activities, entertainment and the provision of toiletries are also included in the fee. Chiropody, hairdressing and dry cleaning are charged extra. Residents have access to a telephone, but may have a telephone installed in their bedroom if they wish, at their own expense. Further information on value for money can be obtained in the report published by the Office of Fair Trading entitled ‘Care Home in the UK, A Market Study’: http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf
DS0000049686.V306351.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8.5 hours on the 5th September 2006. The purpose of this year’s first key unannounced inspection was to review all of the key National Minimum Standards, review progress in meeting the requirements and recommendations that had been made at the previous inspection and to ensure that the residents living at Hillsdon Nursing Home were safe and properly cared for. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with nine residents. The daily routine was also observed during the inspection. Discussion also took place with Mrs Allison Thomas, the registered manager, visitors and members of staff on duty. Mr Graham Thomas also made himself available throughout the inspection, on behalf of Baselink Care Ltd and this was appreciated. Pre-inspection information had been completed and submitted before the inspection. In addition, the Commission received twenty-two completed comment cards from residents and relatives and three from General Practitioners. All expressed satisfaction with the care provided. For the purposes of this report, people who live at Hillsdon Nursing Home are referred to as residents as this is the term generally used within the care home. There were 20 people accommodated at the time of this inspection. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well:
The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities and give a good indication of what a resident can expect at Hillsdon Nursing Home. These documents are available in every residents bedroom. They can also be viewed in the entrance hall by any visitors to the home, as part of an Information File providing a wide range of information about the home. Prior to moving to Hillsdon Nursing Home, care needs are fully assessed. A letter of confirmation is then written to the prospective resident so that they may feel fully assured their care needs will be met. DS0000049686.V306351.R01.S.doc Version 5.2 Page 6 Prospective residents and their relatives are encouraged to visit Hillsdon Nursing Home to assess the facilities available, meet other residents and staff and have an opportunity to discuss their particular care needs. A trial period of four weeks is also available. Relatives commented, “I was shown around and introduced to some residents and I went back a couple of weeks later with my relative and was shown around again. Everything was very “open” and it was easy to ask questions.” Care plans are well laid out and well maintained. Residents or their representatives are involved in care planning and review wherever possible. Residents have access to General Practitioners, dentists, chiropodists, opticians etc and attend hospital appointments as necessary. The home has systems in place for managing medicines and only trained nursing staff dispense medication. Staff were seen to knock before entering bedrooms and to offer personal care discreetly, behind closed doors. Residents appeared relaxed, confident and at ease in the presence of staff. Residents commented, I have always found the staff to be very courteous and polite, even though they sometimes have a lot to put up with.” Sometimes the staff have to do work which isnt very pleasant for them or me, but they are mostly very sensitive and considerate of my feelings. Residents, visitors and staff confirm that visiting times at Hillsdon Nursing Home are unrestricted. A relative said, “I visit regularly at different times of the day and I am always well received.” As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that staff respected their wishes, for example to go to bed early or late. Residents are able to bring their own possessions into the home to personalise their bedrooms. There is a high standard of meal provision at Hillsdon Nursing Home with choices offered and individual specialist diets and preferences well catered for. Residents may eat their meals in the lounge, dining room or in their bedrooms. I think the standard of food is excellent. It is always freshly cooked and well presented. I enjoy my meals, I look forward to them.” (Residents.) “My relative has always said the food at Hillsdon is first class.” “The food is home cooked and appetising.” (Relatives.) The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available in the Information File in the entrance hall. A relative commented: -“If there has been a problem, our point of view has been heard, considered and acted upon. We are very satisfied with the service received.” DS0000049686.V306351.R01.S.doc Version 5.2 Page 7 The home has a comprehensive Adult Protection policy in place to protect residents from possible harm or abuse and all staff have received Adult Protection training. The programme of refurbishment and improvements to the home is now almost complete, ensuring that residents live in safe, comfortable and wellmaintained surroundings. There is a small ramp to the front door and a passenger lift, enabling easy access around the building. Residents enjoy pleasant communal areas with a lounge and adjoining dining room. The home has a sufficient number of communal toilets, showers and bathrooms, including an assisted whirlpool bath. Equipment, such as raised toilet seats, toilet frames and grab rails, is also available. Bedrooms are comfortably furnished and personalised to varying degrees and shared rooms have screening available to aid privacy. The home is well maintained, with a good standard of hygiene and cleanliness. Contact with residents and visitors confirmed, The home is always nice and clean”. “The home is always clean and fresh, with no unpleasant smells.” Trained nurses lead the care staff on duty and at all times the home is in the overall charge of a trained and competent nurse. Sufficient staff are always on duty to meet the needs of residents. Staff were seen to be demonstrating a friendly, caring and gentle approach when dealing with residents and this was borne out by comments received in comment cards and during the inspection from both residents and visitors. There always seem to be plenty of staff around and, because they are permanent, I have got to know and like them. The staff are friendly and affectionate to my relative. Any little problem is noticed immediately and acted upon. (Relatives.) Everyone looks after me. This place is very friendly. You can have a laugh with the staff. It is not all ‘doom and gloom’ like it is in some places. This place is ‘five star’. The food is excellent and the care second to none. This is the best nursing home in the whole area. (Residents.) Good employment and recruiting procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. Mrs Thomas, the registered manager, has a “hands on” approach to her job and this has a positive impact on the home in that she leads staff by example and residents know her very well. The home is well organised and the care and contentment of residents is at the heart of the daily management and running of the home. A resident commented, “Matron is lovely, so very kind and caring. She must be very busy, but she always has time for me.” DS0000049686.V306351.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000049686.V306351.R01.S.doc Version 5.2 Page 9 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 DS0000049686.V306351.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 Standard 6 is not applicable at Hillsdon Nursing Home. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. Information provided about Hillsdon Nursing Home and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. The home assures prospective residents in writing that their needs can be met. Prospective residents and their relatives have opportunities to visit the home in order to assess the quality of facilities and its suitability for their needs. EVIDENCE: The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. The Service User Guide gives a good indication of what a resident can expect from the home. These documents are available in every residents bedroom. They can also be viewed in the entrance hall by any visitors to the home, as part of an Information File
DS0000049686.V306351.R01.S.doc Version 5.2 Page 11 containing the Statement of Purpose, Service User Guide, information about advocacy services for those needing independent help and advice, feedback from Quality Assurance questionnaires, information about funding care, details about the complaints procedure and copies of the last two inspection reports. Individual care records are kept for each resident and three of these were examined. Prior to moving to Hillsdon Nursing Home, care needs had been fully assessed. A comprehensive form has been developed for this purpose and the manager generally carries out all pre-admission assessments herself. A letter of confirmation is then written to the prospective resident so that they may feel fully assured their care needs will be met. The information contained in pre-admission assessments and also any assessments supplied by Social Services, is then used to draw up a detailed plan of care. Prospective residents and their relatives are encouraged to visit Hillsdon Nursing Home to assess the facilities available, meet other residents and staff and have an opportunity to discuss their particular care needs. Mrs Thomas says that prospective residents are welcome to visit whenever they like and a trial period of four weeks is also available. Relatives commented, “I was shown around and introduced to some residents and I went back a couple of weeks later with my relative and was shown around again. Everything was very “open” and it was easy to ask questions.” “I was impressed that the Hillsdon had the Commission for Social Care Inspection report on show in the hall. I was able to sit down and read it there and then.” “I looked around with my relative before coming here. They answered all our questions and we were made to feel very welcome. We also read the Information Guide which was full of helpful information.” DS0000049686.V306351.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. Hillsdon Nursing Home has a care planning system in place, which ensures that staff have the information necessary to meet the health and personal care needs of residents. Health needs are well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are treated with respect and their privacy and dignity is promoted at all times. DS0000049686.V306351.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care records for three residents were examined and each contained risk assessments, which form the basis for care plans and detailed daily records which evidence the care given to each resident. To aid correct identification of residents, each record contains a recent photograph of the resident. Care plans are well laid out and well maintained. Residents or their representatives are involved in care planning and review wherever possible. The resident or their relative signs each care plan when they review the plan, usually every two to three months. There is space for them to add any comments they may wish. Staff regularly review care plans, at least monthly but more frequently where necessary and update them to reflect any changing needs. Good daily records are written by both day and night staff to evidence the care being provided. Discussions with staff demonstrate that they have a good knowledge of residents’ individual care needs. Staff feel there is very good communication about residents needs. Since the last inspection, information about most residents’ background, social history, previous hobbies and interests has been collated and staff have prepared life histories. These will help in the provision of suitable social activities and provide information for staff when talking and reminiscing with residents. Staff carry out the instructions recorded in the care plan. For instance, one care plan notes that the resident’s call bell, drinks and personal effects must be left within easy reach. On visiting this residents bedroom, staff had arranged everything to be easily accessible to the resident. Some highly dependent residents were observed in their rooms and they appeared comfortable and well cared for. One resident said that staff were always helpful and attentive. “I receive the best possible care.” Records demonstrate that residents have access to General Practitioners, dentists, chiropodists, opticians etc and attend hospital appointments as necessary. This was confirmed in discussion with residents and staff. Risk assessments are in place and appropriate steps are taken to ensure any of the risks identified are minimised. The home has systems in place for managing medicines. Only trained nursing staff dispense medication. Observation of the member of staff administering medication evidenced that the nurse took proper care to check each dispensed medicine before administering it to the respective resident and on each occasion secured the medicine trolley to ensure no medicines could be removed or tampered with. Medication Administration Records were
DS0000049686.V306351.R01.S.doc Version 5.2 Page 14 completed accurately, indicating that residents receive prescribed medicines at the correct times and in the correct amounts. Medicines requiring storage at low temperatures were stored appropriately in a separate medicines fridge. The temperature is checked daily and recorded. A procedure is in place for those wishing to manage their own medicines in accordance with a risk assessment process. At present, none of the residents choose or are able to manage their own medicines. A suitable procedure is also in place for the disposal of any medicines that are no longer required. Staff were seen to knock before entering bedrooms and to offer personal care discreetly, behind closed doors. Staff interacted with residents in a considerate manner and were observed throughout the inspection to be treating residents in a friendly yet courteous way, showing kindness and respect. Residents appeared relaxed, confident and at ease in the presence of staff. Residents commented, I have always found the staff to be very courteous and polite, even though they sometimes have a lot to put up with.” Sometimes the staff have to do work which isnt very pleasant for them or me, but they are mostly very sensitive and considerate of my feelings. DS0000049686.V306351.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. A range of activities and entertainment provides variation and interest for most residents. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. Residents are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. Hillsdon Nursing Home serves a balanced and varied selection of food that meets residents’ tastes and dietary needs within pleasant surroundings. EVIDENCE: During the inspection, a complaint received by the Commission regarding the provision of activities was investigated. DS0000049686.V306351.R01.S.doc Version 5.2 Page 16 Outcome: The complaint in respect of the individual resident concerned is not substantiated. The home is taking action to improve the activities on offer for those residents confined to their rooms or needing more one-to-one assistance. A requirement in respect of activities has been made at the end of this report. Previous inspections have identified a need to provide more meaningful activities, especially for those residents who remain in their rooms due to general frailty etc. Of the 11 comment cards completed by, or on behalf of residents, in response to the question Does the home provide suitable activities? 2 residents said Always, 3 said Usually, 3 said Sometimes and 1 said Never. Two other responses indicated that the residents were unable to take any part in any activities. Mrs Thomas has been making improvements to the range of activities and an Activities Record is now maintained. This shows that residents take part in quizzes, listen to music, play cards, do jigsaw puzzles, read newspapers (or have newspapers read to them by staff) take occasional walks or take part in gentle exercise to music. Improvements to the garden are in progress, allowing residents easier access to enjoy sitting out and getting some fresh air. More residents said during this inspection that they were pleased with the activities now being provided. Pet therapy also seems very popular, when residents have the opportunity to be with and stroke animals brought into the home. The home now also has its own pet, a cat named Flinty. Regular entertainment is arranged and on the day of inspection a singer entertained residents in the lounge during the afternoon. All events are detailed on the notice board in the entrance hall. Residents commented, “I like to join in most of the activities. I like quizzes and wish we could do them more often. Sadly, a lot of people cannot take part any more.” “We have very good entertainment. I like it when we can all join in and have a sing-a-long.” For those residents who remain in their rooms due to general frailty, there are fewer opportunities to take part in activities. These residents said they did enjoy “One-to-ones” when they could talk and reminisce with a member of staff. One resident said they would like to experience “One-to-ones” more often. Some of the comment cards received from relatives indicate that they feel activities are often a very limited option. “My relative is unable to do anything, but can listen to “Music Sessions” organised by Hillsdon and the radio and TV.” “My relative is confined to bed and unable to take part in any activities now.” Two residents also wrote in their comment cards that they were “Unable to join in any activities.” One resident said during the inspection, “I am unable to go to the lounge now and I really miss everything that is going on.” DS0000049686.V306351.R01.S.doc Version 5.2 Page 17 Progress has been made in providing activities that residents really enjoy. However, participation is more difficult for some residents. (One resident made it clear that they had no wish to take part in any form of activity.) The home is already planning to employ an additional member of staff who will take time promoting suitable activities, particularly for those residents less able to make their own decisions or who spend a lot of time in their bedrooms. Residents, visitors and staff confirm that visiting times at Hillsdon Nursing Home are unrestricted. A resident commented, “I can have visitors whenever I want. They are always well looked after. They can help themselves to tea and coffee and there is no charge.” Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. A relative said, “I visit regularly at different times of the day and I am always well received.” As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that staff respected their wishes, for example to go to bed early or late. Residents are able to bring their own possessions into the home to personalise their bedrooms. Residents are encouraged to choose what to wear and what to eat or drink. Some residents were able to confirm that their individual preferences and routines are respected. One visitor commented, “The staff put Wimbledon on television for my relative as this was something they always enjoyed.” Lunch on the day of inspection was chicken or steak pie, with creamed potatoes, swede, peas and gravy. Bread and butter pudding, or fruit and custard followed this. A range of alternatives, such as jacket potatoes with a variety of toppings, omelettes, salads, yogurt, icecream and fresh fruit is always available to suit individual taste and preference. For those residents needing assistance with a pureed diet, minced beef with vegetables and gravy was offered, with the elements pureed separately and arranged carefully on plates. Residents may eat their meals in the lounge, dining room or in their bedrooms. Mealtimes can be flexible to fit in with care needs, appointments etc. Special diets are catered for. The menu shows that residents enjoy a healthy, wellbalanced diet. Good supplies of fresh, frozen, tinned and dry foods were seen to be available. Of the 11 comment cards received from residents, in response to the question Do you like the meals at the home? 8 residents said Always and 3 said Usually. The following comments are a sample of those received from comment cards and on the day of inspection: - I think the standard of food is excellent. It is always freshly cooked and well presented. I enjoy my meals, I look forward to them.” On the whole, the food is very good. Occasionally DS0000049686.V306351.R01.S.doc Version 5.2 Page 18 there is something I don’t like, but they always give me something else instead. (Residents.) “My relative has always said the food at Hillsdon is first class.” “The food is home cooked and appetising.” “The food provided seems to be varied and of a good standard, cooked on the premises.” (Relatives.) DS0000049686.V306351.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. The complaints procedure provides information on the procedure to follow to anyone wishing to make complaint. Residents are confident complaints would be listened to and dealt with appropriately. The home’s Adult Protection policy and staff training demonstrates a commitment to understanding abuse and of protecting residents. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available in the Information File in the entrance hall. The complaints record shows that one complaint has been received by the home since the last inspection. This was investigated and appropriate action taken. The Commission also received a complaint, which was investigated during this inspection. (Please see Standard 12 for details.) Discussion with residents and visitors demonstrated they would feel able to voice a complaint if necessary and their concerns would be taken seriously, and acted upon. The following comments are a sample of those received from comment cards and on the day of inspection: - DS0000049686.V306351.R01.S.doc Version 5.2 Page 20 “I have never had any occasion to make a complaint, especially since Allison Thomas took over the Hillsdon.” “If there has been a problem, our point of view has been heard, considered and acted upon. We are very satisfied with the service received.” (Relatives.) If I had any concerns, I would go straight to Matron. She would sort it out.” I have no complaints, none at all.” (Residents.) The home has a comprehensive Adult Protection policy in place to protect residents from possible harm or abuse. All staff have received Adult Protection training. This will ensure that they remain vigilant and protect vulnerable residents from possible risks of abuse and know how to properly respond to any allegation or suspicion of abuse. DS0000049686.V306351.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. The programme of refurbishment and improvements to the home is now almost complete, ensuring that residents live in safe, comfortable and wellmaintained surroundings. Residents have access to pleasant communal areas, including a large garden. There are sufficient bathrooms and toilets available to meet the needs of residents. Bedrooms are comfortably furnished and individually personalised to suit their occupants. The home is clean, pleasant and hygienic making daily life more pleasant for all in the home. DS0000049686.V306351.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered provider has undertaken a full improvement and refurbishment programme since being registered in August 2003. The recent building works to create a new dining room, add three new bedrooms and re-site the laundry, treatment room and lounge have proved very beneficial to the home and are now well used. The new alarm call system ensures all calls for assistance are logged, so the manager can ensure response times are satisfactory. There is a small ramp to the front door and a passenger lift, enabling easy access around the building. The first floor has a divided level accessed by additional steps. A Stair-Matic stair climber is used to assist those who need help to access this level. Since the last inspection, the kitchen has been refurbished and furniture purchased for the new dining room. A small refreshment room has been provided, where residents and visitors can help themselves to tea, coffee or fruit drinks whenever they wish. A relative commented, “My family and I are most impressed with the improvements which have been carried out at the Hillsdon by Graham and Allison Thomas and the way it is now run. Since taking over, the improvements they have made are tremendous. Records show that continual work is carried out to keep the home and garden in good condition. Staff confirm that prompt attention is always paid to any defects. Hot water temperatures at baths were tested and found to be close to the recommended temperature of 43C, to prevent any risk of scalding. Records demonstrate regular servicing of equipment, such as adjustable beds, hoists, passenger lift, sluice, assisted baths, Stair-Matic, the fire warning system, emergency lighting and fire fighting equipment, to ensure the safety of residents and staff. Hillsdon Nursing Home previously had only limited access to communal space. Now that building work has been completed, the lounge has been re-sited and a new dining room created. Residents were observed enjoying the new lounge, which is comfortably furnished and has a fish tank in place, to provide additional interest. The large garden at the rear of the home has not been used by residents, due to a steep flight of steps to access it and also the difficult sloping nature of the whole site. Plans are underway to improve access to the garden and a large raised decking area is now in place, linked by a walkway, where residents may sit out and enjoy the views over the whole garden. It is hoped to complete the landscaping of the garden before the end of the year. This will include a sensory garden, offering additional interest to residents through plants that are scented or pleasant to touch.
DS0000049686.V306351.R01.S.doc Version 5.2 Page 23 One resident commented, “ The garden is going to be lovely when its finished. I have been outside on the deck and it was really nice to be able to enjoy the sunshine. Residents have access to a sufficient number of communal toilets and bathrooms. These include two wet-rooms, offering easily accessible showers and an assisted whirlpool bath. Five bedrooms have ensuite facilities and commodes are available wherever necessary. Equipment, such as raised toilet seats, toilet frames and grab rails is available to assist residents. A tour of the building confirms that all bedrooms are comfortably furnished and personalised to varying degrees. Four rooms are for shared use, but one of these is currently being used as a single, reducing the number of residents accommodated to twenty. Shared rooms have screening available to aid privacy. All bedrooms have adjustable beds equipped with high-risk mattresses to help minimise possible risks from pressure sores. All rooms are centrally heated and have natural light and opening windows. Residents commented, “My bed is very comfortable. I am well looked after here.” I am pleased with my room. I was asked to choose the colour for the walls. “I am happy in my room, I have it as I like it.” An inspection of the premises demonstrated that the home is well maintained, with a good standard of hygiene and cleanliness. Contact with residents and visitors confirmed, The home is always nice and clean”. The laundry has two washing machines and two tumble dryers. Instructions for using this equipment is available in English and other languages to assist those staff where English is not their first language. Suitable facilities and procedures are in place in respect of sluicing equipment and the disposal of clinical waste, to help control the of risk infection. An infection control policy is in use and training for all staff in infection control is booked in September 2006. Residents and visitors commented, “The cleaning staff do a very good job.” “Since Mr and Mrs Thomas took over, the standard of cleanliness has been excellent.” “The home is always clean and fresh, with no unpleasant smells.” DS0000049686.V306351.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working to exceed the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Trained nurses lead the care staff on duty and at all times the home is in the overall charge of a trained and competent nurse. Staffing levels are provided in accordance with the assessed needs of residents to ensure that, at all times, sufficient staff are available to properly meet their needs. On the day of inspection the following staff were on duty: 8.00am – 2.00pm = 1 registered nurse and 4 health care assistants. 2.00pm – 8.00pm = 1 registered nurse and 3 health care assistants. 8.00pm – 8.00am = 1 registered nurse and 2 health care assistants.
DS0000049686.V306351.R01.S.doc Version 5.2 Page 25 As the home is only accommodating 20 residents at the present time, the staffing for the 8.00am – 2.00pm shift is in excess of the recommended level. Mrs Thomas feels this allows greater flexibility and enables staff to spend more time with residents at this busy time of day. The home also employs a cook and domestic staff. An additional member of care staff is currently being recruited to spend more time on the provision of activities. (See also Standard 12.) Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to needs appropriately, demonstrating a friendly, caring and gentle approach when dealing with residents. Staff are enthusiastic about their work and feel they provide a good standard of care to residents. This was borne out by comments received in comment cards and during the inspection from both residents and visitors. The staff are friendly and helpful and work well as a team. I feel my relative got much better care at the Hillsdon than they would have done in hospital. The staff are friendly and communicate with me. There always seem to be plenty of staff around and, because they are permanent, I have got to know and like them. The staff are friendly and affectionate to my relative. Any little problem is noticed immediately and acted upon. (Relatives.) The staff are very kind, very friendly. They are always so willing to help. Everyone looks after me. This place is very friendly. You can have a laugh with the staff. It is not all ‘doom and gloom’ like it is in some places. This place is ‘five star’. The food is excellent and the care second to none. This is the best nursing home in the whole area. The staff are wonderful. I would describe most of them as ‘angels’. Nothing is too much trouble. (Residents.) At present, fourteen care staff are employed at Hillsdon Nursing Home and seven of these hold a National Vocational Qualification (NVQ) in care at level 2 or level 3. A further three staff are currently enrolled for NVQ level 2 training and one is undertaking NVQ level 3. The home thereby meets the standard for at least 50 of the care staff to hold an NVQ. The records of two members of staff were examined and found to contain all essential information to ensure the protection of residents. This includes two written references, Criminal Records Bureau and Protection Of Vulnerable Adults checks, evidence of identity and of induction training. Each member of staff also has a contract and training and development record. Well-ordered files are maintained to clearly demonstrate the recruitment process in action. An equal opportunities policy underpins the employment practice of the home.
DS0000049686.V306351.R01.S.doc Version 5.2 Page 26 Training for all staff in 2006 has included food hygiene, health and safety, moving and handling and protection of vulnerable adults. In addition, most staff have received first aid training and further first aid training is booked at the beginning of October 2006. All staff will receive infection control training in September 2006 and nutritional training is now being organised. Some staff have also received training in stroke care, death, dying and bereavement and Parkinsons disease and associated topics. In addition, nursing staff have received further training and updates in clinical practice. All staff are given a copy of the General Social Care Council code of conduct when they start work at Hillsdon Nursing Home. The home operates in accord with an extensive range of policy and procedure documents, which offer guidance to staff. Staff trained in First Aid are on duty in the home at all times. DS0000049686.V306351.R01.S.doc Version 5.2 Page 27 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Hillsdon Nursing Home. Mrs Thomas leads her staff by example to ensure that residents receive a consistently high quality of care. The home is well organised and the care and contentment of residents is at the heart of the daily management and running of the home. The home regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. Staff are being supervised at the recommended intervals, to ensure good practice. The home works to ensure the general health, safety and welfare of residents.
DS0000049686.V306351.R01.S.doc Version 5.2 Page 28 EVIDENCE: Mrs Allison Thomas, an experienced nurse and manager, is the registered manager of Hillsdon Nursing Home and demonstrated a high degree of competency throughout the inspection. Mrs Thomas has attained her ENB 998 qualification and expects to complete her Registered Managers Award in October 2006. She has a “hands on” approach to her job and this has a positive impact on the home in that she leads staff by example and residents know her very well. Mrs Thomas has the support of a deputy and it is always clear who is in charge at any time in the home. Mrs Thomas keeps her own training regularly updated. Members of staff commented, I enjoy working here, it is a very friendly place. Everything here is well organised, which makes it so much easier to work in. We have everything we need to do the job. Matron always puts the residents first. Matron is firm but very fair with staff. A resident commented, “Matron is lovely, so very kind and caring. She must be very busy, but she always has time for me.” Comment cards from relatives state: Allison and Graham Thomas, with their staff, have created an atmosphere that feels caring for the patients and welcoming for the visitors. Given that the situation could be very stressful, their care and attitude is much appreciated. Allison Thomas treats her staff, residents and their families very well. I feel this makes for a happy, cheerful and mutually supportive atmosphere. The home has a family, non-institutionalised atmosphere and the lounge promotes cheerful interaction between residents and visitors. The home has ongoing systems for checking Quality Assurance and regularly seeks the views of residents, relatives and staff. In addition, internal audits are carried out on a monthly basis, based on the National Minimum Standards. A different set of Standards is examined each month to ensure compliance. In order to protect residents, the home prefers to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs have a relative or other representative to deal with their finances. At present, the home pays for services such as chiropody and hairdressing and this amount is then invoiced to residents, relatives or representatives for payment at cost. Information about advocacy services is available to residents and their relatives in the Information File within the home, should they need independent advice or support. Examination of supervision records shows that care staff are now receiving formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at
DS0000049686.V306351.R01.S.doc Version 5.2 Page 29 individual career development needs etc. Mrs Thomas carries out all staff supervision herself Regular staff meetings are held, one for all staff and another for the trained nursing staff. These meetings also provide opportunities for staff to express their views and ideas. Staff appraisals are carried out annually to ensure they are fulfilling their role satisfactorily and meeting the needs of residents. From touring the premises, looking at records and discussions with staff, visitors and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, gas appliances, hoists etc are regularly serviced and maintained. An annual Legionella check is carried out to ensure the safety of water within the home. All substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows to limit their opening. Radiators are covered to protect residents from potentially hot surfaces and ensure their safety. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training and fire drills are also taking place so that all staff are fully aware of the action to take in the event of a fire. DS0000049686.V306351.R01.S.doc Version 5.2 Page 30 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 4 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 DS0000049686.V306351.R01.S.doc Version 5.2 Page 31 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 OP12 Regulation 16(2) (m) and (n) 12 Requirement Further consideration must be given to ways of engaging those residents less able to participate in the present programme of activities Previous timescale of 31/05/06 not fully met. It is a requirement that Mrs Thomas obtains a National Vocational Qualification level 4 in management. Previous timescale of 31/12/06 still current. Timescale for action 31/12/06 2 OP31 9(2)(b)(i) 31/12/06 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 Standard Good Practice Recommendations DS0000049686.V306351.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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