Inspection on 11/09/07 for Hillside Lodge

This inspection was carried out on 11th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillside Lodge 06/09/06

Hillside Lodge 30/11/05

Hillside Lodge 17/06/05

Hillside Lodge 21/03/05

Hillside Lodge 25/08/04

Hillside Lodge 09/03/04

Hillside Lodge 17/07/03

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

CARE HOMES FOR OLDER PEOPLE Hillside Lodge Braeside Berwick Upon Tweed Northumberland TD15 2BY Lead Inspector Suzanne McKean Key Unannounced Inspection 11th September 2007 10:30 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 Hillside Lodge DS0000048297.V346284.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. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Lodge Address Braeside Berwick Upon Tweed Northumberland TD15 2BY 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) 01289 307500 01289 308566 hillside.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Mrs Margaret Shippen Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three named service users are under 65 years of age. The Commission for Social Care Inspection must be notified immediately should these service users leave the home so that this condition can be removed. 6th September 2006 Date of last inspection Brief Description of the Service: Hillside Lodge is a two-storey purpose built facility of traditional brick and tiled construction. The home is situated in a residential area of the town of Berwick. Car parking areas are provided at the front of the building giving level access to the home. There are grassed sitting areas, which can be used by residents and visitors. The surrounding area is predominantly residential. There are bedrooms and shared areas on both floors and there is a lift in the centre of the home near the entrance. All of the bedrooms are single occupancy with en-suites containing a toilet and hand basin. There are showers and bathrooms and toilets situated on each of the floors and dining areas and lounges of appropriate size to meet the number of resident in the home. The home charges fees of between £378.45 and £380.42 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The nursing care medium band is currently £83 pounds and the high band is £133. The home provides information about the service through the service user guide and a copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 6th September 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 28th August and a further visit was made on 28th August 2007. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. What the service does well: The residents are positive about what it is like to live in the home and are complementary about the staff and the way they support them. An example of their comments was “the staff work hard and they are always there to help” and “I rely on the staff to help me to live the life I want”. The manager and staff are good at making sure that they get specialist advice about resident’s care and working with them to provide the care according to best practice. The home works hard to make sure that the people living in the home are treated as individuals and can live their lives in the way they choose. Staff are well training and skilled in the work they do. There are extensive training opportunities for the staff, which is well documented and planned. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 7 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 Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 8 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No resident is admitted into the home without having a detailed assessment. They can therefore be confident that the home can meet their needs. Residents and relatives are given information about the home prior to admission and are encouraged to visit and spend time looking around. The home does not provide intermediate care. EVIDENCE: The care plans which were case tracked (detailed examination of specific residents care plans and discussion with the service users and named Key Worker/Nurse) contained the care manager assessments, which are carried out before admission and given to the home. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 9 The home had carried out a comprehensive assessment of the prospective residents needs prior to admission for planned placement. In the case of more urgent admissions staff speak to the social worker involved to get as much information as possible. The admission assessment for the service users whose care plans were examined, were detailed and contained the necessary information on which to base a plan of care. Records showed that the residents have been issued with a copy of the company contract / statement of contract. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good individual care planning is carried out and the care is being delivered in line with these plans. The residents are having their needs met. Residents are treat with respect by the staff and they maintain their privacy so far as possible when delivering care and throughout their daily life. The residents received their prescribed medication in line with safe working practices. Medicines are well managed and safely disposed of when necessary. EVIDENCE: All residents’ case tracked had an individual plan of care. This is based on the admission assessment and is then added to during the placement. Four care plans were examined and were completed to a good standard. There were relevant risk assessments and care planning for the prevention of falls, Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 11 nutrition, wound care, moving and assisting, continence promotion and mental health. The plans showed that they are regularly reviewed and updated and that reviews are regularly held with residents and their representatives. The care plans showed that the residents have access to all NHS services and facilities. There was a good range of pressure relieving mattresses in use for the prevention of pressure sores. There is currently one resident who has pressure damage in the home although this is a very minor small wound. The recording of the nursing action taken for this was good with evaluations dated and signed. Daily recording of the care being delivered was up to date and in good detail. The home has good links with the clinical specialists in the area and evidence was in the care plans that these are used for specific advice in relation to end of life care. The staff have received additional clinical training so that they can prevent residents from needing to be re-admitted into hospital for some procedures e.g. replacement of gastrostomy tubes. Residents interviewed confirmed that the staff treat them with respect and contacts between staff and residents through the day was judged to be polite and courteous but friendly. A resident interviewed on the day said “the staff always trying to help” and “I think the staff are lovely and they always make sure I am okay”. The system for managing medicines is appropriate. Staff record the medicines being ordered. The prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. A photocopy of the prescriptions is now kept so that they can be checked against the medication dispensed. The medicines are also checked against the MAR charts when received into the home so that any errors can be picked up. The home has a contract with a Pharmacist, which includes giving advice as necessary. No residents are currently managing their own medication. The treatment room was tidy and well organised. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the flexibility of their routines for daily living, which are appropriate to meet their cultural, social, religious and recreational interests and needs. Good arrangements are in place to support residents to maintain contact with their family and friends and the local community. These are suited to each individual’s needs and vary accordingly. The food being served offers a nutritious and balanced diet with choice and variety. The catering staff work hard to accommodate individual residents’ needs within the restrictions of multi-occupancy living. EVIDENCE: Residents said that they are encouraged to take control of their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. They also confirmed that they are Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 13 able to make choices about how they spend their day and said they were satisfied with the activities available. Some organised activities are available and staff said that residents are able to choose whether or not they are involved. However, due to the dependency level of some of the residents a number of the activities offered are less active and provided on a more one to one basis. The home does not currently have an activities co-ordinator so it the staff are responsible for organising the programme of activities until the position can be filled. The Manager is recruiting for the post. The social opportunities are offered to give individualised activities for the residents in line with their social assessment. The records of the activities provided are detailed and include some outings, the weekly tea dance, bingo and entertainers as well as in house activities on a more ad-hoc basis. The residents’ bedrooms were personalised reflecting individual choices and preferences and three residents asked about their bedrooms said they were happy with the decoration. Residents have visitors at any time and are able to use their own rooms, or the lounges to receive them. Three relatives spoken to on the day confirmed that they are welcomed to the home. Relatives are given information within the residents’ guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints policy, which is known to residents, relatives and staff and is followed by the Manager. The residents are protected from abuse by staff training, recruitment and selection and effective documentation. EVIDENCE: The complaints procedure is available in the service users guide and a copy is displayed in the home. The record of the complaints was examined. There have been three complaints recorded in the last 12 months. The record of complaints was detailed including the response to the complainant improvements made in relation to the issues raised. The residents spoken to all understood how to make a complaint, and how it would be dealt with. Visiting relatives were aware of the complaints procedure but had not needed to use it. Staff are given protection of vulnerable adults training both as part of the inhouse training package and from the training programme. Written guidance is in place regarding the protection of vulnerable adults through detailed policies Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 15 and procedures. Staff knew about the guidance and could identify the action they would take if they were made aware of, or had any concerns themselves, regarding this issue. There have been two Safeguarding adults investigation in the home since the last inspection. These have been managed well by the home and appropriate action has been taken to ensure that they worked within the process to safeguard the people living in the home. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well decorated and maintained. Good records are kept of the health and safety practices and maintenance of the building and facilities. The home is clean and hygienic. It is well organised and the staff are knowledgeable regarding the ways to prevent the risk of cross infection in the home. EVIDENCE: The home is clean and was odour free on both of the visits. The residents’ were asked about their bedrooms and said they were happy with the decoration and that they were kept clean by the staff. The bathroom and toilet areas were tidy and clean. The laundry was clean, organised and well Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 17 equipped. The sluices were tidy, clean and odour free and the disinfectors operational. The lounges and dining rooms are well decorated and are equipped with suitable chairs and furnishings to suite the rooms and support the residents to live comfortably. There are a number of people living in the home who spend long periods in their bedrooms. This is their choice and they are supported by being served their meals in their rooms if they want to. Staff were seen to follow infection control policies throughout the day. Appropriate equipment was available including gloves which were being appropriately used by staff when providing personal / intimate care. The kitchen area was clean and well organised and there is an up to date cleaning schedule which identifies all areas to be cleaned, how often they are completed and who was responsible for undertaking it. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed with adequate numbers of staff who are well trained and knowledgeable about the needs of the people living in the home. The home has an effective recruitment and selection system, which makes sure that residents are cared for by competent staff and are in safe hands. The training programme is up to date for all staff and a significant amount of training is being given to the staff in health and safety, statutory and clinical areas of practice. EVIDENCE: Staff records examined are completed in line with the company policies and procedures, including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. On the day of the visit there were sufficient staff on duty according to the needs of the residents in the home. This was the Manager, two qualified nurses (one of which was the Deputy Manager), five carers, two domestic, the cook, one kitchen assistant, and the administrator. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 19 The training records maintained by the Manager to allow her to plan for training was examined, it was very clearly maintained and offered a good system. There is a significant amount of training in both statutory and clinical areas of practice and all staff are now receiving training in line with the company policy and statutory requirements for moving and handling and fire training. The manager has had some problems producing monthly staffing rotas, which allows staff to maintain a work life balance and allows for planning to cover shifts when sickness occurs. She has now recruited four additional care staff as well as an activities co-ordinator and domestic staff. This will offer a greater flexibility and should ensure that other staff do not need to cover additional shifts as often as they have been for some time. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager, Mrs Shippen, has systems in place to manage the home effectively taking into account the needs and wishes of the residents. The home effective health and safety systems, which include staff training and risk assessments. Resident’s personal finances are managed appropriately. EVIDENCE: There is a system in place to review health and safety in the home involving the staff for which records are available. Records were examined of the staff meeting, the last of which was 14th June 2007. These occur when significant information needs to be given to staff. Information is given to staff during Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 21 “hand over’s”. The Manager also facilitates meetings with the relatives and residents as appropriate and although they are not very well attended they give the relatives the opportunity to meet formally with the manager. The last one was on 13th June 2007. The managers and administrators offices are situated at the entrance of the home this ensures that the visiting relatives can be greeted and that they have the opportunity to speak to the manager informally as part of the “open door” policy. Mrs Shippen continues to consult the residents, staff and other interested parties to review the service provided and manage the staff in a way to improve care delivered. Regular audits are carried out in a number of areas. These include Medication; care planning and nursing documentation, kitchen, and domestic audits. These are ongoing and are used for quality assurance at both the local home level and by the company. Recent introduction of the companies “TAP” audit has been completed and an action plan is in place. The personal records kept in the home of residents who are receiving assistance to manage their finances were examined and are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. There is a system in place to review health and safety in the home involving the staff for which records are available. Training records for the health and safety training such as moving and handling and fire safety are in place and are up to date. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 3 X 3 X 3 X X 3 Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations The Manager should look at the numbers of care staff to make sure that there are sufficient numbers to ensure staff do not need to work too many additional hours to fill gaps in the rota. Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillside Lodge DS0000048297.V346284.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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