Inspection on 26/01/10 for Hillside Lodge

This inspection was carried out on 26th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillside Lodge 07/04/09

Hillside Lodge 20/05/08

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Hillside Lodge Spiro Close London Road Pullborough West Sussex RH20 1FG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beth Tye     Date: 2 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Hillside Lodge Spiro Close London Road Pullborough West Sussex RH20 1FG 01798877700 01798875978 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw Healthcare Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Hillside Lodge is a modern three-storey home registered to accommodate up to sixty people for personal care, dementia and nursing need. Each floor accommodates up to 20 residents who are allocated rooms dependant on their assessed need. The premises are owned by Shaw Healthcare Ltd and are built for specific purpose. The home is situated very close to shops and is on the outskirts of Pulborough village. The home has a new manager in post who is in the process of registering with the Care Quality Commission. Fees range from approximately #360 (residential) to #829 (nursing) per Care Homes for Older People Page 4 of 33 0 7 0 4 2 0 0 9 60 0 Over 65 0 60 Brief description of the care home week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection was carried out by Ms Beth Tye on 26th January 2010. The inspection visit took six hours. The inspection was arranged to assist the Commission in assessing the homes Compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service since the last inspection. The Annual Quality Assurance Assessment was returned to the Care Quality Commission (CQC) and informed us of areas of improvement, which have been carried out and also identified areas for further improvement. Survey forms and comments received from people living in the home, relatives and members of staff also contributed to our planning. On the day of the visit the inspector spoke at length with the manager (new to post) and the deputy manager, staff members, visitors and relatives who provided relevant information about their experience of the home. Care Homes for Older People Page 6 of 33 Six sets of admission assessments and the individual plans of care for people living in the home were looked at. We then looked at aspects of the care provided to these residents to gain insight into how their assessed needs were being met. During the visit we looked at records in respect of recruitment, staff training, complaints, quality assurance and documents relating to health and safety in the home. The premises were viewed including communal areas, kitchens, bathrooms and bedrooms. A number of interactions between people living in the home and staff, arrangements for lunch and medication dispensing and storage were observed. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Since the last inspection, staffing levels at the home have not improved and a large number of agency workers are used to cover shifts. This does not promote a consistent approach in the care and could pose a potential risk to residents. Staff and relatives fed back that the permanent staff at the home worked hard and the level of care practice was good on the whole. The sample of care records seen during the visit supported this. However it was raised by residents, relatives and staff spoken with during the visit that the continual use and high number of agency staff used by the home, puts a strain on the existing staff team (as agency workers do not undertake the same training and are not familiar with the residents care needs). This may lead to a dependency on the existing staff in order for agency workers to fulfill their roles appropriately. A requirement has been made in respect of staffing. Since the last inspection the provider has employed three managers. None of which have been registered with the Commission. A new manager has now been employed at Care Homes for Older People Page 8 of 33 the home (since Novemeber 2009) and is in the process of being registered with the Commission. However until she is registered and a consistent approach to management is implemented the homes management structure can not be considered robust. The requirement to register a manager at Hillside Lodge remains outstanding from the last inspection. The manager confirmed during the visit she is aware of the areas that need improvement at the home and is taking active steps to address them. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure residents needs can be met appropriately by the home, the manager will undertake a full assessment prior to admission. Each resident is provided with a written contract of terms and conditions, which is signed by all involved parties, so residents are clear about their rights within the home. Evidence: Since the new manager has been in post at Hillside Lodge there have been no new admissions to the home. However, during the visit she confirmed it would be part of her role to assesses individuals prior to admission. During the visit, pre-admission assessments were examined for six existing residents. These identified relevant areas of need including, nursing, mobility, communication, health and social needs. Files seen contained correspondence from external health professionals such as social services and health. Records demonstrated the information collated prior to admission is then translated into care plans and reviewed Care Homes for Older People Page 11 of 33 Evidence: on a regular basis by the acting manager. All records are kept in a locked office only accessible by care staff to ensure confidentiality. Residents spoken with confirmed they are given up to date information about the home prior to admission, including a Service Users guide and complaints procedure. Copies of these were seen in some residents bedrooms during the visit. One relative confirmed she had visited the home several times before her mother was admitted to gain a sense of the home and how it was run. Pre admission visits and printed literature helps residents (and their families) to make an informed decision about moving to the home and what to expect. All residents have received a copy of their Terms and Conditions for the home, which they or their families had signed following admission. This informs residents of their rights and what to expect of the home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Permanent staff have appropriate training and information to ensure they are able to meet residents health needs and treat them with dignity and respect. Risk assessments and daily recording specific to individual need promote the welfare and well being of residents. Information is reviewed and updated daily due to effective monitoring systems. Medication is dispensed in line with the homes policies and procedures. Current care practices ensure residents feel they are treated with respect and their right to privacy has been upheld. Evidence: During the visit we looked at six residents care plans. Each care plan contains relevant and detailed information relating to health, personal and social care and gave clear instruction to staff in order to meet the needs appropriately. Information seen on care files was up to date and easily accessible. There was evidence to demonstrate that the senior management undertakes regular care reviews for residents, and up date the care plans as changes occur. Care Homes for Older People Page 13 of 33 Evidence: Health and social care records also demonstrated that the care provided was relevant to individuals assessed needs and links are established with community health professionals to provide this. These include regular visits to the home by a GP, the chiropodist (six weekly) dentist (six monthly) and optician (annually). The home has good links with social workers, PCT, continence adviser and the local mental health team who offer advice and resources as required. Records of visits and correspondence from community agencies were seen on each of the residents files. Pressure-relieving equipment was seen in use when needed and the residents who needed nursing care had adjustable beds and air flow mattresses. Turn charts and air pressure monitoring charts were seen in residents bedrooms and records seen were accurate. The residents observed and spoken with during the visit were tidy in appearance wearing appropriate clothing with their nails and hair well groomed. Most residents were alert and cheerful. Staff were observed communicating with residents in a caring and respectful manner. Those spoken with said they were very well looked after they said staff are kind and caring. Since the last inspection care records have been reviewed by the senior management and information in files is now more clearly laid out. At the last inspection a requirement was made for staff to complete residents nutritional records. During the visit it was noted that each floor now keeps nutrition and fluid monitoring records on each floor, and this information is completed and then transferred to care files on a regular basis. These go along side relevant documentation such as weight charts, nutritional assessments and staff action plans, these records enable staff to assess need and risk in respect of nutrition. A previous requirement made in respect of this has now been met. Daily records and observation sheets are kept for each resident and intervention is recorded at the end of each shift. Daily records are divided into sections which match aspects of the care plans. This enables staff to monitor needs of individuals and records changes as they occur. The sample of care records seen were up to date and in good order. Risk assessments are in place for all residents and contain specific risk areas for Care Homes for Older People Page 14 of 33 Evidence: individuals and appropriate action to be taken by staff. Risk assessments and appropriate action plans for staff promote a better understanding of need and responses in addition to supporting residents to maintain independence safely where possible. Records demonstrated that staff complete a four day induction which covers all aspects of the mandatory training programme. In addition the new manager has introduced an induction specific to their work role at the home and a mentoring system, where more experienced staff guiding new employees. All permenant staff complete annual mandatory training as well as specialist training specific to the needs of the residents. This includes; dementia, pressure care, tissue viability and care for the dying. The training staff receive promotes a skills and knowledge base to respond appropriately to residents health care needs. Residents and/or their relatives are encouraged to sign care plans to demonstrate their involvement in the care planning process. We observed staff directly and indirectly during the visit and noted that they were friendly, caring and professional with the residents and the residents were at ease with the staff. Feedback and discussion with visiting relatives confirmed that residents are treated with dignity and respect. One relative stated the full time staff here have real integrity and take pride in their work. They genuinely care for the residents and try to do their best for them. Those who gave positive feedback about the staff did make a distinction between permanent staff and agency staff. There was on going concern from the relatives spoken with that a high number of agency are still being used by the home and that this could impact on standard the care their relatives recieve (see Staffing) There are three floors in the establishment and each floor has a medicine storage room, which is well equipped. Each floor has two trolleys, which are used at medicine times. The home keeps records of all medicines received, used and disposed off. Keeping these records means that all medicines can be accounted for. Medicine administration process follows safe practice. Medicine administration record charts were checked and in the main good records were kept. Risk assessment and Care Homes for Older People Page 15 of 33 Evidence: disclaimer are kept for those residents who wish to self medicate. During the visit the manager informed us that all the staff (including nurses) would be attending a refresher course in Medication Dispensing. The aim of this would be to promote consistent practice through out the home. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make decisions and choices in their lives. A range of activities is offered to residents. Residents are encouraged to maintain contact with family, friends and links with the local community. Residents are offered a varied diet of good home cooked food in line with their assessed dietary needs and preferences. Evidence: The routines in the home are flexible and in the main are planned around the residents needs and preferences. We looked at six social care assessments during the visit. The assessment of social care needs for each resident is detailed and provides a clear picture of residents individual wishes, life history, their likes and dislikes. Preferences for activities are detailed on each care plan and daily records. Copies of these are available in each residents room so relatives and/or residents can add to them. Activities are organised at the home on a daily basis, offering stimulation to those residents who are less able to explore interests outside the home. These include art and crafts, pampering sessions, music, quizzes, bingo and entertainment. Care Homes for Older People Page 17 of 33 Evidence: Activities are displayed on community notice boards and in rooms. The home also publishes a monthly newsletter, which outlines forthcoming events within the home. The manager confirmed that there is a full time activities co-ordinator in post who at present is doing some one to one work with residents. She acknowledged that the coordinator is new in post and the aim is to build on providing more activities to match preferences of the residents. The manager also recognised that this would be more likely to occur once staff vacancies were filled. There was evidence on files to show all information relating to social care is monitored by the senior staff and reviewed monthly or when changes occur. An activities plan is on display in the home to enable residents to plan their time, although routines are flexible to meet residents needs. Feedback from families confirmed that residents can choose what they want to do as far as social events, routines and also what times they go to bed and get up in the morning. Flexibility enables individuals to have choice and express a preference in their daily lives. Residents and relatives also confirmed that the visiting arrangements for the home are open and visitors can come and go as they please and are made welcome by the staff. Feedback forms confirmed relatives felt welcomed and involved by the home. One relative spoke about attending Christmas lunch at the home. She said it was wonderful, the staff had made a huge effort to spoil everyone and ensure that it was as close to a family Christmas as it could be. The manager has an open door policy for residents families, staff or other involved parties to discuss any issues or aspect of the home. Care plans contain a section to record when families are consulted or notified about the care of their relatives. Where possible care plans are signed to demonstrate their involvement. Staff spoken to during the visit confirmed that the new manager is always available to support us and give advice, she really knows what shes doing. This, alongside regular meetings, demonstrates that staff, residents and their families are encouraged to participate in decision-making about the care the home provides. During the visit staff were observed interacting with the residents. Staff were seen throughout the day being respectful, kind and sensitive to residents needs. One staff member was observed working with the residents, he used gentle prompts and encouragement to engage and persuade a particular resident to eat his lunch and Care Homes for Older People Page 18 of 33 Evidence: maintain his focus throughout the meal. Later we looked at the care records for the resident and found that the staff member had worked with him in a way that was specific to his care needs and nutritional risk assessment. The menu offered at the home takes in to account the preferences of residents and specialist dietary requirements, which are recorded on care plans. All residents have nutritional assessments and attached risk assessments to ensure specialist dietary needs are adhered to and monitored. Preferences and dislikes are recorded and taken into account by the homes cook. An alternative meal is on offer at lunchtime and teatimes. This promotes choice for the residents and provides an opportunity for them to eat what they prefer, whilst meeting their dietary requirements. Residents who completed surveys and were spoken with during the visit reported that the food is very good and there is always a choice if you dont like something We saw records are kept of individuals daily dietary intake, which also indicate if someone chooses an alternative to the main meal and what mid-morning snacks and fluids people have on a daily basis. This ensures dietary requirements and are monitored and reviewed on a regular basis in line with residents assessed needs. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who use this service or their representatives are able to express concerns, and have an access to a complaints procedure. At present the home is having monitoring visits to assess the on going standard of care. This follows safeguarding incidents and referrals made to West Sussex Social Care Adult Services Evidence: The home has a complaint procedure, which is outlined in the statement of purpose and displayed in the home. Complaints are recorded and investigated with feedback to complainant within 28 days with the actions taken. All residents and visitors spoken with said they knew who to complain to and that they would do so if they thought it appropriate. Staff induction and training records indicated that all staff receive training in safeguarding vulnerable adults. Staff spoken to, did know what to do if they suspected abuse. Staff personnel files seen during the visit, were in very good order and held all appropriate checks and references. This ensures residents are safeguarded from risk of harm. Care Homes for Older People Page 20 of 33 Evidence: There have been three safeguarding investigations in the home in the last six months, (the third instigated a week after the inspection visit). In October 2009 the providers of Hillside Lodge were given specific action points to meet by West Sussex Social Care Adult Services. In the interim, they have suspended any new admissions (from October 2009) to Hillside Lodge. At present a programme of on going monitoring visits is being undertaken by Social Care Adult Services. Social workers and care placement managers have met with the management of Shaw Healthcare to assess the homes progress. At present there is no date to re-introduce admissions to the home until such time that compliance has been achieved for a consistent period. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a high standard of comfort and facilities for the people who live there. Bedrooms are all individually personalised and the home is clean, pleasant and hygienic throughout. Evidence: It was evident from the visit that Hillside Lodge is decorated and maintained to a high standard. The home is modern and built for purpose. The premises are laid out over three floors with a staff team designated to each floor. The manager has introduced a new cleaning programme to ensure the standard of cleanliness is met at all times. Communal areas are furnished with flowers, ornaments and pictures, which give the environment a homely feel. The staff have also put personal pictures and art work on the residents doors and communal walls to promote a sense of ownership and in the case of some residents, act as prompts for their rooms. The standard of cleanliness and furnishing throughout the home is high. Residents and relatives commented on the cleanliness and lovely decor of the home. Private accommodation is decorated and furnished to a high standard to suit the needs of individual residents. Residents are encouraged to personalise their own bedrooms to give them a sense of ownership. The majority of the bedroom doors have automatic Care Homes for Older People Page 22 of 33 Evidence: closure fitted which would close in the event of a fire. The dining rooms on each floor are attractively presented. There are also separate modern kitchen areas on each floor so staff can prepare snacks and drinks as needed, away from the main kitchen area. In addition to en-suite facilities the home has shared toilets, which provide ample facilities to the residents. There are hoists, bath aids and specialist nursing equipment to promote the independence of those who require assistance with personal care and nursing needs. Anti bacterial soap was evidenced at shared sinks. Laundry and sluice facilities are provided. Policies and procedures are in place for infection control, and all of the staff have attended relevant training for infection control and health and safety procedures. This promotes good practice in the area of safety and welfare for the residents and reduces the risk of infection spreading within the home. There is a passenger lift for residents with limited mobility to access all floors of the house. All radiators throughout the home have been covered. Records indicated that the temperature of the baths are taken before bathing residents to prevent risks of scalding. A call bell system is provided in every room so staff can attend an emergency situation swiftly, should it arise. The maintenance log showed all maintenance was completed as required on a regular basis. This means the residents environment is kept safe and well maintained at all times. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the standards in respect of staffing have been met. However the high level of current staff vacancies and continual use of agency workers to meet the shortfall is a drain on existing staff resources and could result in potential risks to service users. The management are aware of this and at the time of the visit had taken steps to address the areas in need of improvement. Evidence: Recruitment policies and procedures are in place, to ensure staff employed by the home have the necessary skills and experience to fulfill their roles. CRB checks, terms and conditions and reference checks were seen on file for staff members. This ensures that residents are protected in the home. All permanent staff members spoken to during the visit, demonstrated commitment and enthusiasm for their roles and most had a good understanding of the residents health and social care needs. Staff members knew the residents individual preferences and were confident in their roles and responsibilities. The manager has reviewed the induction process for new staff. In addition to the companys four days, each staff member will now undertake an induction specific to the home. They are then matched with a mentor (experienced staff member) who supports them in their day to day roles until they are fully trained. Records seen show Care Homes for Older People Page 24 of 33 Evidence: that all staff complete a mandatory training programme appropriate to the needs of residents. Staff also undertake more specialist training in respect of health care needs. An up to date training matrix was seen during the visit. This enables management to monitor all staff training and identify which staff are due for annual refresher courses. From examining the staff duty rotas, speaking to staff, residents and relatives during the visit it was concluded that current staffing levels are not always sufficient for the number of residents. When agency staff are used to cover the shortfall, it puts pressure on the other, more experienced staff members. At present one third of the homes staffing hours are being covered by agency staff. This does not promote consistency of care for the residents and may pose a possible risk to their health, safety and welfare. Continual use of agency staff to fill a high number of hours puts pressure on existing staff to support them in their roles, they are not as familiar with the home or its residents and they do not undergo the same induction or on going training that the permanent staff members. The relatives and staff spoken to during the visit confirmed this and stated the staffing numbers was an on going issue at the home. Comments included they do a great job but need more staff, they are always so busy and when they use agency this puts pressure on the existing staff as they agency workers require supervision, its at these times they get really stretched. When speaking to long standing staff members it was clear they were knowledgeable about individual needs and their responses were in line with care plan requirements. However staff fed back that when agency are used they dont do the same training as us, and they dont know the residents so we have to work twice as hard to make sure people are getting what they need and jobs are done properly. Other comments included its getting better here but we need more staff and some agency are long term but when we have new ones in its harder work for everybody. Every floor needs more staff. Relatives and visitors to the home spoke very highly of the existing permanent staff at the home, stating they take such pride in their work and never complain, they work so hard and cant do enough When spoken with during the visit, the manager confirmed she is fully aware of the need to recruit permanent staff. She stated its my aim to ensure consistency of Care Homes for Older People Page 25 of 33 Evidence: staffing throughout the home and as a result, she has recently employed several new staff members, which will cover 289 of the vacant 400 hours. However none of these are yet in post. Once references are checked and they have completed their induction this would make a significant improvement to the current staffing levels, reduce the use of agency staff and increase the number of experienced staff within the home. A requirement has been made to ensure this is undertaken and will be reviewed at the next inspection. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been three changes in management since the last inspection and none of which have registered with the Commission. There is a full time manager in post at Hillside but she has not yet completed the registration process with the Commission. Service users financial interests are safeguarded. The health, safety and welfare of residents are promoted through good administration and record keeping systems. Evidence: There are administrative systems at the home to promote all aspects of health and safety. The inspector examined health and safety records including fire checks, accident book, maintenance checks, water temperatures and environmental risk assessments. Records required to be kept by legislation were in good order and up to date. All care records are kept in a locked rooms to maintain confidentiality. Records and staff feedback demonstrated that staff are now being given support through regular supervision. The manager and staff confirmed that due to Care Homes for Older People Page 27 of 33 Evidence: management changes this had previously been sporadic. In addition staff are required to attend regular staff meetings to discuss practice issues and give them the opportunity to contribute towards decisions made within the home. Minutes of these meetings are kept on file within the home. The policy of the home is not to manage the financial affairs or handle large sums of money for the residents and any expenditure on the residents behalf is billed to their representative to manage for them. Shaw Healthcare has quality assurance procedures in place, which are used to inform their on going business plan. Questionnaires are sent out annually and the results once published, are available to any involved parties. At the last inspection a requirement was made to the providers of Hillside Lodge to ensure a manager was Registered to the home. Since that time two managers have been recruited and applied for registration with the Commission, however both applications were withdrawn before completion. In November 2009 the home recruited another full time manager, she has applied for registration but at the time of the visit her application was still being processed by the Commission. This requirement is therefore still outstanding. The new manager is a Registered nurse with several years management experience in residential and nursing settings. Since coming into post at Hillside Lodge she has already implemented improvements in respect of the environment, staff induction, support and training, care planning and recording. She is supported by the deputy manager, who has several years experience managing residential homes. In addition there is a team leader who oversees each floor of the home, with the support of management. During the visit, staff and relatives referred to introduction meetings which the new manager and senior management that Shaw Healthcare had held when the new manager came into post. The feedback about these meetings was positive. One relative said she felt the manager seems to be making headway. However until the new manager is registered with the Commisssion, staffing shortfalls are addressed, safeguarding referrals reduced and consistent care practice achieved, the overall management of the home can not be considered robust. These issues will Care Homes for Older People Page 28 of 33 Evidence: continue to be monitored by West Sussex Social Care Adult Services and the Care Quality Commission and assessed at the next inspection. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 8 The person managing the home must be registered with CQC The current manager has not yet registered with the Commission. 30/07/2009 Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The registered person shall 30/05/2010 ensure that at all times suitably qualified, competent and experienced persons are working at the care home and will not prevent service users from receiving continuity of care. One third of the staffing hours at the home is being covered by agency staff on an on going basis. 2 31 8 The appointed manager of the home must be registered with the Care Quality Commission The providers have not registered a manager since the last inspection when this requirement was made 03/05/2010 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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