Inspection on 18/09/07 for Hillside Nursing Home

This inspection was carried out on 18th September 2007.

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

The inspector 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 Nursing Home 29/03/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hillside Nursing Home Hillside Avenue Huyton Knowsley Merseyside L36 8DL Lead Inspector Diane Sharrock Key Unannounced Inspection 10:30 18th 19 September 2007 th X10029.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 Nursing Home DS0000069142.V351366.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 and Care Homes for Adults 18 – 65*. 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 Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address Hillside Avenue Huyton Knowsley Merseyside L36 8DL 0151 4430271 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) zurawa@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd vacant post Care Home 119 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (39), of places Physical disability (20) Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 119 service users to include: The PD unit provides care and support to a maximum of 3 service users with alcohol problems . Date of last inspection 29th March 2007 Brief Description of the Service: The home is registered for 119 beds within a variety of categories for each unit. Elm unit has 30 beds for Older people for EMI residential care for people with dementia, Ash unit has 30 beds for EMI dementia nursing care of Older people, Rowan unit has 30- beds for older people with nursing care, and Cedar unit has 20 beds registered for younger adults with a physical disability between the ages of 30 and 55. A further 9 beds were used for older people for Residential care however these beds have now been closed for further development for the younger adult wing. The home benefits from a variety of communal seating areas within each unit. It is set in gardens, which are accessible to the Residents. The home is positioned in Huyton close to local amenities. The home is owned by BUPA and the Responsible person is Ruth Yates. The previous manager has recently left the home and the home currently has a temporary manager Ms Marian Wallace until the company can recruit a permanent manager. The manager has provider the minimum and maximum levels of fees for the home, stating £381.79 to £690 per week. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 5 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of two days. Inspections involve measuring a number of standards considered as important by the Commission. During the inspection discussions took place with 4 Staff and we met over 9 staff during the visit. We also met with approximately 10 Residents that were in the lounge and bedroom areas. A total of 8 comment cards have been submitted to our offices, two from residents and 5 from staff and one from a health professional that visits the home. Selections of Comment cards were also left in the home to offer people further opportunity to give their opinions. We completed this unannounced visit by looking at the homes records and undertaking a tour of the building. Feedback was given to the manager and senior managerial staff at the end of this site visit. During this visit we were accompanied by a volunteer who works for Help the Aged and they were able to chat to residents at the home to gain their opinions of what they think its like living there. Following this site visit representatives of the company met with CSCI to discuss the report and to give further information in how they meet various standards within the home. What the service does well: The expert by experience has made various notes of her experiences of talking and taking part in activities with the residents on 2 of the units at the home. Overall she was able to give very positive feedback from the residents she had chatted to and that they stated they were happy with the choice of meals and the activities on offer. Staff were enthusiastic and observed to have a good rapport with residents and relatives and noted to be very respectful and caring towards residents. A sample of bedrooms seen showed personalised rooms with various personal belongings. The homes pre inspection questionnaire gave details of all maintenance checks in the home. A sample of these were seen during this visit and appeared to be up to date and showed that the home is safely maintained. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? Most of the requirements made at the last inspection were found to be met showing improvements to the home and the companies commitment in making the home a better place. Some staff during discussions stated, They were generally happy and very loyal to the company and felt it was a good place to work. “I work along a lot of caring people and that is a pleasure to work here….” Staff felt they had been through various changes and different changes to the managers but felt “…..the home was generally operating ok.” Currently the manager advises that out of 56 staff over 25 staff have already achieved their care qualification (NVQ) and 2 staff are in the process of obtaining this qualification. This number gives shows that the home has now exceeded the minimum guideline of having at least 50 of the workforce with this qualification which is a good quality indicator for investment in to the workforce. There were no nasty smells during this visit the only area providing some smells was one particular corridor on Elm unit. The company have now employed 4 activity organisers, one allocated to each unit. Currently the staff display an activities planner on some of the units inviting people from each unit to join in. Developments have been made in organising activities and now they continue in developing initiatives to help support and develop activities appropriate to each residents needs and enabling as much choice as possible. Some staff comments from comment cards felt that, “We are working towards an even better social support.” Two comment cards from residents said that “usually” and “sometimes” there was enough activities on offer. Collectively residents said they were fine, those that were able to chat said they enjoyed their lunch and said it was very good, they said it was nice here and they were well looked after. The Cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for many years. Two comment cards said they were mostly happy with meals. One staff comment card said, “Service provides good meals.” Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 8 The company have also developed a good practice initiative for “night bites”, which helps identify and provides access to food over a 24 hour period especially when people are hungry outside normal meal times. An example of good practice has seen the company purchase and install numerous guard stops which help give residents the choice of having their doors open but gives added protection to themselves and others in the event of a fire drill. What they could do better: Full feedback was given to the manager and regional manager during and on conclusion of this inspection. Some areas were noted to need action taken and further evidence to be in place to meet some standards. Finances should continue to be developed and actions taken to provide clear and accurate information for all residents regarding the management of their monies, this will give residents added safety in showing how their funds are managed in their best interest. Records should be clear in identifying who acts as appointee for each resident, and contracts/ terms and conditions should be in place for all residents. All staff must have training in abuse awareness so they are suitable trained and up to date in being able to protect and safely support residents. All staff must be supported with an appropriate induction that covers all their training needs and assists them in supporting all residents at the home. Training records should be updated for all staff so evidence is in place that staff have at least 3 days training and are given the right amount of training both statutory and developmental to meet both the residents and staff needs. All staff should be supplied with all identified training specific to their job eg dementia training for activities staff. All staff should be regularly supported with supervision. To provide risks assessments to any resident that continues to smoke in areas that could put other people at risk. To carry out all identified actions to reduce these risks. To continue developing the environment for example bathrooms and toilets and look further into including residents/relatives and staff in the development of their home and look at introducing strategies as to how they can be more involved. To review care practices and audit current standards so that resident’s privacy and dignity is promoted at all times. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 9 Staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should be included with staff and residents and their opinions should be included in the reviews. Staff must act in accordance with company policy and show evidence of how they have covered any staff absence. Activities should continue to be developed so they can meet all of the resident’s social needs and steps should be taken in taking on board resident’s opinions and including them in the developments of their home. . 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 Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and standard 6 is not applicable. Stand 2 adults 18-65 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before moving to the home in order to ensure their needs can be met prior to moving in. EVIDENCE: Residents who chatted to the inspector and expert by experience stated they were happy at the home. All comment cards received reflected these views. 5 Care plans were looked at during this inspection and two included recently admitted residents to the home. Care plans had pre-assessments in their file, which showed their needs had been assessed prior to moving in. A Social Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 12 Workers assessment and information gained from the hospital staff and relative was also provided with the homes own assessment to show they could meet the resident’s needs Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7/8/9/10 and 6/9/18/19/20 adults 18-65 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home did show they were adequately managing Residents health and personal care needs. EVIDENCE: Five care plans were reviewed as part of case tracking residents care. Individual plans of care are available and identify relevant aspects of health, social and personal care. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 14 All care plan seen were detailed and gave a good account of the residents needs and were able to demonstrate they can meet the diverse needs of residents at the home. Some care plans gave good details how the residents social needs and choices could be met but some plans around social support were very basic with little detail how they resident would be supported with their social needs. The Manager has been previously carrying out audits on care plans to make sure that all parts of the assessments are carried out and show accurate evidence to what care and support is given. The care plans have developed however the continuation of audits was not seen consistently applied to all units. Following this site visit the regional manager has confirmed that the home have been carrying out at least 20 care plans reviews each month and evidence of a company unannounced quality check and report dated 30/7/07 was seen during a meeting with company representatives 28/11/07. Collectively residents said they were fine, those that were able to chat said they enjoyed their lunch and said it was very good, they said it was nice here and they were well looked after. The expert by experience has made various notes of her experiences of talking and taking part in activities with the residents on 2 of the units at the home. Overall she was able to give very positive feedback from the residents she had chatted to and that they stated they were happy with the choice of meals and the activities on offer. Various positive interactions were observed with Staff supporting Residents throughout the day. Staff appeared to have a good rapport with residents. Two staff were seen patiently explaining about the hoist and what they were to do in transferring the person into their wheelchair. One resident was given a cup of tea on request, One staff member was seen sat next to an elderly lady holding her hand. Staff were mainly observed being quietly spoken and explaining what they were doing when talking to each resident. In one lounge 2 residents were seen with food over their clothes late in the afternoon and care not been taken by staff to change their clothes to assist them in their dignity and pride of wearing suitably clean clothes. One resident had a sling around their head and legs. It was obvious it was a sling, it was very visible and no attempt had been made to disguise this piece of equipment. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 15 A sample of medications, records and storage were viewed on one unit. The management of medications appeared tidy and organised showing a wellmanaged area. Staff explained that since the Deputy left the home the regular audit and checks on medications and care plans had not always been carried out. Previously regular medication audits were carried out to show regular checks on each unit and action plans were produced for any identified improvements needed to help provide ongoing safe practices at the home. During this visit we only saw evidence of medication audits for Rowan unit dated 17/8/07 and 5/9/07 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/14/15 and 12/13/15/17 Adults 18-65 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did mainly provide adequate support to residents to meet their social needs. EVIDENCE: One activities organiser described a whole variety of activities that she had started and described the plans in continually developing events and hoped to do further training to help her meet the residents needs. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 17 The homes pre inspection questionnaire did give details of developments to provide a newsletter for the home, which will help give better communication to everyone. The company have now employed 4 activity organisers, one allocated to each unit. Currently the staff display an activities planner on some units inviting people from each unit to join in. Developments have been made in organising activities and now they continue in developing initiatives to help support and develop activities appropriate to each residents needs and enabling as much choice as possible. The expert by experience chatted to staff and residents on two units and was told about the previous nights cheese and wine party were an entertainer came and that a lot of people really enjoyed this night. During this visit she was invited to take part in a game of bingo which staff had organised prizes for, and also invited to have lunch with residents. The expert saw various choices of meals offered and felt the standard of food was very good, she observed very good interactions with staff and residents and noticed they had a good rapport with each other. Some staff comments from comment cards felt that, “We are working towards an even better social support.” Two comment cards from residents said that usually and sometimes there was enough activities on offer. General chats took place with staff on each unit, Some staff stated that they never know when the activities staff are arriving on the unit and that they are not always involved in the activities, they felt they had very limited time to do their care work and felt it didn’t leave them much time to do activities. One activity file was seen and showed evidence of a map of life for each resident giving details about their life and points of interest helping staff to get to know them better. One file showed detailed of recent activities offered in September 07 .eg vase making, DVDs, art and crafts, bingo, movie, hand massage. However there was no obvious evidence of any discussion or choices explored with residents regarding the planning of activities and some units had no display for any regular organised activities and what to expect each week. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 18 Two comment cards said they were mostly happy with meals. One staff comment card said, “Service provides good meals.” Collectively residents said they were fine, those that were able to chat said they enjoyed their lunch and said it was very good, they said it was nice here and they were well looked after. The Cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for many years. The kitchen area was clean and tidy, well organised and well stocked with food, especially a large stock of dry stores. The chef was very knowledgeable about his meals and the residents’ likes and dislikes and he was kept up to date of any reviews with the dietician and speech therapist. They were able to show a well-organised kitchen with plenty of supplies and ingredients for lots of home made foods and he explained he always keeps a supply of frozen food purely for emergencies to cover 100 meals in case a delivery of food fails to appear. The company have also developed a good practice initiative for “night bites”, which helps identify and provides access to food over a 24 hour period especially when people are hungry outside normal meal times. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16/18 and adults 18-65 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are mainly in place to protect residents EVIDENCE: Residents who chatted to us were generally happy and they said they would always discuss their concerns or queries with staff at the home. The home has a complaints procedure, which is time scaled appropriately and includes contact details for the commission. A copy of the complaints procedure is available to residents. The pre inspection questionnaire gave details of 12 complaints over the past 12 months and that they were all dealt with within 28 days. These records showed that the companies’ complaints policy is well managed and carried out to try to address a persons concerns. Some staff had attended some of the mandatory training and were happy with the training on offer. However it was found that some staff had not received abuse awareness training, which is necessary to make sure everyone is aware of how to keep residents safe. Staff who had worked at the home over 12 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 20 months did not know whether a date had been organised to provide this necessary training. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19/26 and 24/30 adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is generally well managed and provides a pleasant environment for Residents to live in. EVIDENCE: A sample of areas throughout the home were seen during this visit. A sample of bedrooms seen showed personalised rooms with various personal belongings. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 22 Some areas that have not yet been redecorated including bathrooms and toilets, which remain basic and sparse and highlight the need to be made more comfortable and homely as standards achieved in some other areas in the home. One bathroom window had frosted glass but no window covering to promote privacy. One bathroom had a hole to the wall from the chair hoist and, scrapes to the bath enamel, which could present risks with cross infection. One bedroom seen had a curtain hanging off its tracks. One armchair and footstool were noted to be ripped on the upholstery. These points showed that some areas still need further improvement to give an overall standard of living to resident’s environments. One resident was seen in one lounge smoking whilst the door was open leading to the main corridor. This highlighted a potential risk that needed to be appropriately managed. An example of good practice has seen the company purchase and install numerous guard stops which help give residents the choice of having their doors open but give added protection to themselves and others in the event of a fire drill. Towels seen in bedrooms were noted to be frayed and of poor quality, however the manager explained that a delivery had arrived the day of the visit and all poor quality frayed towels would be removed. The home offered a friendly environment; all the staff were welcoming. It was evident that there was good management and housekeeping at the home. The home was clean and tidy with no nasty smells except for part of a corridor on Elm unit. The environment is mostly decorated and in good order but very much having similar colour schemes throughout the units. The Manager and Staff described their plans to develop the environment further for the benefit of the residents but acknowledged that they had specific corporate colours that they have to choose from. There was limited evidence to show that residents had been regularly consulted or included in the development of their home. The homes pre inspection questionnaire gave details of all maintenance checks in the home. A sample of these were seen during this visit and appeared to be up to date and showed that the home is safely maintained. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 23 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27/28/29/30 and 32/34/35 adults 18-65 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are mainly supported by adequately qualified staff. EVIDENCE: Everyone in the lounge areas were seen to be supported and helped to feel comfortable. Case tracking of 6 staff files took place and these files showed good recruitment procedures, which helps to safeguard residents at the home. However these staff files showed limited information in showing evidence of updates to training or detailed induction training for recently employed staff. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 25 Some staff stated they had not yet received abuse awareness training or supervisions, which is necessary to help support them in the role and help protect residents in whatever capacity they work at the home. The homes pre inspection questionnaire had already identified that they needed to provide a refresher course on “abuse awareness for staff over the next 12 months.” Staff were able to describe some courses and training they had attended and felt they were suitable to their needs. However they also identified further training that they felt would be useful to their role such as dementia training. Some individual training records had not been updated however the manager felt she had a training matrix which helps her develop training necessary for all staff and to keep them updated in mandatory training. The pre inspection questionnaire did say it had a training development programme for the home but we did not see it during this visit. The homes pre inspection questionnaire gave no details for how many staff are trained in procedures for infection control. Following the previous inspection it was acknowledged that the manager had developed individual staffing levels on each unit and has procedures in place that staff should follow if they need extra staff especially during sickness. However on one unit it was found that due to sickness the unit was operating with one staff down and staff stated they were unsure of the company procedures. This lack of application to the company procedures can put residents at risk and affect the quality and choices in the care and support needed. Some staff during discussions stated, They were generally happy and very loyal to the company and felt it was a good place to work, Some comments from comment cards stated, “have more staff.” One person stated they had “not received induction” and another person said the “induction mostly covered” what they needed. Two resident comment cards stated that staff are “usually” available. “I work along a lot of caring people and that is a pleasure to work here….” Currently the Manager advises that out of 56 staff over 25 staff have already achieved their care qualification (NVQ) and 2 staff are in the process of obtaining this qualification. This number gives shows that the home has now exceeded the minimum guideline of having at least 50 of the workforce with this qualification. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 26 Following this site visit the regional manager has confirmed that all staff are paid for training that they attend. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31/33/35/38 and 37/39/42 adults 18-65 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, welfare and safety of Residents and Staff is mainly promoted and protected. . Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 28 EVIDENCE: The Manager produced a quality assurance file during this visit, which had evidence of previous audits carried out at the home covering care plans and some medication audits. A customer satisfaction survey for December 2006 was in place and seen previously. The manager explained this is usually organised at the end of the year with preparation taking place for this at the end of the year. Continued use of previously organised audits and management tools will show consistent and good evidence in how the home is being managed. They will help to show what actions are taken to consistently evidence how the home tries to maintain the national minimum standards and its own policies and procedures. The Manager had not continued with regular consistent staff meetings. However minutes were seen of recent meetings, which covered various topics in the home. Consistent and continued meetings should ensure that staff members have a regular forum to discuss issues that may affect the service provided to residents. Staff felt they had been through various changes and different changes to the managers but felt “…..the home was generally operating ok.” The only issue for staff was the staffing levels especially in the afternoons and the activities programme. Some staff felt the staffing levels needed to be increased at times and some staff felt there was regular absence and sickness from staff, which sometimes left them short staffed. They also commented on the activities organisers and how in their opinion they didn’t always know when they would be attending certain units, as some units had no organised display of events to help keep everyone informed of what was being planned. Following the previous inspection the company have already carried out an expert financial audit on their management of residents finances. The audit showed clear details of what actions the company are continuing to take to improve the current records and management of finances. The manager explained that they are regularly meeting senior members of the local authority at Knowsley Social Services so that they eventually have detailed and organised financial information with regard to fee income. Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 29 This will eventually help to give clear records to the Resident finances and help safeguard how their finances are managed. Improvements have been made to the current financial records however further work is still be under taken and needed so that the staff can identify who is appointee for various residents as designated staff managing these records did not know who was the appointee for some residents. Further work is also being carried out so that each resident will eventually have a contracts/terms and conditions to make sure they have a clear and open record of what they can expect from the company. The maintenance officer carries out a monthly health and safety check on each of the units and ensures equipment such as wheelchairs and bedrails are functioning correctly. The company have various procedures in place to show how the home is being managed e.g. the inspector looked at a sample of maintenance certificates, which showed what actions were taken to ensure the safety of everyone at the home. Hillside Nursing Home DS0000069142.V351366.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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 2 36 X 37 X 38 3 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 31 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. 1. Standard OP35 Regulation 20 a b Requirement The management of finances must be clear and show that they are managed in the best interest of residents with clear details of who is acting as appointee on behalf of residents. Timescale for action 18/12/07 2 OP18 13 6 2 OP19 13 4 a All staff must have training in 16/11/07 abuse awareness so they are suitable trained and up to date in being able to protect and safely support residents. To provide risks assessments to 16/11/07 any resident that continues to smoke in areas that could put other people at risk. To carry out all identified actions to reduce these risks. 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 OP10 Good Practice Recommendations To review care practices and audit current standards so DS0000069142.V351366.R01.S.doc Version 5.2 Page 32 Hillside Nursing Home 2. OP12 that residents privacy and dignity is promoted at all times, including the provision of clean clothes after meal times, look at the use and display of hoists left behind residents, provide coverings to all windows including frosted glass. Activities should be further planned and developed to meet residents social needs and should be clear in including residents opinions in the development of an activities programme accessible to all residents and displayed on each unit. To include residents in the development of their home and include plans in developing the current bathroom and toilet areas, the corridor carpet on elm unit, any ripped furniture, replace all frayed towels, repair of curtains to promote dignity and choice over their living areas. Staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should be included with staff and residents and their opinions should be included in the reviews. Staff must act in accordance with company policy and show evidence of how they have covered any staff absence. All staff must be supported with an appropriate induction that covers all their training needs and assists them in supporting all residents at the home. Training records should be updated for all staff so evidence is in place that staff have at least 3 days training and are given the right amount of training both statutory and development to meet both the residents and staff needs. All staff should be supplied with all identified training specific to their job eg dementia training for activities staff. All staff should be regularly support with supervision. Effective management of quality audits should be consistently applied to promote best practice in all areas and evidence consistent performance including various areas eg medication, quality checks, care plans, regular and consistent staff, resident and relative meetings and ways of including their opinions regarding the development of the home. 3 OP19 4 OP27 5 OP30 6 OP33 Hillside Nursing Home DS0000069142.V351366.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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