Inspection on 30/07/07 for Hillside Nursing Home

This inspection was carried out on 30th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillside Nursing Home 08/04/08

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Hillside Nursing Home North Hill Drive Harold Hill Romford Essex RM3 9AW Lead Inspector Harbinder Ghir Unannounced Inspection 30th July 2007 09:55 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address North Hill Drive Harold Hill Romford Essex RM3 9AW 01708 346077 01708 376513 managerhs@goldencarehomes.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) GCH (Hillside) Ltd Debra Kathryn O`Hare Care Home 55 Category(ies) of Dementia (55), Old age, not falling within any registration, with number other category (55) of places Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code 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 - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 55 7th June 2006 Date of last inspection Brief Description of the Service: Hillside is a home for 55 older people. The home is situated in a residential area of Harold Hill close to local shops including a small post office. The home provides 24 hours nursing care. Service users are accommodated on 2 floors, each service user has their own bedroom. The home is suitable for wheelchairs and there is a passenger lift to the upper floor. There is a courtyard garden which offers seclusion and safety within the centre of the home. The registered manager of the home at the time of this inspection informed the inspector the fees charged for self funding residents can range between £600£675 and for Local Authority funded residents can range between £435-£500. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 30th July 2007 between 9.55am and 5.00pm. The manager of the home was on annual leave at the time of the inspection. During the inspection the inspector was able to talk to the service users residing at the home, staff and relatives who were visiting during the inspection. Two tissue viability nurses were also spoken to. The London Borough of Havering who are the host authority for the service was contacted, inviting their comments on the service they are commissioning, which have been included in the report. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 6 Medication practices have been reviewed and are now correctly followed ensuring the safety of residents. Residents’ wishes at the time of death are recorded in their care plan. The manager of the home has registered with the Commission for Social Care Inspection. All finances for residents are now individually held. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose needs to be reviewed, to provide information on activities and of any specialist therapies they provide at the home for residents with a diagnosis of dementia, to ensure all residents have the information they needs to make a decision on whether they would like to live at the home. Pre-admission assessments are completed before prospective residents move into the home, ensuring that the service will meet their needs. The service does not provide intermediate care. EVIDENCE: Whilst the Statement of Purpose provides adequate information for prospective residents to make a decision whether they would like to live at the home, the Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 9 document provided limited information for those prospective residents with a diagnosis of dementia. The document did not contain information of any specific activities or therapeutic techniques that are provided at the care home to meet the needs of individuals with dementia. It is Recommendation 1 that the document is considered to be made suitable for all client groups the service intends to accommodate. The service also provides a comprehensive Service User Guide including information on its philosophy of care, which is central to the care provided at the home. The document provides information on the services provided by the home, qualifications and experiences of the registered providers and manager, how to make a complaint and the results of its quality assurance surveys, which were presented in pie chart formats. The guide is available to all residents, and copies were seen in residents’ bedrooms. Both documents were presented in text format, which is not suitable to meet the communication needs of residents living at the home. It is Recommendation 2 the service considers providing the documents in formats, such as Braille, appropriate languages, pictures, video and audio. Four resident files were closely examined which all included a pre-admission assessment. The homes Statement of Purpose states, “Care will be individual and holistic based on the physical, social, emotional and spiritual needs of the resident which will be assessed prior to admission.” Pre-admission assessments were comprehensive in covering the health care needs of residents. However, these assessments included very limited information on residents’ religion, ethnicity and social/cultural needs, and this area needs expanding so that staff understand and are able to meet such individual needs. Very little information regarding the specialist mental health needs of those with a diagnosis of dementia was recorded on the assessment. More detail needs to be obtained around a person’s existing abilities, such as making a cup of tea and other daily life activities. This will be stated as Requirement 1. For three residents who were funded by local authorities, care management assessments from the placing authorities, panel reports, nursing care reports and medical reports had been obtained from health care professionals. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. The care plans need to be more specific with regards to the recording of outcomes for residents around the cultural, religious and social care needs of the individual; and the specialist needs of those people living with dementia and ensure information recorded is consistent throughout the document. There are clear medication policies and procedures to follow, and practices at the home to ensure the safety of residents. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 11 Four care plans were closely examined. The health and personal care needs of residents were recorded and these were found to be generally detailed. However, one care plan viewed of a recently admitted resident identified concerns regarding the individuals weight loss and his poor appetite. The individual had been previously admitted to hospital regarding his rapid weight loss before being admitted to the home. On viewing the resident’s file, a nutritional risk assessment had not been completed in full and the daily nutritional intake of the resident had not been monitored. Care plans must provide consistent information on the identified health care needs of residents and ensure these are being met correctly by the service. This will be stated as Requirement 2. Residents’ religious preferences were briefly recorded on the care needs assessment, but care plans did not identify as to how the service intended to meet their religious needs of individuals in terms of care and activities. Care plans need to include more information with regards to the recording of outcomes around the cultural, religious and social care needs of residents. There was also limited information on meeting the specialist care needs of people living with dementia. The diagnosis of dementia was identified on the initial assessment for residents but limited information was provided on how staff were to meet the needs of residents who were confused or disorientated. On observing staff members, not all staff members were wearing name badges, making it difficult for someone with dementia to identify members of staff. The quality of care, which is experienced by someone with dementia, can be improved by the way staff use and understand care plans. Care plans tended to plan care in terms of risk, dependency or disability. The assumption that people with dementia cannot do much can lead to the dependence of care staff to do tasks that the individuals could actually be doing themselves. It is therefore essential that comprehensive care plans be developed, with the assistance of relatives and friends of the resident, to ensure that staff provide the correct level of care. A requirement in relation to the above findings will be stated as Requirement 3. Records indicated that other health professionals such as the dietician, speech and language therapist; optical, dental and chiropody services see residents. The tissue viability nurses were contacted, who expressed some concerns relating to the management of pressure sores but commented positively on the members of care staff recognising her concerns. One nurse commented on a resident who had developed a pressure sore whilst in hospital, stated “I am currently seeing a resident who has a pressure ulcer on the sole of their foot, the resident has been sliding down the bed with his foot resting on the board at the bottom of the bed. Re-positioning the resident or re-siting the board could have prevented this. On speaking to the nursing staff, they did recognise what I was saying.” Another tissue viability nurse spoken stated, “The nurses have always followed my Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 12 recommendations. Everything seems to be ok at the home and they are good at contacting us through the referral scheme. They are also pretty good at getting equipment.” On viewing the health care records for four residents, health records relating to pressure care management, management of diabetes, catheter care, were found to be detailed and adequately maintained. Evidence was seen of care plans being reviewed on a monthly basis. Risks assessments seen were comprehensive and detailed ways to manage and reduce risks posed to the individual and staff. One care plan file identified an individual who presented challenging behaviour. The risk assessment adequately identified ways for staff to manage this behaviour and calm the resident. Risk assessments covered risks associated to falling, choking, selfharm and wondering. All care plans viewed contained information on the end of life wishes of residents and the contact details of relatives and representatives where appropriate. The accident and incident book was reviewed. Accidents were recorded in full, but residents were not checked after their accident and follow up sheets were not completed for residents to ensure there were no further health associated risks posed to them. The requirement in relation to the above findings will be stated as Requirement 4. The home has a medication policy which is accessible to staff. Medication records were up to date for each resident and medicines received, administered and disposed of are recorded. An audit of three residents’ medication was carried out, which was all found to be in order. Residents and relatives spoken generally spoke positively about the care provided at the home. One resident stated, “I like the home, they’re all right here.” Another resident stated, “The staff are pretty good, I have no complaints.” Further comments received from relatives spoken to included “I am very happy with the care provided, the carers are friendly and my mum has settled in well.” Another relative stated, “The home is very good, and she gets what she wants, I have no problems with the general care provided.” The commissioning unit at the London Borough of Havering who were contacted as part of the inspection stated “We have no problems placing residents at the home.” Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited social activities are arranged at the home, these do not meet the needs of those with a diagnosis of dementia. The meals in the home do not always offer variety or choice, and practices within the home do not always promote service users’ right to exercise choice. EVIDENCE: The homes Statement of Purpose states “The activity organiser arranges activities and outings for all residents. A daily, weekly and monthly programme of events is drawn up and every attempt is made to cater for all residents’ needs and abilities and likes.” Little evidence was seen of this statement being implemented by the service. An activities programme for the week was seen which included activities such as bread making, nail and Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 14 hand massages, residents to be involved in games, watching films, flower arranging, bingo, arts and crafts and music and involvement. On speaking to relatives and family they all commented, that not enough activities or outings were organised for residents. One relative spoken to stated, “There are no trips arranged, they don’t go out anywhere, not even into the garden. The residents need more activities as there is nothing done here to keep them active or motivated.” Another relative stated “They don’t go out enough, the residents must get bored as there are no activities in the day, there is no stimulation for them.” A resident spoken to stated, “It would be nice to go out more, even into the garden.” During the inspection it was observed that none of the residents were sitting in the garden even though it was a bright sunny day. Residents in the downstairs lounge were seen to be sitting by the window looking out into the garden. One resident’s care plan stated “X loves activities that involve music. She likes to chat and cream rubbed into her hands.” On viewing the resident’s daily case notes no evidence could be found of the service meeting these identified needs. On speaking to the activities co-ordinator on what outings were being arranged for residents she stated, “ A lot of them don’t want to go out, because they get set in their ways.” This is an inappropriate statement, providing very little evidence that residents are being individually consulted on their preferences of their social needs and how they would like to be met and how they are encouraged to engage in stimulating activities. There was no evidence of specialist therapeutic interventions or approaches adopted by the service to meet the needs of service users with dementia, to establish emotional security and a consistent sense of identity. A resident’s care plan file stated “Y does not involve themselves at the moment due to dementia.” This is inappropriate and shows a lack of understanding of the needs of people with dementia. Staff that understand residents’ needs and help them with their communication skills can help the quality of life for those individuals with communication difficulties. A range of individual activities must be introduced, which are also appropriate for people with dementia, to ensure they are socially included within activities promoting their sense of identity. This is Requirement 5. The inspector saw a four weekly-devised menu presented in text format. There was a choice of two meals provided at lunchtime and at the evening meal, and snacks and drinks offered throughout the day. The inspector was able to observe meals being served to residents living on the ground floor. Condiments on tables were provided and one member of staff was observed offering residents a choice of drinks. However, staff had already plated meals and the inspector observed residents were not offered a choice of whether they would like gravy, or whether the portion was appropriate for them. One resident stated, “I’m not eating that, that is too much.” On speaking to residents and relatives regarding meals, a mixed response was received. A relative stated “I have just found out today X doesn’t like the food here, she told me the peas are like bullets, and I have had to make her some Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 15 food from home, which she has eaten.” Another relative spoken to stated “The portions of food are totally inappropriate for my dad as they are too small for him, he is still hungry and they never offer him seconds. The omelette he gets, does nothing for him. There is not enough choice, my dads needs are not catered for.” A resident spoken to stated, “They show you the menu, you can choose what you want, I don’t like the meals very much”. Another resident spoken to stated “We can choose what we like, the meals are well portioned and a good size”. A record of particular choices about food likes and dislikes was observed on residents’ files. But in regards to the responses received by relatives and residents, the service must ensure the dietary needs of all residents are met and reviewed to ensure that residents’ dietary needs are catered for; and staff practices at meal times are conducted to maximise service users’ capacity to exercise personal autonomy and choice. This is Requirement 6. Residents’ living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating times to maintain independence and exercise choice around food and eating. This area needs to be developed through the provision of pictorial menus or other methods such as making meals available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. This will stated as Recommendation 3. On speaking to the cook, she was able to demonstrate her knowledge of those residents requiring special diets, for example diabetic and pureed diets. Residents spoke positively regarding their daily routines around going to bed and getting up. All commented that they could go to bed what time they like. Visiting times were flexible, and visitors were observed coming to the home throughout the day. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. But residents, relatives and friend cannot always be confident that their complaints will be listened to, taken seriously and acted upon. Adult Protection policies, procedure are in place but not all staff have attended training in Safeguarding Adults, which does not ensure the protection of residents’ from abuse. EVIDENCE: The complaints procedure includes timescales within which complaints will be investigated. The procedure refers to the Commission for Social Care Inspection as being contacted at any time of a complaint being made or investigated. The complaints folder was closely examined and complaints were adequately logged, investigated with outcomes and actions recorded. The Commission for Social Care Inspection has been informed of one compliant made against the practices at the home, by the London Borough of Havering. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 17 However, on speaking to a relative expressed grave concern that their complaints were not listened to. He stated, “I have complained to the manager but nothing is ever done about it and the same practices carry on.” The complaint made by the relative was case tracked to the complaints folder, which could not be found. The registered manager must ensure all complaints regardless of source are appropriately recorded and thoroughly investigated to ensure complaints are listened to and acted upon. This will be stated as Requirement 7. The service has comprehensive adult protection procedures and protocols in place. However, on observing the staff-training matrix, it was identified that not all staff have attended training in adult protection. The training matrix identified a care staff team of thirty-nine, and fifteen members of staff had not received training in adult protection. All staff must receive training in Adult Protection to ensure the safety of residents is safeguarded. This is Requirement 8. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of the home was clean and generally maintained to a satisfactory level. However, stains on carpets in the lounge on the first floor and stains on kitchen floors in both units reflect poorly on the well being of residents. The signage and décor of the home is not appropriate to those with a diagnosis of dementia, which restricts their choice and independence. The environment must be improved to meet the specialist needs of people living with dementia. EVIDENCE: The inspector undertook a tour of the building. Some residents’ bedrooms were seen, which were comfortable with adequate furnishings and were also personalised by residents with personal family photos and furniture. All rooms Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 19 were lockable and can be overridden by staff in an emergency. One resident spoken to stated, “I’ve got a nice room. My sons made it lovely and brought all my furniture from home, it is very nice.” On viewing two bedroom rooms they were malodorous. The home has two units, each with its own kitchen. The kitchen floors on both units were stained and the areas were generally unclean, with stains on worktops. Household hazardous products were also found in an unlocked cupboard under the kitchen sink on the first floor. On viewing the lounge on the ground floor an emergency call bell was placed out of reach for a resident and the lounge carpet on the first floor was badly stained. The service must provide a safe and comfortable environment and to reduce infection control and health and safety risks posed to residents. This will be stated as Requirement 9 The signage and décor throughout the home was not appropriate to the needs of residents living with dementia. Toilets had some signage but this was not continued throughout the home to aid identification of bathrooms, toilets, lounges, bedrooms and other communal areas. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The home is registered to accommodate people with dementia. Therefore, the general environment throughout the home must reflect good practice guideline on dementia within care homes. This is Requirement 10. On undertaking a tour of the building, the communal bathrooms for residents had picture charts of different types of faecal stools and any changes staff should observe. Whilst it is acknowledged that staff may need information pertaining to employment and clinical practice, it is not appropriate for this to impinge on residents’ communal areas. This will be stated as Recommendation 4. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment practices are not always robust to ensure residents are in safe hands at all times. Adequate staff training is not provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. Residents’ needs are not always met by the numbers of staff on duty. EVIDENCE: Three recruitment and three training staff files were closely examined. Two staff recruitment files contained written references but there were no company stamps on the references and some were character references. These had not been followed up with telephone calls to ensure the validity of references. It is Requirement 11 that service users are supported and protected by the homes recruitment practices, which must be more robust. This is a requirement repeated from the last inspection. Staff training has been provided to some staff, which included training in medication, POVA, dementia, nutrition, wound healing, manual handling, first aid, health and safety and catheter care. On viewing the staff training record, it Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 21 was evident that not all staff had received training in these areas. On speaking to one member of staff she stated, “We would like more training in challenging behaviour due to our dementia registration.” The service employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that the ethnicity of some of the staff team was different to that of the people living in the home. It is important therefore that the manager ensures staff working at the home receive the necessary training in equality issues and valuing diversity, to ensure that staff understand and are able to meet the needs of residents. Training in specialist areas must be provided to all members of staff, to ensure they are equipped with skills and competences to meet the needs of residents. This will be stated as Requirement 12 The service does not have a ratio of 50 of NVQ qualified staff. The staffing levels throughout the care home need to be reviewed as some members of staff and relatives spoken to felt that staff were rushed and there were not enough staff on duty throughout the day. One member of staff spoken to stated, “ We tend to be very rushed in the morning, and everyone gets up late as the doubles never finish before 11am. We could do with more staff on at 8.00am.” Another relative stated, “I have visited the home on a Sunday afternoon and there has been no one around. At one occasion my father needed the toilet and there was no staff on, we eventually found one member of staff who told us that she would need another member of staff to assist and went to call her out of the staff room. The members of staff told me my father would have to wait as they were on their break.” On contacting the London Borough of Havering’s commissioning unit they also expressed concern at the low staffing levels at the home. One of the monitoring officers from the unit stated “Although they probably have what could be described as the minimum, for the level of dependency in some of the units where so many are reliant solely on wheelchairs, the staffing levels may need to be higher during busy times. I was there on one occasion where there were two staff on duty at tea time. One was serving teas and the other was taking someone to the toilet who required hoisting. There was a family member calling for help to take his relative to the toilet and another lady, who I was seeing, who was feeling faint and needed to get into bed who couldnt get any help until the teas had been served. I think this was on the first floor and before the new manager was in place. The provider must be able to demonstrate that staff levels and the deployment of staff are determined according to the assessed needs of people who use the service, to ensure the needs of residents are met ensuring their welfare. Adequate numbers of staff must be on duty to ensure the Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 22 health and welfare needs of all residents are met. This is Requirement 13. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded. The systems for service user consultation are satisfactory, but there was little evidence that service user views are acted on. The health and safety of staff and residents is promoted by the home’s policies and procedures. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is a qualified nurse and recently joined the staff team at the home. Staff spoken to spoke positively about the manager of the home and felt they could talk to her. Staff supervision records evidenced that staff were supervised at least six times a year and to ensure staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Services users’ records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. Evidence was seen of the service holding monthly service user house meetings to ensure service users have other means of expressing their views on the running of the home. Quality assurance surveys have been implemented by the service and evidence was seen of completed surveys by residents, staff, relatives and stakeholders. The results had been collected and collated into pie charts, which were included in the Service User Guide. However, where there was dissatisfaction with the service, no evidence was seen that the registered manager had addressed the issues highlighted. For example on looking at the results, a high number individuals answered “No”, when asked “Are you involved with the planning of activities?” Very limited evidence has been found at this inspection that activities are arranged for residents according to their preferences. It is Requirement 14 that the results of quality assurance surveys are acted upon. Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 26 Yes 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 OP3 Regulation 12 (4)(b) 14 (c) Requirement The registered persons must ensure that pre-admission assessments include information regarding the specialist mental health needs of those with a diagnosis of dementia and the religious; social/cultural needs of the residents are identified. The registered persons must ensure care plans provide consistent and accurate information on the identified health care needs of residents and ensure these are being met correctly by the service. The registered persons must ensure that comprehensive care plans be developed, to ensure that staff provide the correct level of care and meet the needs of those individuals diagnosed with dementia and outcomes are also recorded on meeting the cultural, religious and social care needs of residents; with the assistance of relatives/ friends of the resident. The registered persons must demonstrate that accidents and DS0000068195.V347704.R01.S.doc Timescale for action 30/11/07 2 OP7 12 13 15 30/11/07 3 OP7 12 (4) (b) 15 (1) (2) (c) 30/11/07 4 OP7 OP8 12 13 (1) (b) 30/11/07 Hillside Nursing Home Version 5.2 Page 27 5 OP12 16 (m) 6 OP15 12 (2) 16 (i) 7 OP16 22 (3) falls in the home are monitored and appropriate management action is taken. The registered persons must 30/11/07 consult service users about their social interest, and make arrangements to enable them to engage in local, social and community activities, and ensure activities are also suitable for residents who have dementia. The registered persons must 30/11/07 provide, in adequate, suitable, wholesome and nutritious food, which is suitable to the individual needs of residents, and staff practices at meal times are to be conducted to maximise service users’ capacity to exercise personal autonomy and choice. The registered persons must 30/11/07 ensure that any complaint made under the complaints procedure, regardless of source is fully investigated. The registered persons must 30/11/07 ensure that all persons employed by the registered persons to work at the care home receive training in Safeguarding Adults, which is appropriate to the work they perform and to ensure the safety of people who use the service, The registered persons must 30/11/07 ensure all parts of the home are kept clean and reduce infection control and health and safety risks posed to residents. The registered persons must 30/11/07 ensure the environment throughout the home reflects good practice guidance on dementia care within care home, to ensure the specialist needs of residents are met. 8 OP18 18 ( c) (i) 9 OP26 3 23 (d) 10 OP19 23 Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 28 11 OP29 19 (1) (c) Sch 2 12 OP30 18 (1) (a) (c) 13 OP27 18 (1) (a) 14 OP33 24 The registered persons must ensure that service users are supported and protected by the homes recruitment practices, which must be more robust, through ensuring the authenticity of references is checked and verified in respect to that person. Repeated Requirement. Timescale of 30/06/07 not met. The registered persons must ensure that training and training in specialist areas such as challenging behaviour and equality and diversity is provided to all members of staff, to ensure they are equipped with skills and competences to meet the needs of residents. The registered persons must ensure adequate numbers of staff must be on duty to ensure the health and welfare needs of all residents are met. The registered persons must ensure that the results of quality assurance surveys are acted upon. 30/11/07 30/11/07 30/11/07 30/11/07 Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations It is recommended the Statement of Purpose needs to be reviewed to include information of any specific activities or therapeutic techniques that may be used in the care home to meet the needs of individuals with dementia, to be made suitable for all client groups the service intends to accommodate. It is recommended the service consider providing the Statement of Purpose and Service User Guide in formats, such as Braille, appropriate languages, pictures, video and audio. It is recommended that residents living with dementia may benefit by the provision of pictorial menus or other methods such as making meals available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. It is recommended that picture charts of different types of faecal stools in communal bathrooms be removed. Whilst it is acknowledged that staff may need information pertaining to employment and clinical practice, it is not appropriate for this to impinge on residents’ communal areas 2 OP1 3 OP15 4 OP19 Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillside Nursing Home DS0000068195.V347704.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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