CARE HOMES FOR OLDER PEOPLE
Hillside Nursing Home Bicester Road Aylesbury Buckinghamshire HP19 8AB Lead Inspector
Ms Chris Schwarz Unannounced Inspection 31st January 2006 11:20 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 DS0000019229.V282722.R01.S.doc Version 5.1 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 DS0000019229.V282722.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hillside Nursing Home Address Bicester Road Aylesbury Buckinghamshire HP19 8AB 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) 01296 710011 Trinity Care Ltd Elizabeth Patricia Nicholas Care Home 67 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (36), of places Physical disability (11) Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th August 2005 Brief Description of the Service: Hillside Nursing Home provides care for sixty-six adults, eleven of whom are younger adults with physical disabilities. The building is divided into three units which accommodate service users with a range of personal care needs. All rooms are single and fulfil space requirements. The home is situated in the centre of Aylesbury and is therefore close to shops and transport links. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit took place on a week day and lasted from 11.20 am until 5.20 pm. It consisted of discussion with the manager, a tour of the building, opportunities to talk with staff and service users and to follow up on actions from the last inspection. The visit was positive, with evidence of good practice and compliance with the regulations and accompanying standards for care homes. Staff and service users are thanked for their hospitality and cooperation with this inspection. What the service does well:
Medication is well managed and appropriately stored, ensuring that service users receive their prescribed drugs according to the prescriber’s instructions. A range of activities is arranged for service users, providing them with variety and stimulation and matching social, cultural, religious and recreational interests. Contact with family, friends and the local community is facilitated, to maintain important social relationships. Service users are enabled to exercise choice and control over their lives in order that their rights are protected and they have a say in their care. There are effective complaints procedures at the home, ensuring that service users or their representatives are listened to. Adult protection and whistle blowing procedures are in place to protect service users from harm. A safe and well maintained environment has been created, to provide service users with attractive surroundings, free of hazards. There are sufficient toilets and washing facilities, to ensure that personal care needs can be met. Bedrooms are of a good size, single, comfortable and meet service users’ needs. Service users are enabled to bring in personal possessions to individualise rooms and make them homely. The premises are safe and comfortable, clean and hygienic, providing service users with good standards of accommodation. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 6 Thorough recruitment checks are undertaken of staff employed to work at the home, to ensure that competent staff provide care and that service users are protected from the risk of harm. The home is well managed, to ensure continuity of care and that service users’ needs are met. Service users’ financial interests are safeguarded, to protect against the risk of abuse. What has improved since the last inspection? What they could do better:
Television reception is poor in some parts of the home, resulting in snowy picture. An armchair in the downstairs lounge needs to be replaced as the cover is torn on the underside of the arm. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 7 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. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 8 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 DS0000019229.V282722.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards in this section were assessed on this occasion. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication is well managed at the home, ensuring that service users receive the drugs they require to keep them healthy and well. EVIDENCE: Medication was kept secure with each cabinet and trolley locked, within a locked room. Cabinets and trolleys were tidy with no out of date medications and date of opening had been added to packaging where necessary. The home was using a monitored dose system of medication administration, with drug administration records in good order. There were specimen signatures of the registered nurses and a photograph of each service user was in place. Care plans had been added for “as required” medications. Records were being kept of the temperature within the medication room, all readings showing that this was below 25°C. The medication fridge was also being monitored to ensure that the contents were appropriately stored. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 Service users are enabled to take part in activities which match their social, cultural, religious and recreational interests and needs, providing them with stimulation and variety. Service users maintain contact with family, friends and the local community to promote social relationships. Service users are enabled to exercise choice and control over their lives in order that their rights are protected and they have a say in their care. EVIDENCE: There was evidence of service users choosing to be in their rooms or in the lounges, being enabled to observe religious beliefs and being consulted about menu options for the following day. Service users who were spoken with talked of various activities being offered by the home to provide them with stimulation, both in-house and in the community. Several relatives visited the home whilst the inspection was taking place and visitors were at ease with staff and seen to be offered drinks by staff. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 12 Several service users have their own telephones to maximise contact with family and friends and times of visiting were flexible and acceptable to service users spoken with. Service users have been encouraged to bring in personal possessions to make their rooms homely and comfortable and there was evidence of various pieces of furniture, pictures, ornaments, photographs, televisions and radios as examples. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 There are effective complaints procedures at the home, ensuring that service users or their representatives are listened to. Adult protection and whistle blowing procedures are in place to protect service users from harm. EVIDENCE: The home has a complaints procedure in place and maintains a log of any complaints received, with details of action taken where necessary. The log booked provided evidence of complaints being acknowledged promptly and investigated speedily, with measures put in place to prevent recurrence, where appropriate. Adult protection procedures are in place to prevent the risk of harm to service users and there was evidence of staff passing on concerns to Social Services last year. Whistle blowing procedures are also in place and contained within the staff handbook which is given to each employee. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23, 24, 25 and 26 A safe and well maintained environment has been created, to provide service users with attractive surroundings, free of hazards. There are sufficient toilets and washing facilities, to ensure that personal care needs can be met. Bedrooms are of a good size, single, comfortable and meet service users’ needs. Service users are enabled to bring in personal possessions to individualise rooms and make them homely. The premises are safe and comfortable, clean and hygienic, providing service users with good standards of accommodation. EVIDENCE: Hillside is centrally located within Aylesbury, close to shops, transport and leisure facilities. There is a rolling programme of maintenance and the premises are well presented and attractive and purpose built to accommodate people using wheelchairs. The home has sufficient toilets, bathrooms and
Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 15 washing facilities with adaptations as necessary. Each bedroom is designed for single use with en-suite toilet facilities and all are of a good size and personalised, with space either side of the bed to enable access by carers assisting with care, or equipment. Each room has good natural lighting and service users were able to have windows open or closed, to suit individual preferences. All bedrooms were carpeted and had been furnished with necessary items unless the service user had bought their own furniture with them. Adjustable beds had been provided to facilitate personal care, as necessary. Staff had placed call bell leads close to service users who were in their rooms, in order that they could ring for assistance. Heating and lighting were sufficient to meet needs and there was good regard for hygiene and infection control throughout the building. The kitchen was being maintained to a high standard of cleanliness and order and had achieved praise from an environmental health officer after a recent inspection. The laundry was busy but in good order with due regard for hygiene and infection control. Two observations were made regarding the environment, where improvement would be desirable. Television reception continues to be poor in some parts of the home, resulting in snowy picture, and an armchair in the downstairs lounge needs to be replaced as the cover is torn on the underside of the arm. Recommendations are made to address these. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Thorough recruitment checks are undertaken of staff employed to work at the home, to ensure that competent staff provide care and that service users are protected from the risk of harm. EVIDENCE: The home had no staff vacancies at the time of this visit and there was no need for the use of agency staff to help cover the rota. A sample of six staff files were looked at, covering a range of positions at the home, all of which contained evidence of the required checks. Files were kept secure in the administrator’s office. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 35 The home is well managed, to ensure continuity of care and that service users’ needs are met. Service users’ financial interests are safeguarded, to protect against the risk of abuse. EVIDENCE: The home has an experienced and professional manager who maintains high standards within the home. She is registered with the Commission and has the necessary skills and background to lead the home. Notifiable incidents are promptly reported to the Commission. The home holds individual accounts for service users, using a computerised system which only the manager and administrator can access. Records were in good order, with clear details of money deposited into the accounts, individual expenditure and receipts to verify expenditure. A float of cash is kept at the
Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 18 home to ensure that service users can go out on trips and take part in activities as they wish. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP20 OP24 Good Practice Recommendations Chairs should be replaced where covers are split. Poor television reception should be improved. Hillside Nursing Home DS0000019229.V282722.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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