Inspection on 04/03/08 for Hillside Nursing Home

This inspection was carried out on 4th March 2008.

CSCI found this care home to be providing an Poor service.

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 07/05/09

Hillside Nursing Home 06/08/08

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 HOMES FOR OLDER PEOPLE Hillside Nursing Home 30 Dover Road Southport Merseyside PR8 4TB Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 4th March 2008 09:00 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 DS0000069804.V356423.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 DS0000069804.V356423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address 30 Dover Road Southport Merseyside PR8 4TB 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) 01704566312 01704566312 Veatreey Development Ltd Vacant Post Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Hillside Nursing Home DS0000069804.V356423.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 people 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 The maximum number of people who can be accommodated is: 16 Date of last inspection 5th June 2007 Brief Description of the Service: Hillside is a large detached house, which has been converted into a care home for 16 older persons. It is situated in a residential area of Southport with easy access to the town centre, local amenities and public transport. The service provides accommodation over 3 floors with lift and stair lift access to each floor. Hillside has 12 single bedrooms and 2 double bedrooms. There are no en suite facilities. There is a lounge but the service does not have a dining room. The service has equipment and aids to help residents who are less independent and a call system with an alarm facility operates throughout. There is a large enclosed garden at the rear of the premises with ramp access and parking is available in the front garden area. Veatreey Development Ltd own Hillside. Hillside has no manager at present. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over a one-day period for the duration of 8.5 hours. 10 residents were accommodated at this time. As part of the inspection process all areas of the service were viewed including most of the residents bedrooms. Care records and other home records were viewed. Discussion took place with some of the residents, staff and relatives. The inspection was conducted with Helen Atkinson The registered nurse in charge. During the inspection 2 residents were case tracked (their files were examined and their views of the service were obtained). All of the key standards were inspected. Satisfaction forms “Have your say about…..” were distributed to a number of residents. A number of comments included in this report are taken form the surveys and from interviews. An AQAA (annual quality assurance assessment) was completed by the service prior to the visit. The AQAA comprises of two self-assessment questionnaires that focus on the outcomes for people. The self- assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Weekly fees are £485. What the service does well: The service carry out pre admission assessments of prospective residents therefore ensuring health and personal care needs are identified. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 6 One relative interviewed confirmed that they were happy with the care and stated, “Mum had 2 pressure sores on both feet, (when she came in) the two on her feet have cleared up and the one on her back is very much improved”. Visitors and families are encouraged to visit when they wish. One of the residents interviewed stated, “my family come every week, I was out for lunch on Mothers Day, I’m out often”. Residents and relatives confirmed that families are made welcome at any time. Residents stated, “my family can come anytime they want to” and “my brother visits me, he comes when he wants”. Residents interviewed were complimentary about the service. Residents interviewed stated: “I have been here some years and love it it’s lovely” “I like it here, I like it very much, there’s nothing wrong with it”. One of the relatives interviewed stated, “I think it is lovely, very friendly, I have my mum in law here as well”. Relatives interviewed stated, “the food has drastically improved and the menu is varied, the food is really presented well” and “she is asked what she wants for her meals”. What has improved since the last inspection? The most recent assessment this year shows an improvement in the amount of information collated to ensure residents care needs are identified prior to admission. Since the employment of the new chef all health and safety systems are in place with records kept. Work has commenced on the refurbishment of the fire escape. The sitting room has been newly carpeted and decorated with new light fittings. A new large plasma screen television is fixed to the wall ensuring residents can view easily. The sitting room is pleasantly furnished and residents seemed to be relaxed and comfortable in their chairs. Residents interviewed liked the new décor and thought it very nice. Residents’ comments include, “my bedroom is nice and cosy and yes it’s clean” and “it’s comfortable here”. Other areas of the service have been redecorated including resident bedrooms. New carpets have also been fitted. The laundry has been improved by the purchase of a new washing machine, tumble drier and a clothes rail. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 7 What they could do better: The care plans have not been signed and agreed by the residents or their representative therefore this needs to be addressed as care plans need to evidence that residents choose and agree how they wish to be cared for. One resident interviewed was unsure of what a care plan was and stated, “I’ve not seen a care plan”. The management of medication needs to be improved to ensure resident care is not compromised. Medication prescribed for three of the residents has one or two staff initials missing therefore it is not known if the resident had their prescribed medication or not. There was a problem with overstocking of some medication for some residents at the last inspection visit and this remains a problem. Residents need to have more input from staff with regard to activities they would like, which would prevent feelings of isolation. One relative interviewed stated, “there are no activities at present, they did have but I have not seen any of them doing anything now, sometimes the staff just chat amongst themselves”. Relatives interviewed about how they raise concerns stated: “I have been in the office and discussed concerns with senior staff, I know of the complaints procedure and book, sometimes the complaint is resolved but the laundry ones re occur”. One relative commented, “to be fair everything is ok if I was concerned, I would ring social services, it’s a very friendly home”. Residents are not protected, as many do not have a secure facility in their room. Residents are placed at risk through poor staff pre employment procedures. One staff file evidenced a carer had commenced work before the CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been applied for. There are no written references on file for this carer either. The nurse in charge was advised that this carer is not to work any more at the service until references are in place. The training provided for staff has been inconsistent and erratic. Training records are not up to date therefore an audit needs to be carried out to identify the training needs of all the staff employed in the service. Families interviewed had mixed views of how staff was managing the care of their relatives. Relatives were concerned that there was no manager in place. One relative stated, “there is a high turnover of staff nearly all have left since her admission”. Another relative commented, “the staff have changed completely on the carers side but everything seems to be back on track now Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 8 and they are all very helpful and nothing seems to be too much trouble if I have to ask about anything”. Residents interviewed stated, “staff are lovely, I couldn’t complain, they are very nice” and “there are always staff about if I need them”. The service has no record of registered provider visits and none has been sent to the commission. The registered provider is recommended to visit the service on a monthly basis and document these visits. There are no quality assurance systems in place. Residents have not been canvassed for their views for some time now. Relatives and staff are not canvassed for their views either The certificate of liability insurance is out of date. The portable appliance testing (Pat) has not been checked since 8/06. Immediate requirements were made and left with the nurse in charge to address. The service is placing residents and staff at risk by not providing sufficient mandatory training. 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 DS0000069804.V356423.R01.S.doc Version 5.2 Page 9 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 DS0000069804.V356423.R01.S.doc Version 5.2 Page 10 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): OP3 was assessed. OP6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service carry out pre admission assessments of prospective residents therefore ensuring health and personal care needs are identified. EVIDENCE: Two residents care files were case tracked (care records of each resident are examined). Both files evidence that each prospective resident has been assessed prior to admission. Both assessments were dated and signed by the person(s) carrying out the assessments. Relatives interviewed stated, “we did get all the info before …. Moved in she was assessed at the hospital by the manager and “it included an opportunity to visit (open time) to suit the family, we met matron, staff and visited the accommodation”. One resident commented, “my family helped me to decide about this care home”. Residents interviewed confirmed they had met the manager prior to their admission. One resident stated, “my brother helped with me coming here”. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 11 The assessment process evidences all prospective residents care needs have been looked at including medication, communication, mood, orientation, sight, social needs, mobility and appliances used, diet, pain, allergies, personal care needs, skin care, bowel and bladder care, breathing, sleep pattern, safety including falls risk, chiropody and oral/dental health. Likes and dislikes are discussed and preferences for breakfast included. There is also information regarding one residents skin care and an outline of the area affected is in place with prescribed treatment identified. The most recent assessment this year shows an improvement in the amount of information collated to ensure residents care needs are identified prior to admission. NOK and health professional contacts including GP are included. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 12 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): OP7,8,9,10 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of medication needs to be improved to ensure resident care is not compromised. EVIDENCE: Personal details including family contacts, GP and other health professional contact details are in place. The two files viewed evidenced a care plan had been set up on admission to the home. The care plans have not been signed and agreed by the residents or their representative therefore this needs to be addressed as care plans need to evidence that residents choose and agree how they wish to be cared for. One resident interviewed was unsure of what a care plan was and stated, “I’ve not seen a care plan”. Relatives interviewed stated, “we have not discussed the care plan or had any reviews either”. One of the newer care plans summarises the care needs of the resident. The care plan then goes on to identify goals and interventions including personal hygiene, dressing assistance, choice of clothing, nail care, hair, toileting regime, pressure area care, privacy and night care plan-re sleep pattern. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 13 Daily evaluation records are kept for each resident and evidence day and night entries. One resident had documented evidence on the daily evaluation that they had lost their appetite and were not eating very well but was not reflected in the care plan about how staff were going to manage this residents diet. There is no weight record or nutritional assessment for this resident either, which could have placed this resident at risk. The resident has since regained her appetite therefore minimised the risk but this needs to be carefully monitored. The other resident file evidenced regular weights and nutritional assessment. GP and other health professional visits/interventions including chiropodist, dentist, community physiotherapist and opticians are evidenced in care files. Residents interviewed confirmed they had recently seen the chiropodist. One resident stated, “you get good care, I see the chiropodist every six weeks, he was here yesterday”. One relative interviewed confirmed that they were happy with the care and stated, “Mum had 2 pressure sores on both feet, (when she came in) the two on her feet have cleared up and the one on her back is very much improved”. A resident interviewed stated, “yes I have seen the Dr the girls rub the cream onto my legs-they are a little better”. Risk assessments are in place with regard to the possibility of residents developing pressure sores and preventative measures including specialist equipment are available. Some of the specialist equipment was viewed during a tour of the home including pressure relieving mattresses and cushions. Risk assessments are in place with regard to risk of falls. Manual handling assessments are in place. These just need to identify the sling type and hoist name to ensure all staff are aware of which to use for the individual residents. Bed rails are in use for some of the residents and all have ‘bumpers’ to guard and protect the residents whilst in place. As bed rails are a form of restraint this needs to be monitored on a regular basis by senior staff with documentation identifying this is reviewed. Bed rails need to be examined weekly to ensure they are still fitted correctly according to the manufacturers instructions. The medication file holds a list of current registered nurses with signatures/initials in place. A medication audit was carried out by the previous manager in November 2007 and identifies one or two areas for attention Most of the medication is administered from ‘blister packs’. Medication records evidence ordering and receipt of medication with dose and amount recorded. Allergies are identified. Medication prescribed for three of the residents has one or two staff initials missing therefore it is not known if the resident had their prescribed medication or not. No reason was recorded for the omission. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 14 The daily medication round is administered from a medicine trolley, which is secured to a wall on the ground floor when not in use. Additional medication is stored in a locked medicine cabinet. The trolley was tidy and organised. There was a problem with overstocking of some medication for some residents at the last inspection visit and this remains a problem. There was also prescribed medication/treatments in stock for two residents who are deceased. The dressings cupboard was untidy and difficult to see what was in stock/out of date. The service has a local contract to ensure the disposal of old and unused medications. There is no returns/disposal book but a hand written record evidences the most recent list of medication. Residents confirmed that staff would check it was okay before entering their bedrooms. One resident commented, “everybody is very kind and respectful of my privacy”. Residents in one of the ground floor rooms’ share but the screens that were in place last visit were not there. The RN was asked to replace them to ensure resident privacy and dignity is maintained. A concerned relative stated, “one of the girls was lying on one of the residents beds eating her dinner”. This was passed on to the nurse in charge to resolve, as residents bedrooms are their own personal space. One of the relatives interviewed was concerned that personal care was being compromised and stated, “her finger nails are not being cut, she doesn’t look dirty but we are worried about the food under her finger nails and we don’t know when her hair was last washed”. Another relative interviewed had no concerns about their relatives personal grooming and stated, “her nails seem to be okay, she is always clean and tidy”. Other residents were observed to be well groomed during the inspection visit. The concerns that the relative has raised need to be addressed to ensure residents’ dignity is promoted. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 15 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): OP12,13,14,15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents need to have more input from staff with regard to activities they would like, which would prevent feelings of isolation. EVIDENCE: Many of the residents are very frail and cannot or do not wish to participate in activities. One relative interviewed stated, “there are no activities at present, they did have but I have not seen any of them doing anything now, sometimes the staff just chat amongst themselves”. One resident interviewed stated, “I read magazines, I’m not lonely, I like to sit here and I have a telly if I want it”. Residents interviewed confirmed that there were not as many activities going on. One resident stated, “there haven’t been a lot recently, sometimes we have a game of bingo or skittles”. One staff interviewed stated, “we have bingo and skittles, not so many residents can play, residents that cannot play then we chat to them and sit and talk with them”. One of the relatives commented, “in the past the previous matron organised some activities for the residents including beauty afternoons which made a change along with other things but this doesn’t seem to happen anymore Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 16 which is a great pity. I feel something should be done a couple of times a week with the residents who are able and if they want to take part”. Visitors and families are encouraged to visit when they wish. One of the residents interviewed stated, “my family come every week, I was out for lunch on Mothers Day, I’m out often”. Residents and relatives confirmed that families are made welcome at any time. Residents stated, “my family can come anytime they want to” and “my brother visits me, he comes when he wants”. A relative interviewed stated, “they don’t ask us if we want a cup of tea anymore, it has stopped, I don’t know why” Communion is provided for residents who wish to participate. Residents interviewed confirmed they lived their lives as they wished within their limitations and with staff support were needed. Residents interviewed stated: “I usually go to bed at 11, I see to myself and get up at 8-8:30 and have breakfast in the lounge, I enjoy having it with other residents in the lounge” “I get up when I want to a little girl comes in to help me” “you can go to bed when you want to”. Residents are encouraged to maintain their independence were able. One resident stated, “I don’t need help with my bath someone will come to help when I am ready to come out-they sit outside”. Residents confirmed they were encouraged to make choices about what clothes they wished to wear. One resident stated, “the girl will open the wardrobe and I will say I’ll have so and so on today”. Residents interviewed were complimentary about the service. Residents interviewed stated: “I have been here some years and love it it’s lovely” “I like it here, I like it very much, there’s nothing wrong with it”. One of the relatives interviewed stated, “I think it is lovely, very friendly, I have my mum in law here as well”. The new chef has been in post some months now and he stated, “I have tried and tested various dishes to find out residents preferences, they have a multi choice, residents are allowed to have what they wish. If they don’t like what is on the menu they can have something else”. Milk puddings (various) are served alternate days as residents particularly like them. The evening meal has improved and residents are no longer just served sandwiches. Residents interviewed were complimentary about the meals served and stated, “the food is quite good really, you get a choice” “we get nice food, we have a good chef” “I had a lovely lunch” “you can just go and ask, when you want a cup of tea” Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 17 Relatives interviewed stated, “the food has drastically improved and the menu is varied, the food is really presented well” and “she is asked what she wants for her meals”. One relative commented, “the cook is excellent, the food is varied and very well presented, there has only been one occasion when I have had to complain”. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 18 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): OP16,18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not protected, as many do not have access to a secure facility in their room. Complaints are not fully recorded and confidentiality is compromised as complaints records are not secure. EVIDENCE: A complaints procedure is in place and the service has a copy of the Sefton Adult Protection Procedure. The complaints book was available to view. It was not stored securely. Five complaints have been raised and all were upheld. The complaints record is brief and does not evidence the full procedure of investigation and outcomes for residents. An adult protection procedure was carried out and upheld also. Staff have attended the alerter training arranged by Sefton. There is no valuables book. Some of the residents have access to a locked drawer in their room and others don’t. The registered nurse in charge was unsure if valuables or money were kept on behalf of residents. The nurse stated, “I don’t have a key for the safe or access to financial records held”. The inspector had viewed the financial records at the previous inspection and full records had been kept. Residents in one of the ground floor rooms’ share but the screens that were in place last visit were not there. The RN was asked to replace them to ensure resident privacy and dignity is maintained. A concerned relative stated, “one of the girls was lying on one of the residents beds eating her dinner”. This was passed on to the nurse in charge to resolve. This shows a lack of respect Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 19 towards the residents and their basic human rights. Bedrooms are for the individual residents own private space and the privacy and dignity of the residents have to be promoted at all times. Relatives interviewed about how they raise concerns stated: I have been in the office and discussed concerns with senior staff, I’m not keen to write complaints down, I’d rather discuss and I know of the complaints procedure and book” “sometimes the complaint is resolved but the laundry ones re occur” Relatives commented: “I have no complaints at all” “If you do bring something to mind it is sorted no qualms at all”. “Informally I can speak to staff here and it is always resolved” “To be fair everything is ok if I was concerned, I would ring social services, it’s a very friendly home” “I’ve never had to speak to matron or nurse because I’m happy” “matron or nurse in charge always available for any discussion, never had to complain” Residents interviewed stated: “If I were worried about anything I could talk to my brother, no one has discussed the complaint procedure” “If I were worried about anything I would talk to Helen” (Nurse). Residents’ comments include: “the management are always there to listen to anything that needs to be spoken about and always act on any suggestions made to the best of their ability”. A comments book is on display in the front hall and complimentary comments have been made with regard to various events in the service. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 20 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): OP19,26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides a comfortable and homely environment for residents. The maintenance schedule is not consistent to ensure the service is safe for residents and staff. EVIDENCE: There is no record of any buildings audit being carried out or planned improvement to view although there have been some improvements to the service over the past few months including décor of residents bedrooms, as viewed during the visit. The service was without a maintenance person for a short time and some of the maintenance checks have been missed. The new person has documented evidence of work and checks carried out recently. Work has commenced on the refurbishment of the fire escape. The rear garden has been tidied up but there are no flowers/shrubs in place for residents to enjoy. The sitting room has been newly carpeted and decorated with new light fittings. A new large plasma screen television is fixed to the wall ensuring residents can view easily. The sitting room is pleasantly furnished and Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 21 residents seemed to be relaxed and comfortable in their chairs. Residents interviewed liked the new décor and thought it very nice. The service has no separate dining room therefore residents eat from small individual tables. The ground floor double bedroom in use by two residents was also being used as a storage area for wheelchairs. Call bells were checked on the visit with one faulty. Both of these were related to the nurse in charge so that they could be resolved. None of the bedrooms have an en-site facility. There are some empty bedrooms in the service so residents who share should be offered a bedroom of their own. This would give them privacy. Since the employment of the new chef all health and safety systems are in place with records kept. The kitchen was viewed during the inspection and was observed to be organised and clean. Records are kept with regards to all hot food temperatures and fridge/freezer temperatures are recorded also. A cleaning schedule is in place and identifies daily chores covering all areas of the kitchen and storage. The storeroom was tidy and evidenced dried food goods. The laundry facility is situated in the rear garden. A new hanging rail has been fitted to enable residents clothing to dry. A new washing machine and tumble dryer has been purchased and an iron and ironing board is in place. The flooring has yet to be replaced on one half of the floor, therefore making it difficult to clean. Individual baskets are being used for individual residents. Dirty laundry is stored separately next to the outhouse in a large container as recommended by EH. Staff interviewed confirmed that they had protective clothing supplied and stated, “we have gloves and aprons, and there are no problems with that”. The service had evidence of a waste contract dated 2008. Residents interviewed were mostly satisfied with their laundry but one residents relatives were unhappy with the service and stated, “some items have gone missing, it is very rarely ironed, half of her clothes disappear, usually in the wash” and were unsure if the clothing was still missing. One resident commented, “the laundry is ok but they sometimes get things mixed up”. Relatives commented on the cleanliness of the service include: “I never smell any smells at all, the bedroom is clean Teddy was under the bed were it was a little dusty but 95 of the time it is clean”. “The owner is always trying to improve Hillside”. Residents commented: “my bedroom is nice and cosy and yes it’s clean” “it’s comfortable here” Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 22 “cleanliness, no issues. They have re decorated the front room and hall landing” “sometimes my carpet under the bed and behind my chair could do with a little bit more of a vacuum”. “my room is possibly in need of refurbishing, curtains, bedding etc but I understand this work is planned”. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 23 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): Op27,28,29,30 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are placed at risk through poor staff pre employment procedures. EVIDENCE: The staffing rota evidences staff employed in the service. Registered Nurses provide 24-hour cover. Due to reduced number of residents there are two carers employed in the day. This needs to be closely monitored to ensure resident care is not compromised. Two staff files were examined. Not all pre employment checks were in place prior to staff working in the service. One file evidenced a carer had commenced work before the CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been applied for. The POVA first came through nearly 3 weeks later. The CRB has yet to be returned. There are no written references on file for this carer either. The nurse in charge was advised that this carer is not to work any more at the service until references are in place. Following this she may work under supervision until the CRB has been approved. The other file checked showed evidence of enhanced CRB check. Other information included in the files such as application forms identifying employment history, copies of previous training certificates, job description and staff appraisals. The second file had two written references but there is no Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 24 date on them. Each file has a list of induction covered with ticks in place. The induction is brief and does not cover enough areas for the carer position. The induction is not dated either. One of the carers interviewed confirmed they had an induction and stated, “I did my induction it lasted most of the day and I was introduced to the residents and shown the fire alarms and exits, I felt competent following the induction, I have not had any training since I started”. One carer interviewed confirmed they had attended some training over the years including alerter training, manual handling, infection control and fire training. The carer also confirmed that they had done basic food hygiene training about 5 years ago therefore is out of date. Neither staff interviewed has had equality and diversity training. Two care staff has the NVQ Level 2/3 qualification in care. Most staff have attended the alerter training held by Sefton last year. The training provided for staff has been inconsistent and erratic. Training records are not up to date therefore an audit needs to be carried out to identify the training needs of all the staff employed in the service. Each member of staff needs to have an individual training and development assessment profile. Families interviewed had mixed views of how staff were managing the care of their relatives. Relatives were concerned that there was no manager in place. Relatives interviewed stated: “there is a high turnover of staff nearly all have left since her admission” “we have not come across any worries about staff, ……is unsettled because of all these knew ones” “ we have not observed any horrid behaviour from staff” Residents interviewed about staff stated, “staff are quite kind, some are patient, two staff on nights (ladies) are not very patient” “staff are lovely, I couldn’t complain, they are very nice” “yes there are enough staff to look after us they are very good, very nice” “night staff are nice” “there are always staff about if I need them” Comments received from relatives include: “never a problem, staff always make time to discuss things at all levels” “the staff have changed completely on the carers side but everything seems to be back on track now and they are all very helpful and nothing seems to be too much trouble if I have to ask about anything” Staff interviewed stated: “I like it here, the care is good, staff are nice, all of them. The residents are very well looked after. One of the residents was complaining that they had been sat up here for ages, I explained that we are busy”. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 25 “I am very attached to the home I love it the staff are very good, I think the caring is excellent, Helen is in charge, I think she is wonderful, she is a star”. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 26 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): OP33,38 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service is placing residents and staff at risk by not providing sufficient mandatory training. EVIDENCE: OP 31 cannot be assessed, as the service has no manager employed. The last registered manager left in April 2007 and the deputising manager resigned and left in January 2008. The service has no record of registered provider visits and none has been sent to the commission. The registered provider is recommended to visit the service on a monthly basis and document these visits. These will then be available for the inspector to view during the inspection visits. The purpose of these visits is to canvass the views of the residents and staff on how Hillside is Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 27 run. It also gives the provider the opportunity to audit the management of the service and observe what the service is offering residents. There are no quality assurance systems in place. Residents have not been canvassed for their views for some time now. Relatives and staff are not canvassed for their views either. There have been no residents or staff meetings. A comments book is on view in the hall and relatives’ comments have been recorded. The RN in charge did not know if any monies or valuables are held on behalf of residents and has no access to the safe or financial records. Therefore OP35 could not be assessed. The certificate of liability insurance is out of date. An immediate requirement request was made and left with the nurse in charge to address this and followed up with a letter to the registered provider. A new bath thermometer is now in place therefore staffs need to record the bath temperature prior to bathing a resident to ensure residents safety. The service was without a maintenance person therefore some of the maintenance checks were missed. The checks have recommenced now. The maintenance person checks hot water temperatures at various outlets in the service on a weekly basis and documents the results. The service have a contract with a local fire officer who has checked all the fire alarm system on all zones and documented in the fire log last month as viewed. The maintenance book identifies various jobs that needed doing and signed when carried out. Routine maintenance of light bulb checks, smoke detectors, fire extinguishers and fire alarms have been done. The emergency lighting was last checked in 11/07. The portable appliance testing (Pat) has not been checked since 8/06. An immediate requirement was made and left with the nurse in charge to address this and followed up with a letter to the registered provider. Other certificates evidence the gas boilers and water heaters are in date. The AQAA states the lift was serviced in 10/07 but the certificate available viewed showed 26/1/07. The hoists and stair lift were last serviced in May 07. Policies and procedures have been reviewed in January 2008. Much of the mandatory training for staff is out of date and therefore placing residents at risk. Some of the staff has not attended mandatory training for some time. It is difficult to ascertain what mandatory training has been attended as the training matrix has little evidence of staff attending mandatory training including fire, basic food hygiene, manual handling, infection control and health and safety. Two staff has the first aid certificate and the chef has an up to date certificate in basic food hygiene. Staff induction also needs to Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 28 improve to evidence all new staff have sufficient training to meet government standards. Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X 1 Hillside Nursing Home DS0000069804.V356423.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? New Service 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that all nurses sign the medication record immediately after administering medication to residents, to eliminate risk of medicines being administered twice. The registered person must ensure that the management of medication stock is improved to ensure that residents do not have several months supply of medication. Also must ensure that unused stock is logged and disposed of through the approved contractor. The registered person must ensure that all registered nurses have medication training and an assessment of their skills following the training with records kept to ensure resident safety. The registered person must ensure that where residents share a bedroom screens are used to ensure resident privacy. The registered person must ensure that the service provide a DS0000069804.V356423.R01.S.doc Timescale for action 04/04/08 2 OP9 13 (2) 04/04/08 3 OP9 13 (2) 02/06/08 4 OP10 12 (4) (a) 04/04/08 5 OP18 16 (2) (l) 02/06/08 Hillside Nursing Home Version 5.2 Page 31 6 OP19 23 (2) (b) (c) 19 (1) (b) sch 2 7 OP29 8 OP30 18 (1) (a) (c) (i) 9 OP31 10 OP33 Sec. 11 (1) Care Standards Act 2000 21 (2) 24 (1) (a) (2) (3) secure facility in resident bedrooms so that they can lock away any valuables. The registered person must ensure that the maintenance is consistent to ensure the service is safe for residents and staff. The registered person must ensure that all staff has full pre employment checks in place prior to commencing work at the service. The registered person must ensure that all staff has sufficient training including a structured induction in line with Skills for Care induction standards. The registered person must appoint a manager who will then apply for registration with the commission. 02/06/08 04/04/08 30/06/08 30/06/08 11 OP38 18 (1) (a) (c) (i) The registered person must 02/06/08 ensure that residents, relatives and staff views of how the service is run are obtained and their responses open to inspection. The registered person must 30/06/08 ensure that all staff is provided with mandatory training to ensure the needs of the residents and staff are protected. Staff training records must evidence this. 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 OP7 Good Practice Recommendations The inspector strongly recommends that all residents DS0000069804.V356423.R01.S.doc Version 5.2 Page 32 Hillside Nursing Home 2 OP7 3 OP8 4 OP9 5 OP12 6 7 8 9 10 11 12 13 14 15 OP16 OP18 OP18 OP19 OP22 OP26 OP27 OP28 OP30 OP35 should agree and sign their care plans. The inspector strongly recommends that all residents’ care should be reviewed and where changes take place this is identified in care plans. Families should be involved in these reviews were agreed. The inspector recommends that hoist and slings used for individual residents should be identified in care documentation so that all staff is aware of equipment to be used. The inspector recommends that were deceased residents medication is in stock it should be disposed of to the approved contractor. A record ensuring this has been carried out should be kept. The inspector strongly recommends that residents should be canvassed for their views on activities they wish to participate in according to their preferences and abilities. A list of activities should then be made for residents. The inspector recommends that complaints records should be kept secure. The complaints investigation should also be in more detail with outcomes recorded. The inspector strongly recommends that staff should promote individual residents basic human rights by ensuring residents dignity and privacy is maintained. The inspector strongly recommends a valuables book should be in place to record any valuables held on behalf of residents and ensure they have a copy of any kept. The inspector recommends that the double bedroom on the ground floor whilst occupied by residents should not be used as a storage area for other resident wheelchairs. The inspector recommends that the call bell system in the bedroom identified during the visit should be repaired. The inspector recommends that the laundry floor should be completed. The inspector strongly recommends that staffing levels should be monitored. The inspector recommends that further training should be provided for staff to qualify to NVQ Level 2 in care. The inspector recommends that all staff should have a training and development assessment profile. The inspector recommends that the financial records of residents’ personal monies should be available and open to inspection. Hillside Nursing Home DS0000069804.V356423.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. 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