CARE HOMES FOR OLDER PEOPLE
Hillside Nursing Home Bicester Road Aylesbury Bucks HP19 8AB Lead Inspector
Chris Schwarz Unannounced 06 August 2005 09:45 a.m. 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 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 H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hillside Nursing Home Address Bicester Road, Aylesbury, Buckinghamshire, HP19 8AB Telephone number Fax number Email 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 Old age, not falling within any other category registration, with number (67), Physical disability (11) of places Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Maximum of eleven young Disabled Date of last inspection 02 February 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 H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit took place on a Saturday from 9.45 am until 2.00 pm. It was conducted by Chris Schwarz and Guy Horwood and involved speaking with the senior on duty and other staff, a tour of the building, examination of some required records and speaking with service users. What the service does well: What has improved since the last inspection?
Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 6 Communal bathing facilities are being kept clean and loose radiator covers have been repaired. 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.
Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Prospective service users are assessed prior to admission, to ensure that their needs can be met. EVIDENCE: Assessments had been undertaken prior to the admission of service users. A service user was due to move in on the day of this visit and a named nurse and keyworker had been allocated, needs were identified on the computerised care plan and due regard had been shown toward maintaining levels of independence by allocating a room near to the lounge, in order that the person could walk there. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 9 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 standard(s) 7, 8 and 10 Care plans are effectively produced and reviewed by the home, to ensure that service users’ needs are met. Service users’ health care needs are met, to promote wellbeing. Staff generally treat service users with dignity and respect to promote wellbeing. EVIDENCE: The home uses a computerised care planning system to identify and review care needs. A sample of individual plans was examined and found to be up-todate with evidence of regular evaluation. Risk assessments were in place where necessary and there were regular evaluations for reducing the risk of pressure ulcers. Service users were seen to have pressure relieving equipment and disability equipment as necessary. There was good regard for oral and personal hygiene and service users looked well presented in clean clothes and had been assisted to shave. Inspectors noticed a difference in how pressure evaluations are rated between two staff. It is recommended that this is examined in case there are communication or interpretation issues. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 10 Care plans showed evidence of involvement by other agencies such as doctors, speech and language therapists and dieticians. Notes reflected that staff are observant of changes to service users’ welfare, such as raised temperature, and contact doctors accordingly. All personal care was carried out behind closed doors and most staff were respectful in their interactions with service users. The only issue noted by inspectors was that one member of staff spoke about service users’ conditions and particulars in front of them and other service users. A requirement is set to ensure that staff refrain from doing this. There is a payphone in the entrance area of the home and some service users have their own private telephones. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 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 standard(s) 13 and 15 Service users are enabled to keep in contact with family, friends and others to maintain important social contacts. A wholesome, balanced diet is provided, to meet service users’ nutritional needs. EVIDENCE: Service users confirmed that they are able to see visitors in private and in communal areas of the home, and no restrictions were mentioned. Information for visitors is available in the entrance hall. A range of meals is offered to service users with choices available. The chef described an adequate budget and the current menu showed variety to meals. Soft and liquidised diets can be prepared and these had been well presented when seen at lunchtime. Service users said that food was good at the home. Some service users are tube fed. Care plans documented involvement of dieticians and speech and language therapists where necessary. There was good regard for keeping service users hydrated with drinks in all rooms.
Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 12 Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 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 standard(s) EVIDENCE: None of the standards in this section were assessed on this occasion. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home is a safe and generally well maintained environment, providing service users with comfortable surroundings. Communal areas and lavatory and bathroom facilities are sufficient to meet service users’ needs and the home has the equipment and adaptations necessary to help service users remain independent. Bedrooms are personalised, clean and safe, providing pleasant and comfortable surroundings. Overall, the home is clean and well presented although a few areas need attention to improve infection control. EVIDENCE: Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 15 Service users’ accommodation is on two floors, with a lower ground area containing the kitchen and laundry areas plus staff changing and rest areas and the training room. There is closed circuit television to monitor the entrance and car parking area of the home. Maintenance of the building is generally well managed, according to staff. Some bedrooms had marks on the walls where beds had been raised or lowered and there was evidence of a leak on the ceiling in room 8. These rooms should receive attention over the coming year. All rooms are single and have been personalised to different tastes and have en-suite toilets. Bedrooms are carpeted, kept clean and each room meets the space requirements. Television reception in some rooms was very snowy. It is recommended that this be looked into and improved. Communal space is well presented although a couple of chairs had split covers with the foam visible. It is recommended that these be replaced. Lighting and ventilation were satisfactory. An unpleasant odour was coming from one of the shower rooms, possibly from the drains. It is recommended that this be promptly investigated and rectified. The home has a variety of adaptations and equipment to meet service users’ needs and the building has been designed to take into account the need for widened doorways and corridors and space for manoeuvrability. Lavatories and bathrooms are sufficient in number and close to bedrooms and communal areas. Those service users in bed were placed close to call bells to be able to summon staff, with bedside tables containing the things they needed to hand. Adjustable beds were in use, where necessary. Some of the carpets in Lowry unit, where people are more mobile, had stains. It is recommended that these be shampooed. Some of the towels provided for service users were frayed at the edges. It is recommended that these be replaced. The laundry was busy. Protective gloves, hand wash and towels were available to staff and the person working in the laundry described an induction that included infection control and safe working practices. Whilst in the laundry some hazards were noted. A large pile of coat hangers had built up in one area on the laundry floor. It is recommended that hangers be kept off the floor to prevent accidental injury. The manual and roller irons were seen to be kept on even when not in use. These must be switched off when not in use to prevent injury and reduce fire risk. Cleaning materials and products at one end of the laundry were spread around and a tidy up would be beneficial. No apron was put on when handling soiled washing, which could pose an infection risk. Recommended and required action has been made to improve practice.
Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 16 A collection of unwanted furniture and other items had accumulated outside of the laundry. It is recommended that this be disposed of promptly. Gloves and aprons were available to staff around the building. Some staff were seen wearing protective garments in communal areas after attending to service users in bedrooms or bathrooms. A requirement is set to ensure tighter infection control measures are in place. Some ceiling tiles were missing, for example by room 1 and in the kitchen corridor. These should be replaced. Sluices are located around the building and soiled linen is washed at appropriate temperatures. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home seems to have adequate numbers of staff on duty with a mix of skills to meet service users’ needs. Staff are trained to perform the duties expected of them, ensuring that care needs are met. EVIDENCE: There were sufficient staff on duty at the time of this visit, with a mix of qualified nurses, carers, domestic and catering staff to meet service users’ needs. Call bells were not ringing for long periods of time and one service user volunteered that she was “very well cared for”. One person said “they look after me beautifully”. Some other service users who were able to express an opinion spoke well of staff and interactions were gentle with use of humour where appropriate. One new member of staff showed her induction pack and this was a comprehensive tool supplemented by mandatory training. This member of staff had a mentor and was due to be starting National Vocational Qualification soon. Other staff described good training opportunities and it was good to note that catering and domestic staff are included in abuse awareness training. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 37 and 38 There is effective management of the home, to ensure that needs are met. There are quality assurance systems in place, to ensure that service users’ needs are met at the home. Records are well maintained, ensuring that service users’ rights and best interests are safeguarded. The health and safety practices could be improved, to provide a safer environment for service users, staff and visitors. EVIDENCE: The home has a registered manager with relevant skills and qualifications necessary for the job. A poster displayed in the home confirmed that the
Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 19 manager continues to work until 7 pm on Mondays in order that relatives or other persons who are unable to get to the home during office hours can see her. Notifiable incidents are promptly reported to the Commission for Social Care Inspection. Monitoring visits are undertaken by the provider organisation to assess the quality of care. Reports of these visits have been forwarded up until and including the March 2005 visit. The provider is asked to forward reports of subsequent visits to the Aylesbury office. Record keeping was good for the sample of records seen on this occasion, with evidence of reviewing. There is, overall, good regard toward health and safety. The kitchen was in particularly good order given that it was just after midday by the time inspectors reached this part of the building. Fridge and freezer temperatures and cooked food core temperatures are regularly monitored and dried food is properly stored. It was noted that staff were not using the agreed system for charging equipment in corridors. Timers had been purchased to ensure that hoists and wheelchairs were only charging for set periods of time, not continuously, but these were not being used. A requirement is set to attend to this, to ensure that adequate safeguards are taken against the risk of fire. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x 2 x x x 3 2 Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 21 no 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. 2. 3. 4. Standard 26 26 10 33 Regulation 23(4)a 23(2)d 12(4)a 26(5)a Timescale for action Manual and roller irons must be by 1st switched off when not in use. September 2005 Stained carpets in Lowry unit are by 30th to be shampooed. September 2005 Staff are to refrain from by 1st speaking about service users and September their conditions infront of them. 2005 Reports of monitoring visits by 30th undertaken by the provider from September March 2005 are to be forwarded 2005 to the Aylesbury office. Electrical equipment left to by 1st charge in corridors or other open September areas of the home must be 2005 attached to a timer switch. Infection control measures are to by 1st be tightened through use of September protective garments where 2005 necessary and removal after completion of the task. Requirement 5. 38 23(4)a 6. 26 13(3) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 22 Hillside Nursing Home 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Standard 20 21 20 26 26 19 20 8 24 19 Chairs should be replaced where covers are split. The cause of the odour from the shower room should be investigated and rectified. Frayed towels should be replaced. Coat hangers should be kept off the laundry floor. Cleaning products and materials in the laundry should be tidied up. The unwanted furniture and other items outside the laundry should be promptly disposed of. Missing ceiling tiles should be replaced. A difference in rating pressure risks should be explored. Poor television reception should be improved. Decoration should take place over the coming year to rooms where walls have become marked through use of equipment and where there is evidence of leaks. Hillside Nursing Home H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 23 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 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 H53_H02_S19229_Hillside_UI_V242333_060805_Stage 4_CAS_ces.doc Version 1.40 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
