Inspection on 06/08/08 for Hillside Nursing Home

This inspection was carried out on 6th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hillside Nursing Home 07/05/09

Hillside Nursing Home 04/03/08

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Hillside Nursing Home 30 Dover Road Southport Merseyside PR8 4TB Lead Inspector Mrs Margaret Van Schaick Key Unannounced Inspection 6th August 2008 08:30 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.V363899.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.V363899.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 Manager post vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Hillside Nursing Home DS0000069804.V363899.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 4th March 2008 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 local amenities and public transport to the town centre. 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 no dining room. The service has equipment and aids to help residents who are less independent and a call system with an alarm facility, which operates throughout the service. There is a large enclosed garden at the rear of the premises with ramp access. There is parking facilities in the front garden. Veatreey Development Ltd own Hillside. A proposed manager Beryl Barton has been appointed. Weekly fees are between £500-£543. Hillside Nursing Home DS0000069804.V363899.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 1 star. This means that that people who use this service experience adequate outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over one day for the duration of 8 hours. 9 residents were accommodated at this time. As part of the inspection process all areas of the service were viewed including all of the residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and one relative. The inspection was conducted with Beryl Barton (proposed manager). 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 and requirements and recommendations from the last inspection in March 2008 were discussed. Satisfaction forms ‘Have your say about….’ Were distributed to a number of residents, relatives, staff and health professionals prior to the visit. A number of comments included in this report are taken from the surveys and from interviews. An AQAA (annual quality assurance assessment) was completed by the proposed manager prior to the site visit. The AQAA comprises of two selfassessment questionnaires that focus on the outcomes for people. The selfassessment provides information as to how the proposed 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. What the service does well: The information gathered about prospective residents prior to admission is sufficient to meet the needs of the residents. Residents are encouraged to live their lives as they wish with staff support where needed. The service provides caring and supportive staff, which ensures that residents settle into the service quickly. Residents interviewed gave positive views on the staff employed in the service. Residents stated, “Staff are marvellous and Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 6 kind” and “Staff are very kind, they will do anything for you, Beryl is a lovely person and we have met the new owner, he is very nice”. What has improved since the last inspection? There is documented evidence that residents or their representative are signing to agree their care plans. Resident care is being reviewed as evidenced on care documentation. The screen is again in use in the double bedroom therefore providing privacy for the residents who share. Resident activities have improved. A secure facility has been provided for complaints records to be stored. Procedures are in place to ensure residents are protected. Residents now have a secure facility in their bedrooms. A valuables book is in place. Residents occupied bedrooms are not used for storage of other equipment such as wheelchairs. A maintenance person is employed to work three days each week therefore most of the maintenance checks are up to date. First impressions show an attractive and well-maintained building. The garden grounds are much improved and garden pots and hanging baskets are in place in the rear garden and at the front entrance, which is very welcoming. Residents live in a comfortable environment. There has been a vast improvement to the service with many changes including, new windows and fire doors throughout, new bedroom furniture, soft furnishings, carpeting and lighting. Residents and families are delighted with the improvements. One resident interviewed stated, “Have you seen the new chandelier in the lounge? It’s lovely and we have a new television”. Relatives commented, “Hillside has done a lot to improve the living standards over the last couple of months and it is much more comfortable for everybody” and My Mum’s room has had new carpets, wardrobe and been painted, it is very homely and my mum is very happy here”. The laundry has been completely refurbished. The fire escape is being refurbished. Two staff has commenced Level 3 NVQ. All new staff has all pre employment checks in place prior to taking up employment. A manager has been appointed and has formally applied to the Commission for the post of registered manager. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 7 The proposed manager has commenced some quality assurance to enable the service to gain the views of the staff. The service has improved the training programme for staff including mandatory training. What they could do better: Religious needs and oral/dental care needs to be identified during the assessment process so that care and support needs are not compromised. Care plans need to be improved to ensure that all care needs are addressed. Further advice needs to be sought with regard to catheter care so that all registered nurses are competent in the care and do not compromise residents health. All complaints however minor need to be logged so that it is evidenced that residents are listened to. The training programme needs to continue to ensure all staff has the skills needed to carry out their work and include adult protection, infection control and equality and diversity. It would be of benefit to the service if the proposed manager attends adult protection training so that residents are fully protected. A quality assurance system needs to be in place to evidence that residents’ views are sought. Provider monthly visits need to be recorded and a copy kept on file for inspection. Policies and procedures need to be reviewed to ensure all staff is up to date with new changes. Accident records need to reflect accidents that occur to residents and staff. Staff induction needs to reflect the government guidelines. There are some areas within medicines management e.g. the recording of medicines and ensuring people take their medication when away from the home that need addressing to ensure the health and well being of the people who use the service. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 8 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.V363899.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.V363899.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 information gathered about prospective residents prior to admission is sufficient to meet the needs of the residents. EVIDENCE: The proposed manager carries out pre admission assessments on residents who would like to live at Hillside. The manager also encourages prospective residents to visit the service prior to admission. Where it is not possible for prospective residents to visit the service families do so on their behalf as evidenced in care files. One relative interviewed stated, “I took mum around all the homes and my first impression when we visited was proved to be right, it was mum’s decision”. Two residents were case tracked. Both files evidence that an assessment has been carried out prior to admission. Both assessments were signed and dated by the person carrying out the assessment. One of the residents interviewed Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 11 confirmed that she had met the manager prior to admission and stated, “the home manager came to see me at the hospital and I then made the decision to come here. My daughter sorted everything out for me and chose the bedroom”. The assessment process evidences that prospective residents care needs have been looked at including, communication, sight, hearing, behaviour, medication, allergies, mobility, diet, personal hygiene, bowel and bladder care, pain, chiropody, breathing, likes and dislikes and hobbies. Likes and dislikes are recorded. Some other areas need to be identified such as religious needs and dental/oral care. GP and next of kin contacts are in place. Hillside Nursing Home DS0000069804.V363899.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. Care plans and medicine management need to be improved to ensure that all needs are addressed and people are not put at risk. EVIDENCE: One resident case tracked had a care plan in place. The other resident case tracked did not have a full care plan in place addressing all their needs as they were recently admitted. The manager was in the process of putting this together. Residents or their representative have signed the care plans as evidenced. One of the residents interviewed confirmed that they had discussed their care needs with the manager and stated, “I think they did have a chat with me regarding my care, the care is perfect”. A relative interviewed stated, “The care plan has been discussed and if anything crops up they let you know”. For one of the care plans the needs are mostly addressed with some further advice required from health professionals with regard to one specific area to ensure the resident has the required treatment at regular intervals. Other areas identify goals and interventions needed to promote and care for this Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 13 resident. These include personal care, mobility, skin and pressure area care and incontinence. This care plan was reviewed monthly as evidenced on care documentation. The other care plan was not yet completed as the resident had recently been admitted but needs to include pain management as identified in the pre admission assessment. One of the residents care files evidences the progress they have made since admission including weight gain to the benefit of the resident. Health professional advice and interventions have been evidenced in care documentation. Risk assessments are in place and evaluated regularly. One resident who has been identified as at risk of falling has had falls. One of the falls was not recorded in the accident book therefore this needs addressing. Specialist equipment is in place for residents who need it as observed during the tour. Consent is gained from relatives and documented with regard to bed rail use. Residents interviewed about their care needs gave positive views. One resident interviewed stated, “I have seen the Dr, the care is perfect and I get my medication on time”. Another resident interviewed stated, “All the residents like it here and are well looked after by the staff”. Most of the residents canvassed for their views had their forms completed by their next of kin on their behalf with comments including, “the care in Hillside is excellent, staff are very understanding and the support is always there for residents and families. Whenever I need the Dr the home arrange it straight away” and “matron and staff give personal care to ….and I am happy with the care that they are receiving. One of the staff interviewed stated, “The personal care here is very good they have the personal touch, if my parents were still alive I would have them living here”. Staff were observed to be patient when providing assistance to residents. During the visit staff were observed to be communicating with residents in a friendly and respectful manner. Residents were noted to be suitably dressed and well groomed. The screen is again in use in the double bedroom therefore providing privacy for the residents who share. As part of the inspection a pharmacist inspector looked at how medicines were handled. Administration of medicines to residents was observed. This was done with care and records were completed at the time of administration to each person. However, ‘gaps’ and errors in the record keeping suggested that this was not always the case. We compared a sample of medicines records and stock and found some inaccuracies in the record keeping that could place people at risk of medication errors. We saw that records sometimes wrongly showed Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 14 medicines had been given, when they had not. For example, three records showed that more doses of an antibiotic had been given, than actually received into the home. It was of concern that special instructions such as ‘before food’ were not always followed; this may mean that medicines do not work properly. It was of concern that peoples medication was not considered when they were away from the home. We found that one person had missed several doses of one medication because they were out. Worryingly, the records were wrongly signed to show the medicine had been taken. The tablets were in a monitored dosage system labelled with the days of the week, but this error had neither been noted by nurses’ administering medication, nor by the homes audits (checks) of medication handling. The manager had not been made aware of these errors and no action had been taken. There was a lack of information about the correct use of medicines prescribed ‘when required’. To help ensure consistency, there should be individual guidance about when these medicines should be given. As previously required, the new manager had booked refresher medication training for qualified staff administering medication. But, medicines handling was not currently included in staff supervision and had not recently been discussed at any team meetings. The homes medication policy could be usefully expanded to provide clearer guidance to nursing staff about the handling of medicines at the home. Completion of refresher training and competency assessment will help to ensure peoples’ medicines are safely handled. Medicines were safely locked away and arrangements were in place for the safe disposal of unwanted medicines. Hillside Nursing Home DS0000069804.V363899.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 are encouraged to live their lives as they wish with staff support where needed. EVIDENCE: Residents living at Hillside are happy with their lifestyles. Residents canvassed for their views commented, “the home is very nice and the food is very good”. Relatives canvassed commented, “I am very pleased with the standard of care my mother receives and she is very happy and content in the home”, “Nothing is too much trouble for the staff, even to make visitors a cup of tea on arrival”, and “Staff do lots of things with the residents on most days from playing bingo to manicures”. Some of the residents are frail and unable to participate in many of the activities but are not excluded. One relative commented, “Due to the nature of my mothers illness she isn’t always able to join in with activities but the staff will do something else with her so as not to leave her out”. Activities are provided for residents most days and include bingo, dominoes, classic films, crosswords, with help from staff, reading and visiting the garden Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 16 weather permitting. Residents have also been out on occasional shopping trips. Relatives canvassed for their views commented, “My mum likes the activities which go on in the home, parties for birthdays, outings with staff, games, music etc.” Staff interviewed confirmed that activities had improved and stated, “The activities are better for residents, we do bingo, manicures, one to ones and out to the village for tea”. Residents interviewed about their lifestyles whilst living in Hillside were satisfied that their needs were being met. One resident interviewed stated, “I keep myself to myself, I’m a very private person”, this is accommodated. Another resident interviewed stated, “You get up and go to bed when you like”. Communion is provided for residents who wish to participate once a month and a minister from another church visits one of the residents occasionally. There are no restrictions with regard to visiting. Relatives are encouraged to visit the service when they wish. Residents interviewed stated, “my family come in the afternoons and I go out with them each week” and “Visitors come, whenever and in the evenings also”. Resident’s rights are promoted in this service and this has been evidenced through discussion with residents and their relatives and canvassing their views through the Commission questionnaires. One relative interviewed stated, “They are aware of her likes” and one relative commented, “They listen and act upon what is said”. The chef plans his weekly menu in advance taking into consideration the likes and dislikes of the individual residents as evidenced in the daily diary. Specialist diets are also catered for. The menu evidenced many choices for the residents for all meals. The inspector viewed the meals on offer and all looked home made, appealing and nutritious. Breakfast is served to suit the residents wakening times and a cooked breakfast is made once a week with porridge and other fruits and cereals available daily. Residents and relatives were very complimentary about the food served in the service. Residents interviewed stated, “The food is delicious, they give you what you want-I have met the chef and you can have drinks whenever you want to” and “The food is lovely, the chef comes and speaks to us all and he is a very good chef, he asks us what we prefer”. Relatives canvassed for their views commented, “There is always a choice of meal which is tasty and always well presented. The chef Ken is excellent, the chef really cares about what he does” and “Mum always tells everyone that they get very good meals and I must say they always look good”. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 17 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): OP 16,18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure residents are protected. EVIDENCE: A complaints procedure and a copy of the Sefton Adults protection procedure are in place. A new complaints record from 30/6/08 is in place-the previous complaints log was not found on the day of the visit. The manager stated that, “ no complaints/concerns had come to her attention in the past four months”. The manager stated, “I see the residents every day and chat with them and resolve any concerns”. The manager was advised to ensure that the complaints log evidences any complaints made, however minor. Residents confirmed that they spoke with the manager regularly. Residents interviewed stated, “I’m not aware of the complaints procedure, I am well enough looked after” and “I have no complaints at all, they look after us well”. One relative interviewed stated, “I know they have a complaints procedure-if I have any concerns they deal with it straight away, there are no problems if you want to talk to someone, I am happy with the home and my mother is which is the main thing”. Relatives canvassed for their views commented, “Any concerns are dealt with immediately, on a few occasions if everything has not been just right, whatever the matter, it has been resolved very quickly by the management” and “I can always speak to the nurse in charge or the owner”. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 18 A valuables book is now in place but it does not have a carbon copy so that if residents’ valuables were held, however temporarily they or their relative would need to have a copy. The manager stated, “We do not hold any valuables on behalf of residents”. The manager also advised that the service does not hold any monies on behalf of any residents. The manager advised that relatives were invoiced for services such as chiropody or hairdressing. A lockable facility is now in place in residents’ bedrooms. Some of the staff has attended the Sefton Adult Protection procedure. There have been no allegations of abuse. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 19 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): OP 19, 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in as comfortable and well-maintained environment. EVIDENCE: As part of the inspection process a tour of the service took place to include all of the residents bedrooms. The service is going through a complete refurbishment and it was pleasing to see the improvements made. First impressions show an attractive and well-maintained building. The garden grounds are now much improved with easy level access and walkway around the rear garden. Garden pots with flowers have been placed in the rear garden for the benefit of the residents. Hanging baskets with flowers make a welcoming entrance to the service. A new front door and fire exits have been fitted. New windows have been fitted throughout the service. One or two areas of paintwork in the hallways Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 20 upstairs just need a little attention. The maintenance person is employed for three days each week. Maintenance records evidence all checks are carried out. Many of the bedrooms have been completely refurbished with new carpeting, furniture and soft furnishings. Residents’ bedrooms have been personalised with their own belongings. None of the occupied bedrooms are used as storage areas now. The service now provides a light and pleasant environment for the residents to live in. The sitting room is bright and comfortable seating is in place suitable for residents use. Residents interviewed were very pleased with all the changes made in the service. Residents interviewed stated, “Have you seen the new chandelier in the lounge? It’s lovely and we have a new television, I like my bedroom it’s nice and cosy” and “It’s perfect, I love my bedroom”. Relatives canvassed for their views commented, “The added improvements have enhanced the appearance of the home. “Hillside has done a lot to improve the living standards over the last couple of months and it is much more comfortable for everybody, it is a lovely place to live after all it is our home now, thanks to the home owner” and “I and my mum must say how much nicer the home is looking since they have new windows, chairs and carpets, my mum’s room has had new carpets, wardrobe and been painted, it is very homely and my mum is very happy here”. The call bell system has been serviced and when checked during the visit was found to be working. The fire escape is being completely refurbished with the staircases ready primed for final painting. Fire exits are easily opened. The kitchen was clean and well organised. The kitchen storage is organised and plenty of foods and fresh fruit/vegetables are in store. Fridge freezers are managed well and temperatures logged including hot food temperatures. A cleaning schedule is in place. The laundry has been completely re furbished and staff are able to work in a cleaner and well-managed environment. The service has improved tremendously and all areas were clean and tidy. Relatives canvassed for their views commented, “the standard of cleanliness is excellent, a new lady does the cleaning and she is very good, everywhere is nice and clean with no nasty smells” and “Never any smells and always looks clean”. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides caring and supportive staff, which ensures that residents settle into the service quickly. EVIDENCE: The staffing rota was viewed and evidences sufficient staff was on duty to care for the residents. The manager has been working each day therefore able to supervise for many hours. The kitchen is staffed with a chef each day and domestic cover is in place. The staff files and training records have improved although they still need to be better organised with training and development plans in place for each staff. The manager is in the process of gaining a training matrix to better identify staff training needs. Two care staff has the NVQ Level 2 qualification and two staff have commenced Level 3. The manager stated that she had commenced a new staff induction programme. The three staff files looked at evidence induction has taken place. The induction covers many areas including principles of care. Staff files also evidence certificates for training already attended including, NVQ, manual handling, food hygiene, fire safety and first aid. Further training is planned for September. Infection control and equality and diversity training Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 22 needs to be included to ensure all staff are trained. Not all staff has attended adult protection training therefore this needs to be addressed. Improvements have been made that evidences all pre employment checks are in place. Staff files evidence that new staff have full pre employment checks carried out prior to taking up employment. These checks include POVA (Protection of Vulnerable Adults), CRB (Criminal Records Bureau) and two written references. Staff files also evidence completed application forms and CV’s and previous employment history. Residents interviewed gave positive views on the staff employed in the service. Residents stated, “Staff are marvellous and kind, matron is ever so kind to me” and “The staff are very kind, they will do anything for you, Beryl is a lovely person and we have met the new owner, he is very nice”. Relatives canvassed for their views commented, “staff are very approachable and helpful, there is always a member of staff when needed”, “the staff are all very helpful and will put themselves out to help” and “staff and matron are always pleasant and helpful”. Staff working in the service enjoy being at Hillside. Staff interviewed stated, “I like it a lot, I had an induction, it lasted 3 days, we went through a list and documented it. I have attended mandatory training. We get a report in the morning” and “I commenced induction for 30 minutes and then was no ‘hands on’ for 4 days and worked with a senior carer-I got to know the building, fire escapes etc. I have attended mandatory training and started my NVQ Level 3” and it’s very friendly, you get to know the residents better”. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the service has improved but there are still areas that need improvement. EVIDENCE: The proposed manager has been in place for four months. She has formally applied for the registered managers position. The proposed manager has also applied for the RMA (Registered Managers Award). The proposed manager is a registered nurse. Since commencement of post she has attended the training to include fire safety, health and safety, food hygiene and manual handling. The manager intends to attend further training planned for September/October this year. The manager was advised to try and gain a place on the Adult Protection course run by Sefton. The manager also intends to be in touch with Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 24 the local hospice to ascertain their training programme and choose suitable courses for staff. The new manager has commenced a quality assurance file. The manager has collated staff views with regard to how the service is being run and these views are evidenced in letter/statement format. The views were all positive and commented mostly on the improvements that the service has gone through in the past four months. The service has had two staff meetings held in the past four months with minutes kept. These were viewed and evidence various areas have been discussed. There were some letters from relatives too with all expressing positive views on how the service has improved. The manager stated, “I have not had any residents meetings as there are very few residents who can participate”. The manager then went on to say that she meets with residents’ daily and listens to their views and acts on them. She stated, “I have bought some new glasses for the residents as they did not like the tumblers they were using”. Discussion took place with regard to canvassing the views of the relatives and residents. The manager is planning a social event so that she can meet with families. The manager usually speaks with the relatives when they visit the service The manager stated, “the new owner has carried out provider visit records” but none were available on the day of the visit. The manager gave the inspector a list of the dates these were carried out and advised they had been sent to the Commission. The inspector advised the manager that none had been brought to her attention so far. Policies and procedures were being updated earlier this year and need to be completed. The service holds no money or valuables on behalf of residents. Residents now have a lockable facility in their individual bedrooms. There is another safe keeping facility available for residents in the service. There has been a huge improvement in the mandatory training for the service. Training attended is already listed earlier in this report and the manager stated, “More training is planned with the trainer provider for September/October this year”. The fire detection and alarm system was serviced in April this year and included emergency lighting. First aid boxes are situated in the nurses’ station and kitchen. Some of the staff has attended up to date first aid training. Not all staff has attended infection control training therefore this needs addressing. Controls of Substances Hazardous to Health (COSHH) are stored in a locked external store. Gas and electrical appliances and servicing are up to date with Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 25 certificates evidencing this. Lifts and hoist have servicing in date. Hot water temperatures are checked and recorded by the maintenance person but records show none since June 08. The manager stated, “He has been off sick”. Hot water hazard signs are in place at residents sinks where needed. The new bath thermometer is used to measure bath temperatures prior to bathing residents. Legionella testing is in date and clear. Residents are not at risk with the new windows that are fitted. Doors and locks are secure and keep residents safe. Accident records are in place but on checking one accident although reported in the daily evaluation was not recorded in the accident book therefore this needs addressing. The staff induction programme is being improved at present. Further advice needs to be obtained to ensure all areas are covered. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 26 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 2 9 2 10 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP8 Regulation 12 (1) (a) Requirement Timescale for action 05/09/08 2. OP9 13 (2) The registered provider must ensure that residents receive the correct catheter care to ensure their healthcare is not compromised. The registered person must 05/09/08 ensure that all nurses sign the medication record immediately after administering medication to residents, to eliminate risk of medicines being administered twice. [Previous Timescale 04/04/08 not met.] Medication must be administered as prescribed, and clear and accurate records of medication administration must be maintained to make sure that people’s health and wellbeing is protected. Peoples medication needs must be considered and suitable arrangements made if they are away from the home when medicines are ‘normally’ administered. 3. OP9 13 (2) 05/09/08 Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 28 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Refer to Standard OP3 OP7 OP7 OP16 OP30 OP31 OP33 OP33 OP33 OP38 OP38 OP38 Good Practice Recommendations It is recommended that religious needs and oral/dental care should be identified during the assessment process. It is strongly recommended that further advice should be sought with regard to the continuing catheter care of one of the residents. It is strongly recommended that pain identified at assessment should be reflected in the care plan as to how it is to be managed. It is recommended that all complaints however minor should be recorded on the complaints log and evidence the investigation and outcomes for the resident. It is recommended that the training programmes should continue and include equality and diversity, infection control and adult protection. It is strongly recommended that the proposed manager should attend adult protection training. It is strongly recommended that residents’ views when sought should be documented. It is recommended that provider visits records be kept on file for inspection. It is recommended that all policies and procedures should continue to be updated. It is recommended that hot water temperatures should be checked and recorded on a regular basis. It is recommended that all accidents to staff or residents should be recorded on the accident book. It is recommended that the staff induction should continue to be improved to ensure all areas meet government guidelines. Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillside Nursing Home DS0000069804.V363899.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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