Inspection on 07/05/09 for Hillside Nursing Home

This inspection was carried out on 7th May 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 06/08/08

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hillside Nursing Home 30 Dover Road Southport Merseyside PR8 4TB Lead Inspector Mrs Margaret Van Schaick Key Unannounced Inspection 7th May 2009 09:15 DS0000069804.V375364.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hillside Nursing Home DS0000069804.V375364.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.V375364.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 20th January 2009 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 Benita Calderbank has been appointed. Weekly fees are between £497.50-£543.50 Hillside Nursing Home DS0000069804.V375364.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. 11 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 Benita Calderbank (acting manager) An Expert by Experience took part in the inspection process for approximately 3 hours. An Expert by Experience is a person who, because of their shared experience of using services/and or ways of communicating visits a service with an inspector to help get a picture of what it is like to live in or use a service. During the inspection 1 resident was case tracked (their files were examined and their views of the service were obtained). Four other residents had much of their care documentation looked also. All of the key standards were inspected and requirements and recommendations from the last inspection in January 2009 were discussed. Satisfaction forms ‘Have your say about….’ Were distributed to a number of residents, relatives and staff. Two resident and two relative surveys were completed and returned. None of the staff surveys were returned. 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 acting manager prior to the site 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 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. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 6 What the service does well: The assessment process ensures residents are fully assessed prior to admission therefore their needs have been identified and documentation shows that the service have been able to meet them. Residents who live at Hillside are given choices and where able to, live their lives as they wish. A resident canvassed for their views commented, “Hillside is a very good home”. Relatives interviewed stated, “My mother has excellent care, the staff are wonderful, they do everything to accommodate mum”. What has improved since the last inspection? The pre admission process has improved as more information is collated and this ensures that staff can identify all of the residents needs prior to their admission. The health care of the residents has improved and care documentation reflects this. Residents who were at risk with regard to their nutritional needs now have much improved care plans and GP and dietician input has been accessed and now the home provides good care in this area. Care plans have improved and most of the necessary information is included. A relative interviewed confirmed they had seen their mum’s care plan also stated, “I also have a meeting with the manager to discuss mum’s care. She has excellent care”. Care plans now evidence catheter care and how it is managed. Residents are also assessed for pain problems prior to admission and these have been addressed in the care plans. A medication audit has been carried out and improved practices are being implemented. The daily medication records are being signed following administration of medication. The manager has commenced an update on policies and procedures. The manager has carried out an audit of the building and following this the service is being upgraded to ensure a comfortable environment for the Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 7 residents. The top floor bedrooms are being refurbished and two will provide an en-suite facility therefore giving residents more choice. Many areas of the home have been redecorated with new light fittings, bedroom furniture and bedding. The front porch has been upgraded providing residents with a pleasant entrance to their home. Hot water temperatures are now being checked regularly with records kept. This promotes safety in the service for residents and staff. Accidents are now being recorded in the accident book, which means that the records are available for auditing purposes. What they could do better: Care plans need to evidence new conditions as they are discovered with documented mapping where needed. This will ensure staff are informed about a resident’s progress. Staff signatures need to be evidenced on medication records (returns book) when medication is collected for destruction. Medication amounts carried forward to the next month needs to be recorded on the medication records. This will ensure easier auditing of medications. Residents’ bedrooms should not be used for storage as this imposes on their privacy. Staff should be encouraged to communicate with residents during mealtimes so that this becomes more of a social occasion. The service needs to provide a complaints process and adult protection procedure so that residents and their relatives know that any concerns raised will be dealt with promptly and the correct procedure is used so that they are protected. Thought should be taken with regard to how visitors can sit comfortably when visiting residents in the lounge. The kitchen store needs redecoration including the floor. This will make it easier to keep clean. The storeroom fridge freezer seals on the doors need repair so that food is kept at the correct temperatures. Staff induction needs to be improved to ensure all staff are sufficiently prepared to care for the residents. The service needs to provide training on equality and diversity so that staff are aware of the varying needs of individual residents. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 8 The manager needs to apply formally to the Commission so that they can be registered. Residents and their relatives’ views need to be canvassed to ensure the home is being run in the best interests of the residents. The registered provider needs to complete provider visit reports so that we can monitor how the service is run. These reports will be kept on file in the service. The service need to keep a record of the sling audit so that we know they are being carried out. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hillside Nursing Home DS0000069804.V375364.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.V375364.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP3 was assessed. OP6 was not applicable. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process ensures residents are fully assessed prior to admission therefore their needs have been identified and documentation shows that the service have been able to meet them. EVIDENCE: Prospective residents and their representatives are encouraged to visit Hillside prior to admission. This gives them a chance to meet with other residents, staff and view the facilities on offer. There has been one new admission since the last inspection therefore this was the only assessment document that we looked at. The manager visited the prospective resident in hospital to carry out the pre admission assessment. The assessment evidences the signature of the manager and date of Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 11 assessment. The home also has a copy of the hospital social work assessment on file. A relative interviewed about the assessment process stated, The manager came out to see my mum. Information gathered during the inspection has been recorded on the assessment documentation. The information collated gives a full and detailed picture of the residents needs. The information evidences that many areas have been assessed including medication, allergies, sleep pattern, personal care, sight, diet, pain, dental communication and mobility. This information has then been used to form the care plan. Information with regard to the residents’ family and support provided by them is also included. Religious needs, likes and dislikes and the residents preferred term of address is also recorded. Residents interviewed about Hillside confirmed that they were happy with their choice of home. One resident canvassed for their views, commented “Hillside is a very good home”. Hillside Nursing Home DS0000069804.V375364.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP7, 8, 9, and 10 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care of the residents has improved and care documentation reflects this. EVIDENCE: One resident was case tracked and four other residents had various areas of care documentation looked at in detail. These areas included diet, falls, risk assessments and care plans. Since commencing her post the manager has been auditing some of the care records and this has highlighted three of the residents have had frequent falls over the past months. Each resident had a risk assessment in place and care plans evidenced how the service would manage this risk. Further advice has been sought from other health professionals as to how to manage the risks of falls and action has been taken by the manager to reduce this risk. One resident is to be further assessed to see if their present health Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 13 problems have impacted on increased risk of falls. The manager has also introduced specialist mats to be placed in or at the entrance of resident bedrooms where they have been identified as at risk as they mobilise. The specialist mats alert staff by an alarm system. Staff can then go to the resident quickly to assist them with their mobility. Rather than restricting residents movement the emphasis is on staff being able to assist with residents’ mobility. Care plans now reflect action to be taken where a resident continues to mobilise unsupervised. The plan states that if a resident is unsettled then staff supervises more frequently and one to one supervision of the resident may need to commence. This area has improved. Residents interviewed confirmed that they were happy with the care and support provided. One resident canvassed for their views commented, “Care is shown to us all, respect for all of us, tender loving care shines on all who live here, the nursing care is excellent”. The five care plans looked at showed regular reviews of care with recorded action taken to update them. For one resident the care plan did not evidence a new medical condition. Daily records looked at evidenced this new medical problem and health professional records show visits and treatment prescribed. The care plan did not reflect this new condition and there were no other records such as wound care diagrams to show the extent of this problem. The care plan needs to evidence clear and accurate information about the residents care needs so that staff know the up to date care needed. All issues discussed with families such as feedback from GP and other health professional visits are recorded. Relatives canvassed for their views commented, “I and my family are very happy with the service Hillside provides for my mother, so we feel their service couldn’t be better”. One relative interviewed stated, “Mum has excellent care, I have seen the care plan and I have a meeting with the manager to discuss mum’s care”. Care documentation also evidences other areas addressed including diabetes, depression, pressure area risks, pain, nutrition, mental status, manual handling, personal hygiene and dressing. Previously, residents who have had weight loss and a poor appetite have had no input from the dietician nor have these needs been addressed in their care plans. Both of these areas have now been addressed through access to the dietician and care plans have been improved. Another resident who had a catheter in place did not have a care plan addressing their needs. This resident now has a detailed care plan identifying their individual needs. Both these areas have improved. One resident interviewed confirmed they were able to see other health professionals and stated, “I have seen the Dr, the dietician and the chiropodist, I see them regularly”. Specialist equipment is in evidence in the service and this is used to support residents with their individuals care needs. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 14 A secure medication trolley is used to administer the daily medication. Additional lockable storage contains medicines to be returned. The returns book evidences medication for destruction is recorded with amounts and dates entered. This record did not evidence staff signatures therefore this needs rectifying to ensure audits can be carried out effectively. Medication storage is organised. Medication records were looked at. Monthly records show amounts received, staff signature and date. The monthly records do not evidence any medication amounts carried forward to the next month therefore this needs addressing as it will make it easier to audit stock. The manager has re organised the delivery of medication to ensure that all stock arrives together therefore new medication will be recorded and started on the same day of the month. This will make it easier for staff to follow. The manager has commenced an effective auditing system of medication with records kept. Problems were picked up with regard to medication rounds and the manager has taken action following these audits. The manager had planned to carry out an update of the policies and procedures with regard to medication. This had been identified in the AQAA. Some of these changes had commenced. Two residents share a bedroom and portable screens are provided for privacy. One resident’s bedroom was being used to store wheelchairs. This needs to be stopped so that residents’ privacy is protected. None of the residents has their own telephone and use the office telephone, which can be used in the privacy of their own room. When residents were asked about this during the visit, none wished to have their own telephone line. Hillside Nursing Home DS0000069804.V375364.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP12, 13, 14, 15 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who live at Hillside are given choices and where able to, live their lives as they wish. EVIDENCE: The residents who are living at Hillside told us they are happy with how they live their lives. Two of the residents interviewed confirmed they were able to choose how they spend their time and stated, I still go out mid week and at the weekend with my family and “I like my own company”. A list of activities for residents is displayed in the front hall. Some of the residents who are very frail are unable to participate in some of the activities but they are not excluded from events. One or two residents prefer their own company and are accommodated. Activities organised include card games, hand massage, pedicures, scone and tea afternoons, visiting entertainers and family visits. One resident interviewed stated, There is not a lot on, we do rolling skittles, a game of bingo and we had a party yesterday as it was …..s birthday. Staff told us that they also spend time chatting with residents in the afternoons. An activities record has been commenced for residents and identifies the activity Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 16 and if residents attend or not. A relative interviewed stated, Staff do things, they had lovely singing yesterday, a lady and gentleman, mum doesnt really have the ability. They have nail-painting days, music and the television. Religious needs are addressed. Communion is provided regularly for residents who wish to attend. There are no restrictions with regard to visitors. Relatives are encouraged to visit when they wish. A relative interviewed confirmed this and stated, I visit regularly, four times a week. A resident interviewed stated, “My visitors come when they want to”. Some of the residents interviewed confirmed that they see their visitors in their rooms. Residents who are able to are encouraged to make decisions about how they live their lives. One resident interviewed stated, I get up when I want to and go up about 11pm, I have my drink before going to bed and have a chat with staff. Some of the residents are unable to make choices due to their conditions. One relative interviewed stated, Mum isnt able to, I leave it to staff discretion and I have not had to complain at all. A resident interviewed stated, “I go to bed when I want to and get up when I want to”. The new chef meets with residents to discuss their views on meals served at mealtimes. He knows their preferences very well and plans the meals around this. The manager and chef have improved the menu by providing a nutritious and appetising diet for residents of all abilities. Some foods are liquidised for some of the residents depending on their individual dietary needs. There is a good choice of meals available for residents. The daily menu is printed out and displayed in the front hall. Further choice is available on the additional choice menu for residents whose needs are varied. This menu was on display in the lounge. A relative interviewed stated, My mum had a poor appetite and ‘B’ (manager) brought in the dietician, the food is really good now that Ken is back in the kitchen, the presentation is excellent, mum still has a soft diet, but you can recognise the different foods. One of the residents has their meals pureed together so that they will eat a nutritious meal otherwise vegetables would not be eaten. We observed some of the staff helping the residents at mealtimes. One or two of the staff did not seem to make any conversation with the residents whilst they assisted them. Staff did not have space to sit down with the residents when helping them with their meal. One staff was however courteous, considerate and kind and gave the residents time without feeling rushed at all. The television remained on but the volume was turned down. The food served was attractively laid out but plates were cold. The chef bakes regularly and a cooked breakfast is available once a week for residents who wish it. Porridge is available each morning and other cereals and fruits made available. Residents are able to eat breakfast when they wish. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 17 Lunch and evening meals are served at set times but there is also provision for residents whose dietary needs are more complex, to eat their meals when they wish to. This enables residents to eat when they feel like it rather than meal times being forced on them. One resident interviewed stated, “The food is quite good, we have plenty of choice, I am able to choose what I wish”. Relatives confirmed they were happy with the care and support provided. Relatives canvassed for their views commented, “I feel Hillside is caring towards residents, also supportive, patient, understanding and provide good wholesome food” and “Hillside is small and so I think gives a more personal service”. Staff interviewed stated, “Residents get a choice of food, residents also decide what time they want to get up in the morning and go to bed”, “I have not been involved in activities but have seen staff do their nails, dominoes and cards and a sing a long with them”, “Visitors can come and go when they wish, the food is very nice, Ken is a good cook and residents get enough and can have more if they wish, we play games”. Hillside Nursing Home DS0000069804.V375364.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP16, 18 were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints log needs to be in place so that it is evident that any complaints raised are noted, fully investigated and outcomes are recorded. The service must also provide a copy of the adult protection procedure so that staff are aware of the procedure and know how to follow it. EVIDENCE: Through discussion it is apparent that the manager is aware of what to do in the event of an adult protection issue. The manager has previous experience in this area and is aware that local procedures exist. The local adult protection procedure could not be found during the visit. It is important for the service to have this procedure so that all staff are familiar with it. Staff need to know the procedure and be aware of what to do. Some of the staff has attended the adult protection training in the past as evidenced in staff files. One staff interviewed with regard to any concerns raised stated, “I would see the person in charge or manager, I have attended abuse training”. All staff needs to access this training so that residents are protected and all staff are aware of local procedures. The service did have a copy of this procedure previously as it was viewed during the visit. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 19 The complaints log could not be found during the visit and the manager confirmed that there was none on the premises. A complaints log needs to be in place so that we know that residents and their representatives who complain are listened to. The log needs to evidence any complaint raised, the date of complaint, the investigation and outcomes for the complainant. The complaints procedure needs to be updated so that complainants know whom to contact. The manager stated that she is in the process of improving this. One of the relatives interviewed stated, “I know how to complain”. Hillside Nursing Home DS0000069804.V375364.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP19, 26 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being upgraded to ensure a comfortable environment for the residents. EVIDENCE: As part of the inspection process a tour of the service took place including resident bedrooms. The manager has carried out an audit of the service about six weeks ago to identify areas needing refurbishment. This was not available to view during the visit. The service continues to go through an upgrade. One of the top floor bedrooms has been enlarged and the other three are being refurbished. Two are to provide an en-suite facility therefore giving more choice to residents. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 21 Other bedrooms, including the hallways have also been redecorated. The front porch has also been refurbished making it a pleasing entrance for residents and their visitors. New curtains, light fittings and bedding have improved the overall look of the home and residents confirmed they liked the changes. Residents have been involved in choosing the colour schemes for their rooms. A relative interviewed stated, We are absolutely happy with the bedroom. A resident canvassed for their views commented, “My bedroom is so lovely and cosy, newly decorated and a new bed and beautiful bed covers add the finishing touch, it really is a home form home”. A resident interviewed stated, “I am moving to another bedroom, it’s bigger and I can choose the décor”. Residents can easily access the rear garden. Mature planting and flowerpots are in place. New garden furniture suitable for residents use was seen. Residents eat most of their meals in the lounge. They use small tables for this. The lounge is not big enough to accommodate a dining table and there is no separate dining room. Visitors to the service do not have comfortable armchairs to sit on in the lounge and use hard back chairs. The kitchen has some improvements also with new crockery, cutlery and shelving. The kitchen was clean and organised. A cleaning schedule is in place. Fridge/freezer and hot food temperatures are evidenced in the daily kitchen diary. Plenty of food, fresh fruit and vegetables are in store. The kitchen storeroom needs to be decorated to include the floor surface. This will help to keep all surfaces clean. The fridge freezer seals are broken therefore need replacing. The home was clean and tidy. The laundry service was satisfactorily managed. Sufficient equipment was in place. The call bell system has been service and bells checked at random worked during the visit. Fire exits are easily opened and all were clear. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff induction needs to be improved to ensure all staff are sufficiently prepared to care for the residents. EVIDENCE: The staffing rota was viewed and evidences sufficient staff was on duty. The kitchen is staffed with a chef and domestic cover is provided over 5 days. Care staff manages the laundry facility. The laundry was organised on the day of the visit. Staff files were viewed of two new staff and a longer serving staff member. The staff files evidenced application forms and all pre employment checks were carried out prior to commencement of post. References and police checks were confirmed before employment started. Four of the care staff has the NVQ Level 2 qualification and three staff has commenced this course. Two care staff has commenced Level 3 NVQ. Staff files evidence previous training that staff has attended including, manual handling, fire, food safety infection control, health and safety and basic life support. Much of the training was with previous employers. Some staff has Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 23 attended Dementia, equal opportunities and diabetes training provided at Hillside this year. Equality and diversity training has not been arranged for staff so this needs to be looked at so that staff have a better understanding of the needs of various residents. The induction checklist that is in staff files is signed and dated by the trainer and covers many areas including fire, risk incidence reporting, health and safety, infection control and handling complaints. The induction is carried out over one day with the certificate confirming this. It is not in line with Skills for Care induction therefore this needs to be improved to ensure all staff has the induction that is needed to ensure they are skilled in caring for the residents living at Hillside. The service need to ensure sufficient time is spent with individual members of staff to ensure the induction and training provided has met their individual training and development needs. Staff were interviewed with regard to their induction. Staff interviewed stated, I have had no training, the induction lasted a week, there was no one really to teach me”, “I was supernumerary for three shifts”, “My induction was a tour, I have had no training” and “I had induction training with hoists, health and safety, basic life support, fire and infection control”. We observed some of the staff helping the residents at mealtimes. One or two of the staff did not seem to make any conversation with the residents whilst they assisted them. Staff did not have space to sit down with the residents when helping them with their meal. One staff was however courteous, considerate and kind and gave the residents time without feeling rushed at all. The television remained on but the volume was turned down. The food served was attractively laid out but plates were cold. Staff were interviewed and asked their views about working at Hillside. Staff interviewed stated, “I think staff are great with residents, “Staff are nice and very helpful”, “I think the residents are very well looked after and well fed”, “We have a handover in the morning, I know how to work all the hoists and stand aid, I think people who work here are good to the residents”. A relative interviewed stated, “The staff are wonderful, they do everything to accommodate mum, they are the same with all the residents”. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives’ views need to be canvassed to ensure the home is being run in the best interests of the residents. EVIDENCE: The acting manager has been in post approximately three months. The manager has the Registered Managers Award, is a registered nurse and has also gained further knowledge through the English National Board training courses. The manager has many years experience as a registered nurse in hospital. She is supernumerary 6 hours each week for administrative duties. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 25 The manager is also supported in her role on an occasional basis by the registered manager and senior nurse of a sister service. Staff interviewed about the new manager stated, “Benita is lovely, I have no complaints” Relatives canvassed for their views commented, “The service has improved generally over the past year, the new matron has made improvements” Residents canvassed for their views commented, “The new matron “B” is wonderful. She is very enthusiastic in everything she does, very caring, gets on well with her staff and staff moral has risen and everyone seems happy in their work, long may she continue at Hillside”. The registered provider visits the service regularly as confirmed by the manager and these visits are recorded. The registered provider should prepare a written report on a monthly basis regarding the conduct of the care home. This record needs to be kept and be available for inspection. There are few effective quality assurance systems in place. The manager advised us that discussion has taken place regarding this area as an external consultant may become involved. There are no residents meetings, nor are they canvassed for their views. The manager has arranged staff meetings since her appointment and the minutes of one held in April were viewed. Items raised during the meeting included resident accidents, medication incidents, risk assessments, general management of service, improvements, training and hours of duty. The manager advised that none of the residents’ monies are held on their behalf. A secure facility is available for residents needs. The AQAA identified the servicing of equipment used at Hillside. Some of the certificates for servicing were viewed during the visit and included electrical and general lighting and power, fire alarm, lift, emergency lighting, gas testing, hoists and fire extinguishers. All of these were up to date. The chair hoist is to be tested and a copy of the certificate is to be forwarded to the Commission. Hoist slings have been checked by staff but no record is kept of this. Therefore the manager was advised to record this audit regularly. Routine testing of water and sterilisation of shower heads is carried out with records kept. The environmental waste contract is up to date. Fire records show that testing takes place weekly. The maintenance record was viewed and evidences regular maintenance is carried out with repairs signed off. An equipped first aid box is stored in the office. The accident book was viewed and all accidents entered correctly. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 26 Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 27 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 3 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 2 17 X 18 2 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.V375364.R01.S.doc Version 5.2 Page 28 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 OP16 Regulation 22 Requirement The registered person must ensure the complaints procedure is updated so that it is easy for residents to follow. The service must also keep a record of all complaints logged, the investigation and outcomes for the complainant. This will evidence that complainants are listened to. The registered person must ensure that a copy of the local adult protection procedure is in place so that staff understand and know what to do. Staff must also be provided with adult protection training so they understand the procedures. This will ensure residents are protected. The registered person must ensure that the acting manager applies to the Commission so that they can be approved as the registered manager. Timescale for action 01/07/09 2. OP18 13 (6) 20/07/09 3. OP31 9 03/08/09 Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations It is strongly recommended that should changes occur in a resident’s condition that the care plan reflects the changes. It is strongly recommended that wound care mapping should be used to identify areas of skin/tissue conditions such as cellulites so that staff can follow the progress of healing. It is recommended that two staff signatures should evidence the destruction of any medication. It is recommended that amounts of medication carried forward to the next month should be recorded on the medication administration record. This ensures easier auditing. It is recommended that the practice of storing other residents’ wheelchairs in residents bedrooms should stop as it invades the resident’s privacy. It is recommended that staff should converse with residents whilst they are assisting them at mealtimes as it would make mealtimes more sociable. It is recommended that the service should consider providing more comfortable chairs for visitors. It is recommended that the outside kitchen store should be redecorated to include the floor. This will make it easier to keep clean. The fridge freezer in the store has broken seals. These should be replaced to ensure food is stored at the correct temperature. It is recommended that staff should attend training in equality and diversity so that they become familiar with and understand the varying needs of individual residents. It is recommended that the new induction programme should reflect the skills for care guidelines so that new staff are fully trained and individually have the skills to meet the needs of the residents who live in Hillside. It is strongly recommended that the registered person should carry out visits to the service and prepare a written report on the conduct of the service. A record of these visits should be kept on the premises. DS0000069804.V375364.R01.S.doc Version 5.2 Page 30 3. 4. OP9 OP9 5. 6. 7. 8. OP10 OP15 OP20 OP26 9. 9. OP30 OP30 10. OP33 Hillside Nursing Home 11. OP38 It is strongly recommended that residents, relatives and staff should be canvassed for their views on a regular basis so that the service knows what people think of how the service is run. It is recommended that the service should send in a copy of the chair hoist certificate so that we know it has been serviced. It is recommended that the service should keep a record of sling audits so that it will show they have been carried out. Hillside Nursing Home DS0000069804.V375364.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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