Inspection on 08/04/08 for Hillside Nursing Home

This inspection was carried out on 8th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillside Nursing Home 30/07/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hillside Nursing Home North Hill Drive Harold Hill Romford Essex RM3 9AW Lead Inspector Harbinder Ghir Unannounced Inspection 9:35am 8 and 9th April 2008 th 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 DS0000068195.V361257.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 DS0000068195.V361257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address North Hill Drive Harold Hill Romford Essex RM3 9AW 01708 346077 01708 376513 managerhs@goldencarehomes.com 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) GCH (Hillside) Ltd Debra Kathryn O`Hare Care Home 55 Category(ies) of Dementia (55), Old age, not falling within any registration, with number other category (55) of places Hillside Nursing Home DS0000068195.V361257.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 service users 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 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 55 30th July 2007 Date of last inspection Brief Description of the Service: Hillside is a home for 55 older people. The home is situated in a residential area of Harold Hill close to local shops including a small post office. The home provides 24 hours nursing care. People who use the service are accommodated on 2 floors, each individual admitted to the home has their own bedroom. The home is suitable for wheelchairs and there is a passenger lift to the upper floor. There is a courtyard garden which offers seclusion and safety within the centre of the home. The current Statement of Purpose informs that the fees charged at the home can range between £650 and £750 per week. Hillside Nursing Home DS0000068195.V361257.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 the people who use the service experience adequate quality outcomes. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place over two days on the 8th April 2008 between 9.35 am and 5.00 pm and the 9th April between 9.30 am and 12.35 pm. The registered manager of the home was available throughout both days of the inspection and feedback was provided to the registered manager and the registered proprietor at the end of the inspection. During the inspection the inspector was able to talk to residents residing at the home and relatives and who were visiting. Staff on duty during the day were also spoken to. A second day was spent contacting relatives and professionals by telephone for further feedback; their feedback has been included in the report. The London Borough of Havering, who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. Their feedback has been included in the report. Unfortunately, the Annual Quality Assurance Assessment form was sent to the incorrect email address, which did not allow the Commission for Social Care Inspection to receive the document prior to the inspection. The inspector would like to thank everyone involved in the inspection What the service does well: There is a pre- admission assessment process, to ensure the service can fully meet the needs of people admitted to the home and trial visits are offered to all prospective residents. Routine risk assessments are undertaken, to ensure residents are supported to take risks, as part of an independent lifestyle. There are clear medication policies and practices to follow. Residents and relatives are actively involved in the running of the home through regular meetings. Residents, relatives and professionals spoken to during the inspection, spoke very positively about the service. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose provides comprehensive information on the services provided at the home. But needs updating to provide the further information on staffing at the home, to ensure prospective residents have the right information they need to make an informed choice about whether they would like to live at the home. The service completes satisfactory pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. The service does not provide intermediate care. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home provides a statement of purpose that is specific to the individual home and the resident group they care for. The document provides detailed information on the services provided at the home and clearly sets out the objectives and philosophy of the service supported by a service user guide. It has now included information on social activities arranged at the home, but continues to lack specific information on social activities for those with dementia. Unfortunately, both documents were presented in text format, and not in a format, which would meet the communication needs of all residents admitted to the home, which was highlighted at the last inspection. It is Recommendation 1 the service considers providing the documents in formats, such as Braille, appropriate languages, pictures, video and audio. The document also does not specify the number, relevant qualifications and experience of the staff working at the care home, to ensure prospective residents have the right information they need to make an informed choice about whether they would like to live at the home. This will be stated as Requirement 1. Five pre-admission assessments were closely examined. Care management assessments by the local authority and healthcare professionals had been obtained prior to admission. Assessments covered the health and personal care needs of residents. When identifying the needs of residents with dementia, practice was not always consistent or well applied. The service has started to complete personal and social histories for residents who have a diagnosis of dementia but this was not completed for all residents. Where these had been completed little evidence was seen of how the service had utilised this information in the care plan. For one resident whose social history identified their love for gardening and was a lead organiser for Rainham Fuschia flower group. The care plan did not include this information when identifying the social needs of the resident. Another resident’s pre-admission and care management assessment identified their main diagnosis as dementia but there was no further information on their past life. Knowing a person’s ‘life story’ can help to communicate with people with dementia. Their ability to communicate now may be related to their ability to communicate before they had dementia. Knowing about their earlier personality and approach to life is important. Which could be invaluable for a resident who has dementia. It is Recommendation 2 that social histories are completed for all residents who have dementia, to ensure the service can fully identify and meet the needs of people using the service. For residents who are self-funding the service is able to demonstrate how they have undertaken the assessment. The same assessment process is completed as local authority funded residents. Which is undertaken satisfactorily. Staff Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 10 have the necessary specialist skills and abilities to care for individuals who are admitted. New prospective residents would be able to visit the home as many times as they like. Relatives and family are also invited to visit the home. A relative spoken to during the inspection said, “We viewed a few homes, but we didn’t get that smell here. There is a sense of relief for us that she is in here and we love her room. The staff all seem to be friendly.” “We had a look at the home, we have had no major problems since mum has bee here,” another relative informed. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9, 10, 11 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans set out the personal and social care needs of people who use the service, but they must be further developed to ensure they are person centred and to set out in more detail the specialist needs of those living with dementia to and provide staff with the information they need to meet residents’ needs. The right for residents to exercise choice and control is not always promoted by the service and they are not actively consulted on in all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle and are updated according to residents’ changing needs. There are clear medication policies and procedures to follow, and practices at the home ensure the safety of residents. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 12 EVIDENCE: People have access to health care services both within the home and in the local community. On examining the health care records relating to pressure care areas; management of diabetes and falls, they were found to be detailed and adequately maintained. There was evidence that care plans were being reviewed at least monthly. Risk assessments were routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and were reviewed on a regular basis. Monthly weight checks were undertaken for all residents and appropriate action being taken where necessary. Turn charts for residents were also examined which were completed and signed by staff, ensuring that residents who were bed bound were turned at regular intervals preventing the onset of pressure sores. Records indicated other health professionals such as the tissue viability nurses, optical, dental and chiropody services saw residents. One of the tissue viability nurses who visits residents was spoken to as part of the inspection. She spoke very positively of the home. She said, “We don’t go to the home very often, which is a good thing. We have had no problems with the home or the referrals we have received. They follow our recommendations if there are any issues. If a resident needs equipment they get it. I don’t have any issues with the care provided.” Five care plans were closely examined. Care plans covered the health and social care needs of people who use the service. However, care plans were not always person centred and tailored to meet the needs of residents. Each care plan included a form to record the personal preferences of residents in regards to the likes of food, drinks and their preferred times of going to bed. However, staff did not always follow these preferences and recorded information on some forms was very limited. On speaking to some residents they informed that some residents are put to bed as early as 6.30 pm. “I go to bed what ever time I want to, because I tell them. But some residents do go to bed very early. Some go to bed as early as 6.30 pm, especially the ones that don’t say anything. They will take them if they haven’t said anything” informed a resident. Further comments were received from a resident informing that not everyone receives a hot drink at night. The resident stated “Not everyone is offered a drink before they go to bed. Anyone who stays up, they might get a cup of tea about 7 pm. The ones that are more vocal get a cup of tea. Sometimes it depends which member of staff is on.” On case tracking this information by examining the daily case recording sheets information did not include what times residents were supported to go to bed or if drinks were being offered, accepted or refused. Good care recognises that individuals and those with dementia have the same rights as any other person to make decisions about their lives. It is Requirement 2 that person centred care plans Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 13 are developed and followed to ensure practices at the home promote residents’ right to exercise choice and control and ensure people who use the service are actively consulted on in all aspects of life in the home. It is Requirement 3 that daily case recording sheets are recorded in detail to reflect the actual care provided at the home. Care provided for residents with a diagnosis of dementia are being developed to focus on meeting their specialist care needs. A care plan viewed for a resident who had a diagnosis of dementia and had difficulty in communicating, clearly recorded that staff are to talk slowly and clearly to the resident, to ensure her communication needs were met. All members of staff were wearing their name badges and large signage was displayed around the unit. Staff were observed to be interacting positively with residents, talking to residents, maintaining eye contact, talking slowly and in a manner which was appropriate to the communication, needs of residents. However, this practice was not yet consistent, as a care plan examined for a resident who had a formal diagnosis of dementia, included no information on how the service was going to meet this individuals specialist needs. Personal care of residents was not always maintained at the home. One resident who was bed bound had black residue under their fingernails. On speaking to a relative of the resident, they stated “I’m not sure when they washed X or if anyone’s encouraged to get X out of bed.” It is Requirement 4 that the service makes proper provision for the health and welfare of people who use the service and ensure personal care is regularly attended to and maintained. All care plans viewed contained information on the end of life wishes of residents and the contact details of relatives and representatives where appropriate. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined, which were all in good working order. Medication files included the identification signatures of staff with permission to administer medication. Relatives and residents spoken to as part of the inspection gave some very positive feedback regarding the services and staff at the home. “Care staff are friendly and helpful. We’ve had no major problems here,” said a relative. A resident informed, “On the whole the staff are quite nice.” Another resident stated “Staff do their best, especially when they’re short staffed. The carers are very good, they are lovely.” Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 14 Hillside Nursing Home DS0000068195.V361257.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): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A programme of activities has been introduced and residents are given the opportunity to take part in activities. But needs to be reviewed to ensure residents’ recreational needs are met to their preference. There is a choice of meals in the home, but this needs to be reviewed, to ensure it can meet the needs and choices of all residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: Since the last inspection the activities programme has been reviewed and an activities co-ordinator has been employed. The activities organiser has completed her NAPA training for implementing further activities with elderly frail and dementia care residents. The weekly activities included activities such Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 16 as painting nails, hand massages, puzzles, picture making, painting, colouring, folding napkins, prize bingo, music and movement, and cake making. The service has also arranged access to a mini bus, which the home has on a quarterly basis for a week. In March this year residents were supported to visit local attractions and the mini bus has been arranged to come to the home in August, later this year. However, this was felt to be a long length of time for residents to be waiting to be supported to go out again. The activities coordinator was spoken to who informed that they have been potting plants with residents and have also introduced dementia appropriate activities, such as reminiscence sessions. The home also has a pet rabbit, which is housed in the garden and comes to into the home regularly for residents to see. However, one activities co-ordinator providing activities for 55 residents is not meeting everyone’s needs at the home. It was evident that residents who are bed bound were prone to being excluded from social activities at the home. The activities co-ordinator informed that “I can find it difficult to provide activities over two floors, there should really be two co-ordinators.” Residents and relatives spoken to also gave mixed responses to the amount of activities arranged at the home. One relative said “They’ve had a few changes in activities, but I haven’t seen any vast improvement. They do go outside in the summer, but there is not a lot being done to stimulate them. They do sometimes have live entertainment.” “ There are not many activities here. We have bingo but there isn’t much exercise, and we do some puzzles here and there. We do have a entertainers and we have another one coming in next week. They do try to do their best,” informed a resident. Another resident stated, “In the summer time we do go out into the garden, but we do have to persuade them, we have to keep on saying that it’s a nice day. We have a bit of entertainment. Things are a little better.” These comments were discussed with the manager and the registered proprietor of the home, who agreed that there was a shortfall in this area and informed they will be looking into recruiting another activities co-ordinator. It is Requirement 5 that the Registered Persons consults with residents about their social interests and makes arrangement to enable them to engage in local, social and community activities, to ensure the lifestyle experienced in the home matches their expectations and preferences. There is a four weekly menu, which included a variety of fresh fruits and vegetables and a choice of two meals at lunchtime and at suppertime and snacks throughout the day. Pictures of foods were displayed in the dining areas and the choice of menu on offer on the day was communicated to each resident verbally, ensuring that all residents understood choices available to them. Records were seen of residents’ choices of meals for each day that they had chosen when consulted with by carers. On speaking to the chef, she was able to demonstrate her knowledge of those residents requiring special diets, for example diabetic and pureed diets. However, it was identified that the evening mealtime was not flexible as this was ready by 4.30 pm and served by 5.00 pm. If residents wanted to eat later on in the evening staff would not be able to access anything from the main kitchen, as this would be closed. There Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 17 are kitchenettes on each floor, which do stock cereals and snacks, but this would limit staff in preparing a meal, if a resident requested one. The lunchtime meal was observed being served. Condiments were placed at each table and residents were given the choice of whether they would like gravy and were offered a choice of drinks. The meal looked and smelt appetising. On speaking to residents regarding the meals a mixed response was received. One resident informed, “The quality of food isn’t good. They do however say, if there’s anything else you want, they will do their best to get it. The portions suit me. The food and the taste of food has improved.” Another resident spoken to said “The meals are not my sort of thing. There is enough choice but the food is not to my taste. They can be improved. The portions are good, I can’t grumble about that. There needs to be a better variety of deserts, there is too much jelly, custard, peach and ice-cream.” A member of staff spoken to informed, “The food has improved but they do get the same deserts.” She also pointed to deserts on the menu that she said had never seen being served. It is Requirement 6 that the menu is reviewed to ensure that suitable food which is varied is available at such times as may be required by people who use the service and is an accurate reflection of meals available. Visiting times were flexible and visitors could visit at any time convenient to residents. Relatives, family and friends were seen to visit residents throughout the time of the inspection and were made to feel welcomed by the staff at the home. The service also promotes and encourages residents to express their sexuality and maintain personal and intimate relationships. There is a couple who have been placed at the home to ensure they are together. The service also has a policy staff must follow to ensure each individual has the right to express their sexuality, promoting their rights to equality and diversity. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service cannot always be assured their views are listened to and acted on. The service needs to broaden its way of recording complaints to include concerns to ensure any dissatisfaction is recorded and acted upon regardless of source. All staff are in the process of receiving up to date training in safeguarding adults, to ensure the protection of residents. However, safeguarding protocols are not always correctly followed. EVIDENCE: The complaints procedure is clear and easy to follow and was displayed at the home. Timescales within which a complaint would be investigated were stated on the complaints procedure and included the contact details for the Commission for Social Care Inspection. The complaints file was viewed. Complaints received this year by the home, were responded to within the specified timescales and were responded to appropriately. Since the last inspection the Commission for Social Care Inspection has received one complaint and have been informed of a further two complaints by the London Borough of Havering, which they had received. The complaints were Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 19 investigated by the local authority. Two complaints were found to be ‘disproved’ and the third complaint in one part was partly substantiated with the complainant complaining that syringes had not been rinsed before being used. The service accepted their shortfalls and nurses were reminded of the procedures. However, not everyone felt his or her complaints were listened too. On speaking to a relative they informed that they had made a verbal complaint regarding an incident that took place at the home involving another resident who tried to attack their mother and also bought the incident to the manager’s attention at the relatives meeting. The relative informed, “When we read the minutes of the meeting, the whole incident was down played.” On case tracking the complaint to the complaints file, no record was found of the complaint. All complaints or concerns about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to ensure their complaints will be listened to, taken seriously and acted upon. This will stated as Requirement 7 On speaking to the manager she informed that the resident who presents challenging behaviour has “slapped another resident across the knees.” This incident should have been reported to the London Borough of Havering safeguarding adults’ team and reported to the Commission for Social Care Inspection in line with safeguarding protocols. A requirement in relation to the findings will be stated as Requirement 8. Since the incident the service has implemented behaviour-recording charts for the resident to monitor their challenging behaviour and ensure the safety of other residents and have also requested a care management review by the funding local authority. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Some staff have had training in safeguarding adults but others are still due to attend this training, forming an inconsistency of understanding and knowledge. The service has comprehensive safeguarding adults procedures and protocols in place. It has obtained safeguarding adult protection procedures devised by The London Borough of Havering but as discussed above they are not always followed. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home was satisfactory but needed redecorating in some parts of the home, to ensure residents live in a wellmaintained environment. EVIDENCE: The home provides a physical environment that meets the specific needs of the people who live there. The home has two main lounges, two dining rooms, which are homely, and adequately furnished. A number of residents’ bedrooms were seen. Bedrooms were personalised by furniture residents had brought with them when moving to the home and by personal family photographs, pictures, televisions and radios. Residents say that the home is clean, warm and well lit. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 21 During a tour, it was identified that areas throughout the home needed to be redecorated as the paintwork and walls were scuffed in places. Some bedroom furniture was showing signs of wear; a wardrobe in a residents room had no door, another bathroom door in a residents room had a dent on it, which needed to be repaired. On viewing a resident’s room a large brown stain was seen on the wall. A relative of the resident informed that it had been there for a very long time. The home has a programme to improve the decoration fixtures and fittings. However, the home must be maintained to ensure the safety and comfort of the residents. This is a repeated requirement and will be stated as Requirement 9. The home has also built a sensory garden and is in the process of planting plants with different textures, smells and colours. The garden is located at the front of the property and has added character to the property. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. The service provides suitable aids and adaptations where required. There were hoists and other aids available at the home. Hillside Nursing Home DS0000068195.V361257.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service receive adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. However, staff training in manual handling needs to be reviewed to ensure staff understand the procedures which ensure the dignity and safety of people who use the service. There is good skill mix of staff to meet the needs of residents. EVIDENCE: At the last inspection a requirement was made in relation to reviewing and increasing staffing levels to meet the needs of residents. This has now been met by the service. The staffing levels at the home consist of a qualified nurse on each floor during the day and an average of five carers on the first floor and four carers on the ground floor. There are four waking night staff on duty during the night shift and a registered nurse who floats between the two floors. Two shift increases have taken place, which includes an extra shift of 8 am to Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 23 12pm, and the afternoon shift is now 8 am to 3 pm increased by an hour. Staff informed that changes to the staffing hours have made a “big difference” as staff are not rushing so much. The London Borough of Havering spoken to as part of the inspection commented “most of the homes problems were due to staff shortages and sometimes the attitudes of staff.” They further informed now that the home has increased their staffing levels they expect to see things improve at the service. Relatives spoken to spoke very positively about the staff team. “My mother is looked after very well. The carers seem to look after her and make a fuss of her, she seems quite happy. I haven’t really got any complaints” informed a relative. Another relative said” They are a friendly bunch at the home. It’s a nice home, we are happy that she’s there.” “Staff attitude is very good. We are very, very happy with the care. Attention to medical need is very good. We are always contacted promptly. My mother had a fall and they contacted us straight away. I’ve not had a reason to complain” informed another relative. Three staff files of recently recruited members of staff were closely examined, which were all in good order. References and Criminals Records Bureau checks had been obtained for all three members of staff. The staff training matrix was examined which identified that staff receive training in manual handling, safeguarding adults, infection control, first aid, health and safety, dementia, challenging behaviour, Mental Capacity Act 2005, and COSHH. Registered nurses also receive training in medication administration, wound management, catheter care and nutrition. The service has also enrolled senior care staff on to train the train course through the Mulberry training programme. Allowing qualified senior care staff to train other staff within the home. The service has not yet received a ratio of 50 of a NVQ qualified staff team but a large number of staff have commenced the course. Although the service has implemented a comprehensive training programme it was concerning to find that one resident expressed concern at staff attitudes and the way some members of staff treated her when being hoisted. She said “When I’m hoisted the sling is too high up and it catches my skin, which really hurts. When I tell staff they just ignore me.” Another resident was observed being hoisted during the inspection. The resident was calling out for reassurance whilst on the hoist. Staff did not stop the procedure and carried on hoisting the resident. This practice is unacceptable and does not value residents’ rights to dignity. The service must ensure training is provided to all members of staff in manual handling which they understand to ensure they can provide care, which is person centred and care which promotes the dignity of people who use the service. This will be stated as Requirement 10. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 24 Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36, 38 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service cannot be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded. The systems for service user consultation are satisfactory, but there was little evidence that views are acted on. The health and safety of staff and residents is promoted by the home’s policies and procedures. EVIDENCE: Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 26 The manager is qualified and has the necessary skills to run the home. The registered manager is a registered nurse with experience of managing services for this client group and has completed the registered managers qualification. The manager trains and develops staff who are generally competent and knowledgeable to care for people who use the service. The service works in partnership with families or close friends, as appropriate and professionals. The manager is improving and developing systems that monitor practice and compliance with plans, polices and procedures but as the findings in this report have highlighted, more work is needed in this area. Services users’ records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. The latest supervision records were viewed for all staff. A supervision programme is in place but staff files evidenced that staff members are not supervised regularly (at least six times a year). It is Requirement 11 staff are supervised regularly, to ensure staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. There is an annual quality assurance programme and the results of the staff survey completed in January 2008 were viewed. These results had been analysed. The service is also in the process of completing surveys with people who use the service. Regulation 26 visit reports were examined which had been completed monthly and provided evidence of how the registered provider is monitoring practice and care at the home. Health and Safety records were inspected. All documentation was in order and appropriately completed. Evidence was seen of water temperatures checks completed at all outlets throughout the home on a monthly basis. Hillside Nursing Home DS0000068195.V361257.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 2 x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation Schedule 1 Requirement The registered persons must ensure that the statement of purpose is updated to ensure prospective residents have the correct information they need to make an informed choice about whether they would like to live at the home. Timescale for action 30/07/08 2 OP7 OP10 12 (4) (b)15 (1) (2) ( c ) 3 OP7 17 (1) (3) (a) 30/07/08 The registered persons must ensure that person centred care plans are developed and followed to ensure practices at the home promote residents’ right to exercise choice and control and ensure people who use the service are actively consulted on in all aspects of life in the home. Care plans must consistently identify the needs of those with dementia and record how the service intends to meet these specialist needs. The registered persons must 31/05/08 ensure that daily case recording sheets are recorded in detail to reflect the actual care provided at the home. Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 29 4 OP8 12 The registered persons must ensure that the service makes proper provision for the health and welfare of people who use the service and ensure personal care is regularly attended to and maintained. The registered persons must consult service users about their social interest, and make arrangements to enable them to engage in local, social and community activities to ensure activities are also suitable for residents. Repeated Requirement. Timescale of 30/11/07 not met. 30/07/08 5 OP12 16 (m) 30/07/08 6 OP15 12 (2)16 (i) The registered persons must that 30/07/08 the menu is reviewed to ensure that suitable food, which is varied, is available at such times as may be required by people who use the service and is an accurate reflection of meals available. The registered persons must ensure that any complaint made under the complaints procedure, regardless of source is fully investigated. Repeated Requirement. Timescale of 30/11/07 not met. The registered persons must ensure safeguarding protocols are always correctly followed, to ensure the protection of people who use the service. The Commission for Social Care must be informed of any Safeguarding alerts through the completion of Regulation 37 notification forms. The registered persons must ensure the home is maintained DS0000068195.V361257.R01.S.doc 7 OP16 22 (3) 30/07/08 8 OP18 13, 22 31/05/08 9 OP19 23 30/07/08 Page 30 Hillside Nursing Home Version 5.2 to ensure the safety and comfort of the residents. Repeated Requirement. Timescale of 30/11/07 not met. 10 OP30 18 (1) (a) (c) The registered persons must ensure training is provided to all members of staff in manual handling which they understand to ensure they can provide care, which is person centred and care which promotes the dignity of people who use the service The registered persons must ensure that staff are supervised regularly, to ensure staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. 30/07/08 11 OP36 18 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended the service consider providing the Statement of Purpose and Service User Guide in formats, such as Braille, appropriate languages, pictures, video and audio. It is recommended that social histories are completed for all residents who have dementia, to ensure the service can fully identify and meet the needs of people using the service. 2 OP3 OP4 Hillside Nursing Home DS0000068195.V361257.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000068195.V361257.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!