CARE HOMES FOR OLDER PEOPLE
Hillview Nursing Home Meadowgate Eston Middlesbrough TS6 9NN Lead Inspector
Val Daly Key Unannounced Inspection 15th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillview Nursing Home DS0000000175.V340311.R02.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. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hillview Nursing Home Address Meadowgate Eston Middlesbrough TS6 9NN 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) 01642 440560 01642 452438 www.bupa.co.uk BUPA Care Homes (GL) Ltd Mrs Sheila Wendy Smith Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That a maximum number of 5 places may be used at any one time for the accommodation of persons who are 55 years and over with a physical disability. 14th November 2005 Date of last inspection Brief Description of the Service: Hillview is a care home that provides personal and nursing care to older people. It is a large building in it’s own grounds situated close to the Cleveland Hills. The home has 53 bedrooms on two floors. Fifty-three of the bedrooms are single with 28 of those having en suite facilities. There is one double bedroom. There are a number of lounges for the residents to use along with two spacious dining rooms. The home is accessible from the A174 and through Eston, where there are shops and pubs. The home is owned by BUPA and the Responsible Individual is Lesley Tart. The Registered Manager is Sheila Smith. Weekly fees are from £430 to £560 Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was a key inspection and was completed by an inspector over two days. As a key inspection, all of the key standards were examined. A tour of the home took place, residents records were examined, records including accidents, complaints and menus were looked at and five residents, three members of staff, the manager activities co-ordinator, and administrator were engaged in discussion about life at Hillview The Commission for Social Care Inspection sent a number of questionnaires to the home for residents and relatives to complete. Thirteen were returned from residents and relatives. Comments from residents and relatives include: • The staff are very helpful and cheerful. • The nursing staff are wonderful and nothing is a trouble for them. • I like my room and the view is lovely, with my bits of furniture it looks like home. • I enjoy the meals and have a good appetite. • Sometimes the food is rather plain and bland, I would enjoy a little less traditional, spices, sauces. • The hairdresser sometimes fails to turn up on Mondays and Fridays and carers are often too busy to give time to shower and hairwash. • The main meals are very good but sometimes soup and sandwiches for lunch does get boring day in, day out. • No-one deputises if the activity co-ordinator is away. Trips into Eston would be nice if enough staff available. • I have come in for respite care, very happy with the way I have been looked after. • I stayed for two weeks respite and decided to stay as by that time talking to other people and my own opinion I had decided the home was the best in the area. • I find things alright. What the service does well:
The home employs an activities co-ordinator who is very enthusiastic and committed to providing activities, which the residents will enjoy. There is a manual of guidance of activities, which is broken down into the seasons of the year. There are ideas for celebrations for each month such as Queens Birthday, having a tea party; Royal ascot, having a ladies race night; Wimbledon, having strawberries and cream. Residents also enjoy games such as play your cards right and who wants to be a millionaire along with bingo, aromatherapy and listening to music. Some residents prefer not to join in and like to have parts of the newspaper read to them or have chats in general. On the day of the inspection a number of residents were enjoying taking part in a quiz and others were watching a film.
Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 6 Staffs receive Skills for Care induction training with different handbooks for each job. Each new member of staff has a mentor who guides them through the induction process. The home has a training plan in place with one senior member of care staff being responsible for ensuring training is up to date and staffs is aware of the available training. Several quality assurance systems were seen to be in place focussing mainly on care documentation, activities and medication. There are also monthly audits looking at accidents, pressure sores and maintenance. The Area Manager carries out monthly visits and reports on many aspects of the home, the building, care records, health and safety and also has discussions with residents and staff. 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. Hillview Nursing Home DS0000000175.V340311.R02.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 Hillview Nursing Home DS0000000175.V340311.R02.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): 3&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs assessed. EVIDENCE: Each resident has his or her needs assessed by a care manager prior to moving into the home. The manager also carries out her own assessment meeting the prospective resident in either their own home or in hospital. Four resident’s files were examined. Since the previous inspection new assessment and care planning documentation was in the process of being put in place and each resident’s needs are being re assessed. The documentation is person centred and the areas covered are; communication, lifestyle, maintaining a safe environment, mental state and cognition, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, sleeping, pain, medication, end of life arrangements, any personal needs and expectations or medical conditions, activities including comments from the resident and showed evidence of resident/relative involvement. A map of the resident’s life is included, showing their younger life, where they lived, employment, children, hobbies and interests.
Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 9 The home does not provide intermediate care. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Four resident’s files were examined and they each contained an individual care plan following on from the assessment. Personal and social care needs were included in the plans. They were reviewed regularly and showed involvement from residents/relatives. There was documentation to demonstrate that general practitioners, consultants and other health care professionals are meeting resident’s health care needs. Policies and procedures are in place for the ordering, receipt, storage, disposal and administration of medication. At the time of the inspection there was one resident, who managed their own medication. There was a resident agreement form was in place along with a risk assessment and agreement by the resident’s Doctor. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their lifestyle. A variety of food is offered. EVIDENCE: The home employs an activities co-ordinator who is very enthusiastic and committed to providing activities, which the residents will enjoy. There is a manual of guidance of activities, which is broken down into the seasons of the year. There are ideas for celebrations for each month such as Queens Birthday, having a tea party; Royal ascot, having a ladies race night; Wimbledon, having strawberries and cream. Residents also enjoy games such as play your cards right and who wants to be a millionaire along with bingo, aromatherapy and listening to music. Some residents prefer not to join in and like to have parts of the newspaper read to them or have chats in general. On the day of the inspection a number of residents were enjoying taking part in a quiz and others were watching a film. There was also a ‘fruity week’ planned when residents would be having a coffee morning and tasting various fruits in smoothie drinks and having chocolate on marshmallows and strawberries. Representatives from different religions regularly visit the home to ensure needs are met. Residents interviewed said friends and family could visit at any time and were invited to all the celebrations. The menu showed a variety of food is offered with choices and five fruit and vegetables offered are highlighted daily. Special diets are catered for and the
Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 12 chef said she always offers more alternatives to any resident who does not like of want what is on the menu. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: Four residents interviewed said that they would be comfortable speaking to a member of staff if they had any concerns. The home has a complaints policy and procedure in place. This has been updated since the previous inspection and includes the Contracts and Commissioning department of the Local Authority. Records showed that complaints were investigated promptly and there were written reports of action taken in place. Following the outcome of the investigation complainant is asked if they are satisfied or not. The home has a whistle blowing policy and an adult protection policy in place. There was evidence in the staff training files to show that staff had received training in Adult Protection’. During interviews with staff they confirmed they had received training and were aware of the procedure to follow in the case of suspected abuse. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe well-maintained and comfortable environment. EVIDENCE: A tour of the premises found the home to be warm, welcoming and friendly. Suitable communal space is provided for residents and these areas are decorated in a homely and comfortable manner. Resident’s bedrooms are homely and personalised with personal possessions being evident. The home is well maintained and re decoration and refurbishment is ongoing. Since the previous inspection a new carpet has been purchased for the first floor corridor and all the paintwork has been re done. A new sit in shower has been installed. The manager said that the large garden to the rear of the home is to be landscaped and more seating areas for residents will be in place. The home was extremely clean and odour free. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: The home has a rota in place, which shows a skill mix of staff being on duty on each shift. The home has a policy and procedure in place for the recruitment of staff. Four staff files examined showed that the required information, references and CRB checks were in place prior to staff commencing work in the home. Staffs receive Skills for Care induction training with different handbooks for each job. Each new member of staff has a mentor who guides them through the induction process. The home has a training plan in place with one senior member of care staff being responsible for ensuring training is up to date and staffs is aware of the available training. Since the previous inspection staff had undertaken training in Moving and Handling, Basic Food Hygiene, Health and Safety, Fire Safety, Personal Best, and activities. A number of staff has undertaken distance learning in Equality and Diversity, Safe Handling of Medicines and Palliative Care. Some of the qualified staff has also attended Train the Trainers courses in Violence and Aggression and The Mental Capacity Act. Training is then cascaded to other staff in the home. 73 of staff have achieved NVQ level 2 or above in care. Domestic and kitchen staff has also achieved NVQ level 2. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 16 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 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and has effective quality assurance systems. EVIDENCE: The Manager is a qualified nurse and has achieved the Registered Managers Award. She has many years experience in care services. Several quality assurance systems were seen to be in place focussing mainly on care documentation, activities and medication. There are also monthly audits looking at accidents, pressure sores and maintenance. The Area Manager carries out monthly visits and reports on many aspects of the home, the building, care records, health and safety and also has discussion with residents and staff. Questionnaires are sent out annually to residents to seek their views about life in the home. Resident and staff meetings are held regularly and minutes are kept.
Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 17 A number of health and safety documents and records were examined at the inspection including the accident book, the gas safety certificate, hot water temperatures and various other records. These were all found to be up to date. A check of residents’ finances and records was correct and showed that any monies kept on behalf of residents is in safe hands. Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 18 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 4 X X x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 3 Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hillview Nursing Home DS0000000175.V340311.R02.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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
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