Inspection on 22/06/06 for Hillview Nursing Home

This inspection was carried out on 22nd June 2006.

CSCI 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 CSCI judgement.

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

Hillview Nursing Home 18/12/09

Hillview Nursing Home 25/02/09

Hillview Nursing Home 26/02/08

Hillview Nursing Home 31/05/07

Hillview Nursing Home 15/12/05

Hillview Nursing Home 20/07/05

Hillview Nursing Home 13/01/05

Hillview Nursing Home 10/08/04

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

CARE HOMES FOR OLDER PEOPLE Hillview Nursing Home 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX Lead Inspector Kathy McCluskey Key Unannounced Inspection 22nd June 2006 10:00 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 DS0000054819.V292838.R01.S.doc Version 5.1 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 DS0000054819.V292838.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hillview Nursing Home Address 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX 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) 01278 783192 01278 783192 hillview@almondsbury.fsnet.co.uk www.almondsburycare.com Almondsbury Care Limited Mrs Shirley Anne Ruane Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Places for up to 13 person for personal care. Registered for a total of 30 places in category DE(E). One existing named service user under the age of 65 years in the category DE to remain at the home with no further admissions for service users under this category. One existing named service in the category MD(E) to remain at the home with no further admissions for service users under this category. The existing Manager to be supported by a named Clinical Manager who is suitably qualified and experienced RMN (Part 3 or 13 of the NMC Register) and will work a minimum of 30 hours per week at the home. In the event of Room 11 being vacated by the current service user, no further admission to this bedroom until work to increase the size of the bedroom has been carried out and approved by the NCSC. The following bedrooms should not be used for service users who require the use of a hoist or wheelchair to mobilise or staff assistance with regard to moving and handling; Rooms 2, 10, 17, 22, 23 and 26. 15th December 2005 6. 7. Date of last inspection Brief Description of the Service: Hillview Nursing Home is situated approximately 1 mile from the seaside town of Burnham-On Sea. The home is registered with the Commission for Social Care Inspection to provide nursing care for up to 30 people not less than 65 years of age who suffer with dementia. Within this provision, the home is registered for up to 13 places for personal care. Conditions of registration are detailed later in this report. Currently Social Services have a block booking some single occupancy beds at the home. Hillview is owned by Almondsbury Care Ltd. The Responsible Individual is Mr K.Smith. The Registered Manager is Ms Shirley Ruane. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was carried out in line with the CSCI framework ‘Inspecting for Better Lives 2’. This unannounced key inspection was conducted over one day (7hrs or 14 inspector hours) by CSCI Regulation Inspectors Kathy McCluskey and Justine Button. At the time of this inspection, 26 service users were living at the home. The inspectors were able to meet with the majority of service users and staff. Service users were positive about the care they received. Staff stated that they felt well supported. The registered manager was available throughout the inspection. A tour of the premises was carried out where all communal areas and the majority of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. As part of this inspection, CSCI comment cards were sent to 15 service users and their representatives and to all G.P’s and Care Managers. At the time of this report 7 completed comment cards were received from service users, 2 from care managers and 1 from a G.P. Comments from service users were positive. The majority of service users indicated that the staff were kind and always listened. Comments from the GP and care managers were positive and indicated that they were happy with the overall care provided. The inspectors would like to thank service users, staff and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Hillview provides a comfortable environment for older people who have dementia. Service users are cared for by appropriately trained registered nurses and care staff. The home provides 24 hour nursing care. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 6 The numbers of staff on duty are appropriate to meet the needs of service users. Service users and staff benefit from an effective and stable management team who promote an open and inclusive style of management. The home ensures that prospective service users are provided with the information they need to enable them to make an informed choice about moving to the home. No service user moves to the home unless their needs have been fully assessed. This is to ensure that the home can meet an individual’s needs and aspirations. During the inspection the inspectors observed staff interactions with service users. Staff were heard communicating with service users in a kind and respectful manner. Service users appeared comfortable in their surroundings. Service users benefit from a wholesome and varied diet. The inspector was able to observe service users enjoying lunch. Choices were offered. Meals, including special/soft diets were attractively presented and portions were generous. Service users enjoyed lunch in a relaxed an unhurried manner. Staff sat with service users and offered assistance where required. This was carried out in an unhurried and respectful manner. Service users spoken with stated that they liked the food. The manager needs to ensure that the menu board is displayed. This was removed during redecoration of the dining area. The home ensures that service users have access to appropriate/specialised healthcare professionals. What has improved since the last inspection? Since the last inspection, the registered provider has been proactive in addressing requirements relating to environmental improvements. New carpets have been fitted in the hall and corridors and some bedrooms. Some bedrooms have been redecorated and work was on-going at the time of the inspection. The home was able to demonstrate that complaints were being investigated in line with the home’s complaints procedures. Staff supervision records had improved and now contained more detailed information and had been signed/agreed by the employee. Health and safety issues raised at the last inspection have been addressed. These included the replacement of a broken windowpane and ensuring that adjustable beds were fitted with appropriate mattresses. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 7 As recommended at the last inspection, the home now maintains copies of service user contracts/financial agreements at the home. 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. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 8 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 DS0000054819.V292838.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 is not applicable, as the home is not registered to provide intermediate care. The quality for this outcome group is good. Prospective service users have the information they need to make an informed choice about moving to the home. The home takes appropriate steps to ensure that an individual’s assessed needs can be met by the home. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide. Copies are made available to service users, prospective service users and their representatives. These documents are also displayed in the reception area of the home and include a copy of the home’s last CSCI inspection report. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 10 The registered manager provided the CSCI with pre-inspection information which stated that the home’s current fees are £600 per week. Fees are determined upon the assessed needs of an individual. Any ‘Free Nursing Care’ element awarded is incorporated into the fees and is not refunded to the service user. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. The home also makes additional charges for transport and for staff time to escort service users to and from appointments. As recommended at the last inspection, copies of service user contracts/financial agreements are now maintained at the home. The manager or her deputy visit a prospective service user and carry out an assessment to ensure that the assessed needs and aspirations of the individual can be met by the home. Documented evidence of pre-admission assessments were seen in the care records examined. Assessments from other professionals were also seen in care records. Prospective service users and/or their representatives are invited to visit the home prior to making a decision. Service users move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. This was confirmed by the most recent service user. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The quality in this outcome group is adequate. The home’s procedures for documenting individuals assessed needs requires improvement. The home ensures that service users have access to appropriate healthcare professionals. Service users are treated with respect. The home’s procedures for the management & administration of medication is generally good though further improvements are needed. EVIDENCE: Four service users were case tracked at this inspection. This involved meeting with the service users, examining care and related records and viewing their bedrooms. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 12 Care plans contained up to date assessments which included moving and handling, reducing the risk of pressure sores & falls. Social histories were documented, as were the preferences of service users. Records are maintained relating to the preferences of service users following death. The inspectors noted that care plans were not always raised when there was an identified need. Some care plans required more detailed information relating to the individual’s assessed needs. Findings were as follows; - A care plan was in place for a service user who had lost weight. The care plan was not fully reflective of current needs as it did not identify that the service user was on a fluid balance chart as they were experiencing difficulties with fluids. Staff were also providing regular ‘oral care’ with swabs. This was not identified in the care plan. There was no evidence in the daily records that dietary supplements were being offered as per plan of care. - Care records relating to a service user with pressure sores was examined. Pressure sore risk assessments had been completed but no care plan had been raised to identify preventative measures or what pressure relieving equipment was in place. There was nothing to indicate that, apart from the wound management plan, this service user currently had pressure sores. The wound management plan was examined for this service user and another service user with a wound. From the information available, the inspectors were unable to ascertain the progress of the wound as ‘measurements’ were not consistently recorded. The need to introduce photo’s and tracings was discussed with the registered manager at the time of the inspection. - Another service user was noted to have wounds/dressings in place. There was no care plan or wound management plan in place to address this. - Another service user had a wound care plan in place, which had last been reviewed in September 2005. The service user had dressings in place at the time of the inspection. Entries in the care records were insufficient – i.e.: ‘dressed as per care plan’. There was no evidence that prescribed dressings had been reviewed. - Care plans to meet psychological/behavioural needs need to be more ‘person centred’ and require more detail relating to assessed needs and interventions for staff. This was discussed with the registered manager at the time. - Care plans were not in place to address individual’s oral hygiene needs. In all bedrooms examined, the inspectors found toothbrushes to be dry/hard. Although care plans require improvement, the inspectors were able to see evidence that the home was proactive in seeking the input of appropriate professionals. This included input from district nurses, GP’s, Social workers & Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 13 palliative care specialists. The home has also made referrals for input from a tissue viability nurse and dietician. Service users who were able to express a view were very positive about the care they received. Staff interactions with service users were noted to be very warm, professional and respectful. Interventions were observed to be ‘unhurried’. Staff were heard explaining interventions to service users before carrying out. Service users appeared relaxed and comfortable throughout the day. The homes procedures for the management and administration of medication was examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). Medicines are administered by the registered nurse on duty. Medicines were found to be securely stored. MAR charts were generally good but hand transcribed entries had not always been confirmed with two signatures. Creams in use, seen in service user bedrooms, had not been marked with an expiry date. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome group is good. Service users are given the opportunity to exercise choice and control over their lives. The home provides service users with a wholesome and varied diet. EVIDENCE: As previously mentioned in this report, the home takes appropriate steps to ensure that wherever possible, the preferences of service users are identified in the individual’s plan of care. Relatives & friends are encouraged to provide information relating to their loved one’s social history, previous hobbies/interests, preferences, likes and dislikes. Those service users able to express a view informed the inspectors that their wishes were respected and that they could choose what time to get up or go to bed. Service users can choose where and how to spend their day. Any restrictions would be identified in risk assessments. Due to mobility difficulties, not all service users can move freely around the home. Throughout the day the inspectors observed regular staff presence in Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 15 each of the lounges. As previously mentioned, staff interacted with service users in a kind and respectful manner. No activities took place during the inspection. The inspectors were informed that the clinical manager, who takes the lead in activities/therapies, was on a training course so no activities were planned. The inspectors recommended that, in the absence of the clinical manager or any planned activities, care staff should be encouraged to provide stimulating activities for service users. The home welcomes visitors at any reasonable time in accordance with the wishes/preferences of the service user. No relatives/visitors were available at this unannounced key inspection. No completed CSCI comment cards were received from relatives. All meals are prepared and cooked on the premises. Copies of a two week menu were made available to the inspectors. The menu appeared wholesome and varied. The main meal is served at lunchtime with a lighter cooked meal at tea time. Alternatives/choices are offered. This was evident at the time of the inspection. The inspectors were informed that milky drinks and sandwiches were offered in the evening. Special diets are catered for. The inspectors observed soft diets being served to those with an assessed need. These were seen to be attractively presented. Sweets were available for those requiring a diabetic diet. Environmental Health examined the home’s kitchen and procedures on 25/04/06 and the report states that the home is being recommended for the ‘Somerset Food Hygiene Award’. Staff were observed assisting service users in a manner which was relaxed, unhurried and respectful. Service users able to express a view were positive regarding the meals available and stated that there was always plenty to eat. The inspectors noted that the menu board had not been replaced following redecoration of the lounge/dining room. This was discussed with the registered manager who agreed to address. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality for this outcome group is good. The home’s procedures for responding to complaints have improved. The home takes appropriate steps to reduce the risk of harm or abuse to service users. EVIDENCE: The home has a complaints procedure, which is displayed in the reception area of the home. The home has received one complaint since the last inspection. Records were examined and the inspectors were able to see evidence that this had been investigated and responded to in line with the home’s procedures. Comments from a care manager, received in a CSCI comment card, regarding how the home conducted their investigations into the complaint were very positive. Staff are made aware of the home’s whistle blowing policy and information on ‘elder abuse’. These documents are also displayed in the main reception area of the home. The home follows robust recruitment procedures. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The quality in this outcome group is good. The standard of décor in the home has improved and improvements are ongoing. Service users live in a comfortable & clean environment and have access to a range specialised equipment. The home needs to ensure that orientation aids are available to assist service users. The home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: During this inspection, the inspectors were able to examine the majority of bedrooms and all communal areas. The home benefits from a large lounge/dining room with a smaller area off, and two additional lounge areas. All communal areas are situated on the Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 18 ground floor. The office, kitchen and laundry area are also situated on the ground floor. On the day of this inspection, service users were observed utilising all lounge areas and service users appeared relaxed and comfortable in their surroundings. Bedrooms are situated at ground and first floor levels. A shaft lift is fitted. Bedrooms consist of 16 single rooms 3 of which have en-suite facilities. There are 7 double bedrooms, 1 of which has en-suite facilities. All bedrooms are fitted with a wash hand basin as a minimum. 8 single rooms and 2 double rooms fall below the National Minimum Standards for space. As a result the home has conditions added to its Registration Certificate. No breaches in these conditions were highlighted at this inspection. The inspectors were informed that one service user was due to be moved to a more appropriate bedroom due to mobility needs. There are two level access showers, two assisted baths and one unassisted bath. Grab rails, ramps and nurse call points are appropriately sited throughout the home. The home has three mobile hoists and a stand-aid. Moving and handling belts and slide sheets are also available. The home has a good supply of adjustable beds. Given that the home is registered for older people with dementia, it has been recommended that the home considers displaying appropriate signage for service users and ‘orientation boards’ in each of the lounge areas (Standard 22.6). As required at the last inspection, the provider has been proactive in addressing areas of the home that required redecoration. Since the last inspection new carpets have been fitted to corridors and some bedrooms. Several bedrooms have been redecorated and work was ongoing at the time of the inspection. Paintwork to doors and skirting boards in some areas (noted at the last inspection) still require attention. The inspectors were assured that this was due to be addressed by the home’s maintenance person. Progress will be followed up. All areas of the home were noted to be clean. No malodours were apparent. The home takes appropriate steps to reduce the risk of the spread of infection. Hand washing facilities are appropriately sited throughout the home and staff have access to protective clothing. It was apparent from bedrooms seen that service users are encouraged to personalise their rooms. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality in this outcome group is good. Staffing levels and skill mix are appropriate to the numbers and needs of current service users. The home follows appropriate staff recruitment procedures. EVIDENCE: At the time of this inspection, 26 service users were living at the home. Staffing levels are currently adequate to meet the numbers and assessed needs of the 26 service users at the home. The registered manager informed the inspectors that staffing levels would be increased to reflect any increase in service user numbers or any increase in assessed needs. Copies of a two-week staffing rota were made available to the inspectors. As a minimum, one registered nurse is on duty during the day and night with the following care staff; 4 in the morning, 4 in the afternoon and 2 at night. Staff spoken with during the inspection did not raise any concerns about staffing levels. Since the last inspection the home have employed an additional registered mental health nurse who also provides management support. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 20 The home also employs kitchen staff, domestics, laundry staff and a maintenance person. The registered manager provided the inspectors with information indicating that of the 12 care staff employed, 8 had achieved a minimum of an NVQ level 2 in care. This gives an overall percentage of 67 . Two staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were also in place. Newly appointed staff follow a TOPPS induction programme. This covers the initial induction programme and on-going training for staff. Staff spoken with during the inspection were positive about the training opportunities available to them. Staff also indicated that they had received appropriate training to enable them to meet service users’ assessed needs. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36 and 38 The quality in this outcome group is adequate. Service users and staff benefit from an effective management team who promote an open and inclusive style of management. The home’s procedures for ensuring the health & safety of service users and staff have improved. EVIDENCE: The home is effectively managed by Shirley Ruane. Shirley is a registered general nurse with experience in caring for older people. She is supported by a registered mental health nurse, Julie White and an additional registered mental health nurse who also provides management support. Shirley is a moving and handling, food hygiene and fire trainer. Shirley is currently working towards the Registered Managers Award. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 22 Staff spoken with at this inspection were positive about the management style at the home. The manager and her deputy are very much ‘hands-on’ and both have a good knowledge of the assessed needs of service users. Service users and staff spoken with stated that they found the manager and the clinical manager supportive and approachable. The views of staff are sought through regular staff meetings. Minutes are maintained. The last staff meeting was held on 11/04/06. Formal meetings for service users are not felt to be appropriate. Any concerns/views of service users would be recorded in the individual’s plan of care with action taken as appropriate. The home manages small amounts of ‘pocket monies’ for service users where requested. Records of transactions were examined at this inspection. Receipts are obtained for all purchases. The registered manager is currently the only signature for transactions. It has again been recommended that all transactions are confirmed with two staff signatures. All staff receive regular one-one supervision sessions. Records were examined and the inspectors were able to see evidence that these now contained more detailed information and had been signed by the employee. This was raised as a requirement at the last inspection. All records seen at this inspection were stored in accordance with the Data Protection Act 1998. The home’s procedures for ensuring the health and safety of service users, staff and visitors were examined and a tour of the premises was carried out. The findings were as follows: FIRE SAFETY – The home conducts weekly checks on the home’s fire detection systems and monthly checks on emergency lighting. Records are maintained. Fire detection systems and fire fighting equipment are serviced by an outside contractor on an annual basis. This was last recorded as 16/05/06. On the day of this inspection, 14 staff received fire training by an external trainer. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried out 05/02/06. The home has an up to date electrical hardwiring certificate which expires in February 2010. GAS SAFETY – The home’s last annual gas safety check was conducted on 12/12/05. The certificate was seen at this inspection. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 23 ACCIDENTS – The home maintains appropriate records for all accidents. All accident records were seen to be appropriately stored in accordance with the Data Protection Act 1998. Accidents are analysed monthly by the registered manager and action to address is taken where appropriate. HOT WATER OUTLETS/SURFACES – The inspectors noted that hot water in wash hand basins was extremely hot. Warning signage was in place but given the needs of service users, it has been recommended that individual risk assessments are completed with action taken as appropriate. To reduce the risk of injury to service users, radiators are fitted with a guard. EQUIPMENT SERVICING – All equipment relating to the transportation of service users is serviced by an outside company in accordance with LOLER regulations every 6 months. The home’s passenger lift was serviced on 14/02/06, 2 fixed bath hoists, 2 mobile hoists and 1 stand-aid were also serviced on 14/02/06. To ensure the safety of service users, all upstairs windows are restricted, radiators covered and wardrobes are secured to the wall. The home records weekly checks to ensure continued safety. No concerns were noted with regard to adjustable beds, mattresses or bed rails seen at this inspection. Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 24 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X 3 2 3 3 2 Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation 15(1) Requirement The registered person must ensure that care plans are fully reflective of assessed needs. Particular attention should be given to the prevention of pressure sores. (Previous timescale of 10/01/06 not met) The registered person must ensure that wound care plans contain sufficient detailed information to ensure continuity of care. (Previous timescale of 10/01/06 not met) Consideration should be given to the use of photos/tracings. Timescale for action 31/07/06 2. OP8 12(1) 31/07/06 Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 26 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 OP35 Good Practice Recommendations The registered person should ensure that, where the home manages monies for service users, that all financial transactions are confirmed with two staff signatures. (This was raised at the last inspection) The registered person should ensure that hand transcribed entries on Medication Administration Records (MAR) are confirmed with two staff signatures. The registered person should ensure that service user creams/ointments in use are marked with the appropriate expiry date. The registered person should give serious consideration to ensuring that appropriate signage and orientation boards are made available to assist service users with dementia. To ensure the health & safety of service users, the registered person should complete individual risk assessments for service users relating to hot water outlets from wash hand basins and take action as appropriate. 2. 3 4 5 OP9 OP9 OP22 OP38 Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillview Nursing Home DS0000054819.V292838.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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