Inspection on 26/02/08 for Hillview Nursing Home

This inspection was carried out on 26th February 2008.

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

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

Other inspections for this house

Hillview Nursing Home 18/12/09

Hillview Nursing Home 25/02/09

Hillview Nursing Home 31/05/07

Hillview Nursing Home 22/06/06

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 Unannounced Inspection 10:15 26 February 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 Hillview Nursing Home DS0000054819.V356750.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 DS0000054819.V356750.R02.S.doc Version 5.2 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 785445 hillview@almondsburycare.com 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.V356750.R02.S.doc Version 5.2 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. Key inspection – 31st May 2007 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. Currently Social Services have a block booking some single occupancy beds at the home and the home have a Social Services Quality Rating. Hillview is owned by Almondsbury Care Ltd. The Responsible Individual is Mr K.Smith. The Registered Manager is Ms Shirley Ruane. Fees are £650 per week. Additional charges include; hairdressing, chiropody, newspapers/magazines, personal items and staff escorts to appointments. Any ‘Free Nursing Care’ element awarded is incorporated into the fees and is not refunded to the service user. Social Services have a block contract with the home for 10 beds. Hillview Nursing Home DS0000054819.V356750.R02.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 this service experience Adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service for each outcome group under four general headings. These are; - excellent, good, adequate and poor. The home’s last key inspection was carried out on 31st May 2007. A further visit to the home was made on 11th July 2007. In November last year, the home was partly damaged by a fire. Work is nearing completion on affected areas. People using the service were safely evacuated and were temporarily placed at other services. All have now returned to the home. This unannounced key inspection was conducted over one day (6hrs) by the Commission’s regulation inspectors Kathy McCluskey and Jane Poole. The registered manager was available for the majority of this inspection. At the time of this inspection 24 people were living at the home. The inspectors were able to speak with some people and a period of time was spent observing staff interactions with people using the service. The inspectors spoke with 4 staff and 1 visitor. As part of this inspection the Commission sent comment cards to a number of staff, relatives, people using the service and healthcare professionals. At the time of this inspection one completed comment card was received from a healthcare professional. Comments have been incorporated within the report. A selection of records were examined relating to the care of people using the service, the management and administration of medication, staff recruitment and health and safety. A selection of bedrooms and all communal areas were viewed. The inspectors would like to thank all present 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. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Requirements were raised at the last inspection relating to care plans for the management of wounds. Some improvements were noted at this inspection though further improvements are still needed to ensure a consistent approach. The home has taken steps to ensure that care plans are fully reflective of an individuals needs. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 7 As recommended at the last inspection, appropriate signage has been located throughout the home to assist people to orientate themselves around the home. The home has taken steps to replace loose carpet tiles in one bedroom. 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 Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 8 be made available in other formats on request. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home takes steps to ensure that people are appropriately assessed. People are given the opportunity to test drive the home. The home needs to ensure that all staff are able to communicate effectively with people using the service. EVIDENCE: Three care plans were examined at this inspection and there was evidence that people are appropriately assessed prior to a placement at the home being offered. People considering Hillview are assessed by the registered manager or her deputy. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 11 Care plans also contained assessments from other healthcare professionals and these assessments are used when formulating the plan of care. The home encourages people to visit the home prior to making a decision. People move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. During this inspection, one inspector spent a period of time observing staff interactions with people using the service. The inspector sat in the main lounge/dining area of the home. Interactions were noted to be kind and respectful. It was noted that some care staff, whose first language was not English, did not communicate with people when offering assistance. This was brought to the attention of the registered manager who stated that these staff were currently undertaking English lessons to improve their understanding and command of the language. The registered manager also stated that these staff were always on shift with staff whose first language was English. As the home is registered to provide nursing care for people with dementia and to ensure that the psychological needs of people can be fully met, it has been recommended that the home ensures all staff have the skills required to enable them to communicate effectively with people using the service. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The home’s procedures relating to care planning has improved. Care plans viewed were reflective of the individuals’ assessed needs. The management of wound care has improved though further improvements are needed. The home’s procedures for the management and administration of people’s medication requires some improvements. Staff communicate with people in a kind and respectful manner. Some bedrooms could be improved to ensure that people’s dignity is respected. Policies and procedures are in place for staff relating to death and dying. The home should ensure that people’s preferences are recorded in their plan of care. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 13 EVIDENCE: Three care plans and four wound care plans were examined at this inspection. Care plans contained assessments relating to moving and handling needs, risk of pressure sores and falls. Specialised equipment such as pressure relieving mattresses were seen to be in place for those with an assessed need. Assessed needs had been clearly identified in care plans and included the preferences of the individual as appropriate. Social/life history had been recorded for the individual. This provides staff with useful information about each person. Care plans gave evidence that people’s weights were being monitored on a monthly basis. Appropriate action had been taken where there were concerns about weight loss. As people using the service are not always able to be involved in their plan of care or review process, the home provides a monthly update to peoples representatives as appropriate. The registered manager confirmed that the home has established very good links with appropriate healthcare professionals. Care plans examined demonstrated that people have regular access to doctors, dentists, chiropodists and mental health professionals. Records of visits are maintained. At the last key inspection, it was required that the home ensures wound care plans contain sufficient information to ensure continuity of care. At this inspection the registered manager stated that four people were currently receiving treatment for pressure sores. Wound care plans for these people were examined at this inspection. Care plans contained good information about the size and status of the wound and photographs had been used to map progress. Information about the treatment and frequency of treatment had been identified in all but one of the care plans. Running records for this person did confirm consistency for the management of the wound as dates recorded varied between 2, 3, 4, 7 and 15 days. To promote healing and to ensure the individual’s health and well being, the registered person must ensure that details relating to the frequency of treatment is recorded and that this treatment is delivered in a consistent manner. Apart from the running records, wound care plans contained documented evidence of regular reviews, which included photographic updates. These Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 14 records could be further improved if details about the size/depth of the wound were recorded. This information was not available in two of the wound care plans examined. A recommendation has been raised. The home’s procedures for the management and administration of people’s medication were examined at this inspection. All available medication administration records (MAR) were examined and were found to be appropriately completed. Photographs are used to aid identification. Medicines were noted to be securely stored and no excess stocks were noted. Only the registered nurse on duty administers medication. On examination of controlled medicines, medicines for two people who had past away in October 2007, had not been returned to the pharmacy. One Fentanyl patch could not be accounted for. This was brought to the attention of the registered nurse on duty at the time of the inspection and with the registered manager the day after the inspection. A requirement has been raised. Nobody currently using the service is able to self-medicate. During the inspection staff were heard communicating with people in a kind and respectful manner. People appeared well groomed and well attired. The home currently has some shared rooms still in use though these will be de-commissioned when current building works are completed. Screening was available in all but one of the shared rooms seen at this inspection. This was brought to the attention of the registered manager who took immediate action to address. Duvet covers and pillowcases were mismatched in one of the shared rooms viewed, which was occupied by a married couple. People’s dignity could be further enhanced if staff gave consideration to this. The registered manager expressed her disappointment that this had happened and took action at the time of the inspection to ensure that this was addressed. She also indicated that she would be speaking to staff about the importance of this. In one bedroom shared by two females, the two chests of drawers were marked with the names of two males who had previously occupied the room. Not only could this be confusing for people, it also impacts on their dignity. It has been recommended that the home has systems in place to ensure that bedrooms promote people’s dignity. The home’s policies and procedures relating to death and dying were not examined at this inspection. It has again been recommended that the home records an individual’s preferences for their last days and following death, in their plan of care. The registered manager advised that she was in the process of doing this. Progress will be followed up at the next inspection. Hillview Nursing Home DS0000054819.V356750.R02.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 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. People have the opportunity for social stimulation and for trips outside of the home. The home ensures that people maintain contact with their family and friends in line with their preferences. People are offered a wholesome and varied diet where preferences and special diets are catered for. EVIDENCE: The home employs two members of staff who are responsible for delivering a programme of activities for people living at the home. These staff members provide a total of 6 hours each weekday. The home’s deputy manager takes the lead in arranging activities/therapies for people using the service. Given the complex needs of people living at the home, a planned activity programme is not always appropriate. Activities/therapies are decided on the Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 16 day and would be in accordance with the abilities and preferences of the individual. Many people benefit from one to one time with staff rather than group activities. The home obtains information about a person’s social history and previous hobbies/interests when they first move there. Details are recorded in the plan of care. The inspector was informed that people are given the opportunity to go on trips outside of the home. Examples during the winter months included shopping trips and trips out for coffee. Records relating to activities were not examined at this inspection and will be followed up at the next inspection. During this inspection, people were observed moving freely around the home. Some people had chosen to spend time in their rooms after lunch. Visitors are welcomed at the home at any reasonable time and in line with the wishes of people living there. One relative spoken with confirmed that they were always made to feel welcome. All meals are prepared and cooked on the premises by designated kitchen staff who have been appropriately trained. Photographs of meals are displayed in the dining room to assist people with their choices. The main meal is served at lunchtime with a lighter cooked meal at teatime. Alternatives/choices are offered. Milky drinks and sandwiches are offered in the evening with an appropriate alternative for those people requiring a soft diet. Special diets are catered for. There was evidence that the calorific content of meals had been enhanced for those people with an assessed need. An example of this was adding fresh cream to mashed potatoes. On the day of this inspection lunch was observed being served in the dining room. The meal appeared wholesome and plentiful and soft diets had been presented appropriately. The lunch time experience was relaxed and unhurried. Staff were observed assisting people in a respectful manner. Protective clothing was available for staff and for people at the home. Throughout the afternoon people living at the home were offered unlimited hot drinks, cakes and biscuits. One of the inspectors spent time talking to people at the home and to a relative and comments about the food were positive. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place and complaints are appropriately investigated. Procedures are in place to reduce the risk of harm or abuse to people using the service. EVIDENCE: The home has a complaints procedure, which is displayed in the reception area of the home. The home has received two complaints since the last inspection. The registered manager had made the Commission aware of these at the time they were received. Records were examined and there was evidence that these had been investigated and responded to in line with the home’s procedures. 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 has an up to date copy of Somersets Policy on Safeguarding Adults and there was evidence that staff had received training in reducing the risk of abuse. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. Work is on-going to refurbish some areas following fire damage. Major building works are planned to extend the home. Orientation aids are in place to assist people with dementia. Some bedrooms have been refurbished/redecorated and a number would still benefit from this. Bedroom locks in use do not allow people to lock their door when not in their room. Lockable storage is only available on request. The garden area and bathing facilities are currently limited due to on-going works. People have adequate comfortable communal facilities. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 19 The home have a good supply of moving and handling equipment and mobility aids. Storage is limited but there are plans to address this. The home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: In November last year, fire damaged part of the home. This area which included five bedrooms, one lounge, and a shower room are currently not accessible to people living at the home and are being completely refurbished/redecorated. Communal space requirements remain adequate for the number of people using the service. The home has a large communal lounge/dining area and a further lounge in addition to the lounge currently out of use. Major building works are planned and some demolition work has taken place. Whilst this work is on-going, people only have access to a small outside area. One person was observed utilising this area during the inspection. Current bathing facilities are reduced to one assisted bath located on the ground floor and a level access shower and unassisted bath on the first floor. Twenty four people are currently living at the home which means that current assisted bathing facilities fall short of the ratio of 1 to 8. This situation will be resolved once work has been completed. The registered manager indicated that the home were still able to meet the personal care needs of people living there. No concerns have been raised directly with the Commission. Grab rails, ramps and nurse call points are appropriately sited throughout the home. The home has three mobile hoists and two stand-aids. Moving and handling belts and slide sheets are also available. As recommended at the last inspection, the registered manager has ensured that appropriate signage is displayed in the home which assists people with dementia to orientate themselves around the home. Storage areas for wheelchairs, hoists and other mobility aids remains limited but there are plans to address this with the home’s refurbishment plans. Mobility aids were observed to have been stored so that they did not pose a risk to people living at the home. Bedrooms are located on the ground and first floor with a shaft lift giving access to the first floor. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 20 Since the last inspection some bedrooms have been redecorated and have benefited from new furniture. Some bedrooms would still benefit from this. Three bedrooms viewed had a linoleum type flooring which was looking very ‘tired’. A copy of the home’s redecoration/refurbishment programme has been requested and progress will be monitored by the Commission. As required at the last inspection, action has been taken to address the loose carpet tiles in one bedroom. Two bedrooms affected by the fire were viewed. These were nearing completion and benefit from new furniture including a comfortable chair. One double bedroom in this area has been decommissioned and space has been used to enhance a previously very small bedroom. Consideration should be given to providing locks on new bedroom doors which are appropriate to the needs and abilities of people living at the home and which are of a type which allow people to lock their doors when they are not in their room. We noted that locks fitted to the new bedroom doors were of a type normally used for bathrooms/toilets. This type of lock does not allow people to lock the door when they leave the room. It was also noted that new bedroom furniture does not have the provision of lockable space for people as recommended in the National Minimum Standards. This is also the case for existing furniture. The registered manager stated that this provision would be made available to people on request. As this provision is a ‘minimum’ standard expected, a recommendation has been raised. Given recent events at the home, which have impacted on the homes refurbishment/redecoration plan, it has been recommended that the registered person provides the Commission with a revised plan which includes timescales. The home has procedures in place to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriate sited throughout the home. Disposable aprons and gloves are readily available for staff. The majority of bins are foot operated. In two bedrooms, one bin was not a foot operated type and the other was missing a lid. The registered manager confirmed that she would take action to address this after the inspection. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels appear appropriate to the needs and numbers of people currently living at the home. The home promotes NVQ training for staff. The home’s staff recruitment procedures do not fully protect people from the risk of harm of abuse. Newly appointed staff follow an appropriate induction programme. EVIDENCE: The registered manager advised that 24 people were currently living at the home and that staffing levels are as follows; During the day/evening – 1 registered nurse and 5 care staff At night – 1 registered nurse and 2 care staff all waking Ancillary staff include; kitchen, domestics and a maintenance person. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 22 The deputy manager works supernumerary hours to provide management support and therapeutic activities. Two staff provide 6hrs of activities during weekdays. The registered manager works in addition to the nursing staff. The registered manager stated that the home has vacancies for one full time and one part time carer and a laundry person. Shortfalls are currently covered by the use of agency staff. The registered manager and staff spoken with did not express any concerns about current staffing levels or being able to meet people’s assessed needs. The registered manager confirmed that staffing levels would be increased where people’s assessed needs increased. The registered manager advised that of the 14 permanent care staff employed, 8 have achieved an NVQ level 2 in care. This equates to 57 which is in excess of the 50 recommended in the National Minimum Standards. Three staff are currently working towards this award. Recruitment records for three staff recently employed were examined at this inspection. Each file contained all required information including evidence of an enhanced criminal records check (CRB) and Protection of Vulnerable Adults check (POVA). It was concerning that one member of staff employed from outside of the UK, had commenced employment before a full CRB and POVA check or a POVAFirst check had been received. Records indicated that the staff member worked at the home without the minimum of a POVAFirst check, from 12th November ’07 to 18th January ’08. This practice does not protect people living at the home from the risk of harm or abuse. An immediate requirement was issued at the time of the inspection. The registered manager gave her assurances that staff working with a POVAFirst check pending a full CRB were supervised at all times. No risk assessments had been completed. This is recommended to ensure that staff are fully aware of the restrictions upon them during this period. The home should also ensure that the person responsible for supervising these staff during this period is clearly identified. The registered manager needs to ensure that where issues have been highlighted on CRB’s, that this is discussed and documented. Risk assessments should be completed as necessary. One file contained two references addressed ‘to whom it may concern’. These had been supplied to the home from an overseas recruitment agency. There was no evidence that the home had satisfied themselves as to the authenticity of the references. A requirement has been raised. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 23 Newly appointed staff follow a detailed induction programme following the ‘Common Induction Standards’. There was evidence that newly appointed staff had received mandatory training. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. People using the service benefit from an effective and stable management team. The home has an effective quality assurance programme which seeks the views of stakeholders. Correct health and safety procedures are followed by the home. EVIDENCE: Management arrangements at the home remain unchanged. The home is effectively managed by Shirley Ruane. Shirley is a registered general nurse Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 25 with experience in caring for older people. She is supported by a registered mental health nurse, Julie White. As part of its quality assurance programme, the home sends questionnaires to relatives on an annual basis. These are due to be sent out this year. A selection of completed questionnaires sent out in May 2007 were examined at the last inspection. Comments were generally positive. Records relating to monthly visits conducted by the responsible individual were available at the home. The home manages small amounts of money for people where requested. Records of transactions are maintained and are confirmed with two signatures. Receipts are obtained for all purchases. As recommended at the last inspection, action has been taken to ensure that monies are stored individually for each person. 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 25/04/07. The registered manager confirmed that all staff received fire safety training in November 2007. The home has a fire risk assessment and fire evacuation strategy. The home safely evacuated service users to a place of safety following a fire at the home in November last year. The registered manager praised staff for their actions as all procedures were followed correctly and nobody sustained any injuries. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried out in January 2008. The home has an up to date electrical hardwiring certificate, which expires in February 2010. GAS SAFETY – The home has an up to date annual Landlords Gas Safety Certificate dated 04/02/08. ACCIDENTS – The home maintains appropriate records for all accidents. Accidents are analysed monthly by the registered manager and action to address is taken where appropriate. The inspector was able to view a recent analysis at this inspection. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 26 HOT WATER OUTLETS/SURFACES – To reduce the risk of injury to service users, radiators are fitted with a guard. Hot water outlets are fitted with thermostatic controls to ensure that temperatures do not exceed Health & Safety Executive safe upper limits. Outlets checked at this inspection were within safe ranges. The home maintains monthly checks on all hot water outlets. 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, mobile hoists and bath hoists were last serviced on 14/01/08. To ensure the safety of service users, all upstairs windows are restricted, radiators covered and wardrobes are secured to the wall. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 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 2 2 2 3 3 2 x 3 STAFFING Standard No Score 27 3 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12(1) & 13(4)(c ) Requirement To promote healing and to ensure the health & well-being of individuals, the registered person must ensure that wound care plans contain information regarding the frequency of any treatment and that this treatment is delivered in a consistent manner. The registered person must ensure that the correct procedures are followed for the recording and disposal of controlled drugs. The registered person must not permit a person to commence employment at the home until receipt of a satisfactory enhanced CRB and POVA check. In extreme circumstances and providing all other required information has been received, staff may commence employment on receipt of a satisfactory POVAFirst check and must not work unsupervised. An immediate requirement was issued at this inspection. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 29 Timescale for action 10/03/08 2. OP9 13(2) 10/03/08 3. OP29 13(6), 19(1) & Schedule 2 26/02/08 4. OP29 19(1)(c ) The registered person must 10/03/08 demonstrate that they are satisfied as to the authenticity of references received for prospective employees. References addressed ‘to whom it may concern’ must be avoided. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP4 OP8 Good Practice Recommendations The registered person should ensure that all staff have the skills needed to enable them to communicate effectively with people using the service. To ensure progress can be monitored fully, the registered person should ensure that wound care plan reviews contain information about the size and status of the wound. The home should have systems in place to ensure that bedrooms promote people’s dignity. Care plans should contain sufficient information to ensure that the wishes and preferences of service users following death can be met by the home. A revised copy of the home’s refurbishment/decoration plan which includes timescales, should be sent to the Commission. Consideration should be given to providing locks on new bedroom doors which are appropriate to the needs and abilities of people living at the home and which are of a type which allow people to lock their doors when they are not in their room Bedrooms should have the provision of lockable storage for people. Where CRB’s raise issues, the registered person should ensure that these are discussed and documented with the DS0000054819.V356750.R02.S.doc Version 5.2 Page 30 3. 4. OP10 OP11 5. OP19 6. OP24 7. 8. OP24 OP29 Hillview Nursing Home 9. OP29 employee. Risk assessments should be completed where required. Risk assessments should be completed for any staff working at the home pending a full CRB so that staff are fully aware of the restrictions upon them during this period. The home should also ensure that the person responsible for supervising these staff during this period is clearly identified. Hillview Nursing Home DS0000054819.V356750.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Hillview Nursing Home DS0000054819.V356750.R02.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!