Inspection on 31/05/07 for Hillview Nursing Home

This inspection was carried out on 31st May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 31st May 2007 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.V335740.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillview Nursing Home DS0000054819.V335740.R01.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.V335740.R01.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. 22nd June 2006 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. Pre-inspection information supplied by the home indicate that the current fees are between £417 and £650 per week. Additional charges include; hairdressing, chiropody, newspapers/magazines and personal items. Any ‘Free Nursing Care’ element awarded is incorporated into the fees and is not refunded to the service user. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over one day (7hrs) by CSCI regulation inspector Kathy McCluskey. The registered manager Shirley Ruane was available for part of the inspection. At the time of this inspection, 26 service users were living at the home and the inspector was able to meet with the majority of them. A tour of the premises was carried out where all communal areas and a selection of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. As part of this Key inspection the Commission sent comment cards to service users, relatives, staff, GP’s and care managers. Six completed comment cards have been received from relatives, 4 from staff, 1 from a GP and 1 from a care manager. No concerns were raised and comments have been incorporated throughout this report. The inspector 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 24hr nursing care for older people with dementia. Service users are cared for by appropriately trained registered nurses and care staff. 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. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 6 The home ensures that the needs of prospective service users are fully assessed prior to a placement being offered. A trial period is offered and the home has information about its services which enables prospective service users to make an informed choice about moving to the home. The home has established good links with healthcare professionals and liaises closely with them. Service users are supported to maintain contact with their relatives in line with their preferences. Meals are freshly prepared and cooked at the home. Menus appear wholesome and varied and special diets are catered for. Since the last inspection the home have been awarded the ‘Somerset Food Hygiene Award’ The home has procedures in place to ensure that complaints are listened to and responded to appropriately. Robust procedures are followed for the recruitment of staff and the home takes appropriate steps to reduce the risk of abuse to service users. What has improved since the last inspection? What they could do better: Care plans in place for the management of wounds still require improvement. Requirements were also raised at the last inspection. Care plans examined at this inspection were not always reflective of the individual’s assessed needs. This related to a service user with recent weight loss and other who’s bed base had been removed. Further details can be found in the main body of this report. The registered manager stated that care plans are discussed with the individual and/or their representative though records to demonstrate service user involvement were not available. A recommendation has been raised. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 7 The home also needs to ensure that the preferences/wishes of an individual following death are discussed and recorded. Although building work is ongoing to improve the size of service user accommodation, the standard of décor in some areas of the home has fallen to an unacceptable level and requires attention. This has been raised in previous reports. 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). This was also recommended at the last inspection. To ensure the safety of service users, all upstairs windows are restricted, radiators covered and wardrobes are secured to the wall. During this inspection the inspector found one upstairs window not restricted and one wardrobe not secured. The home’s maintenance person took action to address this and make safe before the inspection ended. It has been required that the registered person takes appropriate action to ensure that the loose carpet tiles in one identified bedroom do not pose a hazard to the service user (refer also to standard 19). 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 DS0000054819.V335740.R01.S.doc Version 5.2 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.V335740.R01.S.doc Version 5.2 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. 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that prospective service users have the information they need to enable them to make an informed decision about moving to the home. Prospective service users are appropriately assessed to ensure that their needs and aspirations can be met by the home. EVIDENCE: The home’s Statement of Purpose and Service User Guides are displayed in the entrance foyer of the home. Copies of the Commission’s inspection reports are also displayed. The inspector was not advised of any changes to these documents. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 10 Care records examined at this inspection contained contracts/statement of terms and conditions. Service users funded by social services are also issued with a financial agreement. 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. The registered manager agreed to ensure that the home’s pre-admission forms are updated to ensure that the person conducting the assessment, signs and dates the records. Assessments from other professionals are obtained where available. 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. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements in how care plans are written but further improvements are required. The home ensures that service users have access to appropriate healthcare professionals. The procedures for the management and administration of service users medication has improved. EVIDENCE: Three care plans and other care records were examined in detail at this inspection. Care plans contained detailed social/life history about the individual, which provide the staff with useful information about the service user. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 12 Care plans seen for dementia care needs were written so to promote a more person centred approach to care. This is an improvement since the last inspection. Care plans contained assessments relating to moving and handling needs, risk of pressure sores and falls. Details of GP and other healthcare professional’s visits are recorded. Service user weights are recorded on a monthly basis. One care plan needed updating to reflect recent weight loss and the introduction of food supplements. This was discussed with the registered manager at the time. One care plan and moving and handling assessment was not fully reflective of the fact that this service user’s bed base had been removed and that they were sleeping on a mattress on the floor. The care plan seen made reference to a bedrail assessment, though bedrails were not in use. The manual handling assessment did not identify the sleeping arrangements or how staff were to assist the service user up from the floor. The registered manager stated that care plans are discussed with the individual and/or their representative though records to demonstrate service user involvement were not available. A recommendation has been raised. The home also needs to ensure that the preferences/wishes of an individual following death are discussed and recorded. Records were examined relating to the management of wounds. As required at the last inspection, further improvements are still required to ensure that wounds are appropriately managed and that staff are consistent in their approach. Records did not contain sufficient information regarding the size and status of the wound or the dressings to be used and the frequency of change. Records also need to indicate a review date to ensure that action can be taken where a wound is not healing satisfactorily. These records were examined with the registered manager present and all observations were discussed at the time. Before the inspection ended, the registered manager had taken some steps to amend paperwork in use to ensure that staff are prompted to record information in more detail. Pressure relieving equipment was seen to be in place for those service users with an assessed need. The home liaises closely with individual’s healthcare professionals and ensures that regular reviews take place. One GP and one healthcare professional completed comment cards for the Commission. No comments were raised though responses to questions were positive. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 13 Six comment cards were received from relatives. All indicated they felt that the home met the needs of their relative and that the staff had the skills required to look after their relative. Three care staff completed comment cards for the Commission and all indicated that they were involved in the care planning process and that they were clear on what the needs of service users were. The inspector examined the home’s procedures for the management and administration of service users medication. Medicines are administered by the registered nurse on duty. Medicines were found to be appropriately stored and there were no excess stock levels. Medication Administration Records (MAR) were examined and were found to be appropriately completed. As recommended at the last inspection, the home now ensures that hand transcribed entries on the MAR chart are confirmed with two signatures and that creams in use are marked with the use by date. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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 service users have the opportunity to continue with their social interests. Service users are supported to exercise choice over their lives. The home provides a wholesome and varied menu. EVIDENCE: 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 relative’s social/life history, previous hobbies/interests, preferences, likes and dislikes. The home’s deputy manager takes the lead in arranging activities/therapies for service users. Given the complex needs of service users living at the home, the inspector was advised that a planned activity programme is not always Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 15 appropriate. Many service users require a one-one approach rather than a group activity. The inspector was informed that activities/therapies are decided on the day and would be in accordance with the abilities and preferences of the individual. This standard could not be fully assessed at this inspection as no activities were observed taking place. The inspector was able to meet briefly with the deputy manager who was on a training course. Systems for how activities are recorded were discussed and it was recommended that the home introduces a recording system which will provide useful information as to activities that have taken place for each individual and the outcome i.e; whether the individual benefited from or enjoyed the activity. Both the registered manager and deputy manager agreed to devise a new recording system. This will be followed up at the next inspection. Six relatives completed comment cards for the Commission and three indicated that their relative is supported to live the life they choose. Three felt that this question was not appropriate given the complex needs of their relative. Comments made include; ‘my relative wanders at will and the carers always know where he is and keep an eye’, ‘I feel my relative is happy and comfortable’ All meals are prepared and cooked on the premises. Copies of a two week menu were made available to the inspector. The home also displays photographs of the meals to assist service users with their choices. 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. The inspectors were informed that milky drinks and sandwiches were offered in the evening with an appropriate alternative for those service users requiring a soft diet. Special diets are catered for. Service users able to express a view were positive regarding the meals available and stated that there was always plenty to eat. Environmental Health examined the home’s kitchen and procedures on 25/04/06 and recommended the home for the ‘Somerset Food Hygiene Award’. The home received this award in October last year. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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 complaints procedure and ensures that complaints are appropriately responded to. The home has procedures in place 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 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 the inspector was able to see evidence that these had been investigated and responded to in line with the home’s procedures. The Commission received six comment cards from relatives and all confirmed that they know had to make a complaint. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 17 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. Four comment cards were received from staff and all confirmed that they were aware of adult protection procedures. The home follows robust recruitment procedures. Hillview Nursing Home DS0000054819.V335740.R01.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 and 25 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Service users have access to a choice of communal areas. The standard of décor in some parts of the home need improving. Due to building works at the home, the garden area is limited. The home has an adequate supply of moving and handling equipment. Appropriate orientation signage should be introduced. The home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: All communal areas and a selection of bedrooms were examined at this inspection. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 19 Communal areas consist of a large lounge/dining room with a smaller area off, and two additional lounge areas. All communal areas are situated on the ground floor. Service users were observed utilising all of these areas during the inspection and appeared comfortable in their surroundings. Bedrooms are located on the ground and first floor with a shaft lift giving access to the first floor. Some bedrooms seen were in need of redecoration. Furniture in some bedrooms looked ‘tired’ and would benefit from replacement. Carpets in two bedrooms seen were threadbare in places and need replacement. The carpet tiles fitted in one bedroom were beginning to ‘peel back’ and could pose a trip hazard to the service user. A requirement has been raised (refer to standard 38). Paintwork to some bedroom doors and skirting boards remain very badly chipped. At the last inspection in June 2006 the inspector was assured that this would be addressed. At this inspection, the inspector could see no evidence of further improvements to the environment although the inspector was informed that a ground floor bedroom had recently been decorated. The inspector noted that the window in one upstairs bedroom had been boarded up. The inspector was informed that this happened approximately two weeks earlier. At the end of the inspection, the inspector was informed that the glass would be replaced the next day. The inspector telephoned the home the next day and was informed that the work had been completed. One upstairs window was found to not be restricted and one wardrobe was not secured to the wall. The inspector immediately brought this to the attention of the nurse in charge and the maintenance person and both items were made safe before the inspector left. Whilst it is acknowledged that building works are currently on-going which will eventually improve the sizes of rooms, the registered person should take appropriate steps to ensure that the existing areas provide a pleasant environment for the service users living in the home and that décor is maintained to an acceptable standard in all areas. The garden area has been reduced whilst building work is ongoing. There is currently a small patio area off the main lounge, which service users may sit in. The registered manager’s office has also been temporarily located to this area. There are two level access showers, two assisted baths and one unassisted bath. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 20 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. 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). This was also recommended at the last inspection. 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. Hillview Nursing Home DS0000054819.V335740.R01.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 and 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home ensure that service users needs can be met. Staff receive appropriate training. The home follows robust staff recruitment procedures. EVIDENCE: The inspector was informed that the home is currently staffed as follows; During the day – 1 registered nurse and 5 care staff At night – 1 registered nurse and 2 care staff Ancilliary staff include; kitchen, laundry, domestics and a maintenance person. The deputy manager works supernumerary hours to provide management support and therapeutic activities. The registered manager works in addition to the nursing staff. The inspector was informed that there were no concerns in meeting service users needs with the current staffing levels. No concerns were raised by staff. The inspector was informed that staffing levels would be increased where service users needs dictated. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 22 Pre-inspection information provided by the registered manager indicated that of the 13 care staff employed, 7 had achieved a minimum of an NVQ2 in care or equivalent. This equates to 54 which exceeds the recommended 50 in the National Minimum Standards. Recruitment files for the two most recent members of staff were examined at this inspection. All required information was available, which included criminal record and vulnerable adults checks. Newly appointed staff follow a detailed induction programme following the ‘Common Induction Standards’. Evidence of this was seen in the two staff recruitment files examined. Four staff completed questionnaires for the Commission and all indicated that they had received an appropriate induction programme on commencement of employment. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 23 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, 32, 33, 34, 35, 36 and 38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Service users and staff benefit from an effective management team who promote an open and inclusive style of management. The home has systems in place to seek the views of staff and stakeholders. Staff are appropriately supervised. Systems are in place to ensure the health and safety of service users, staff and visitors. EVIDENCE: Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 24 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. Shirley is a moving and handling, food hygiene and fire trainer. Since the last inspection, Shirley has achieved the Registered Managers Award. The manager and her deputy are very much ‘hands-on’ and both have a good knowledge of the assessed needs of service users. The views of staff are sought through regular staff meetings. Minutes are maintained. The last staff meeting was held on 26/04/07. 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. As part of its quality assurance programme, the home sends questionnaires to relatives on an annual basis. A selection of completed questionnaires sent out in May of this year were examined at this inspection. Comments were generally positive. Records relating to monthly visits conducted by the responsible individual were not examined at this inspection. The home displays an up to date employers liability insurance certificate in the foyer area of the home. The home manages small amounts of money for service users where requested. Records of transactions were examined at this inspection and the inspector was able to see that appropriate action had been taken to address the recommendation of the last inspection. All transactions are now confirmed with two staff signatures. Receipts are obtained for all purchases. The registered manager needs to ensure that money is stored individually for each service user and not pooled. All staff receive regular one-one supervision sessions. A selection of records were examined at this inspection. Four comment cards were received from staff and all confirmed that they received regular supervision. 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. Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 25 The registered manager confirmed that all staff received fire safety training on 29th and 30th May 2007. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried out in January 2007. 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 12/12/06. 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. HOT WATER OUTLETS/SURFACES – Since the last inspection, thermostatic temperature controls have been fitted to wash hand basins to ensure that temperatures remain within safe limits. 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 18/04/07, 2 fixed bath hoists, 3 mobile hoists and 1 stand-aid were also serviced on 18/04/07. The home have purchased an additional stand-aid since the last inspection. To ensure the safety of service users, all upstairs windows are restricted, radiators covered and wardrobes are secured to the wall. During this inspection the inspector found one upstairs window not restricted and one wardrobe not secured. The home’s maintenance person took action to address this and make safe before the inspection ended. It has been required that the registered person takes appropriate action to ensure that the loose carpet tiles in one identified bedroom do not pose a hazard to the service user (refer to standard 19). Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 26 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 3 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 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 X 3 Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 27 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 individual’s assessed needs. Previous timescale of 10/01/06 & 31/07/06 not met. The registered person must ensure that wound care plans contain sufficient detailed information to ensure continuity of care. Previous timescales of 10/01/06 & 31/07/06 not met. Consideration should be given to the use of photos/tracings. The registered person must ensure that the loose carpet tiles in the identified bedroom do not pose a risk to the service user. Timescale for action 30/06/07 2. OP8 12(1) 30/06/07 3. OP38 13(4) 30/06/07 Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 28 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 OP7 Good Practice Recommendations The registered person should ensure that service users and/or their representative are involved in the care planning process and that evidence is documented in individual’s care plans. Care plans should contain sufficient information to ensure that the wishes and preferences of service users following death can be met by the home. The registered person should ensure that all areas of the home are decorated to an acceptable standard. The registered person should give serious consideration to ensuring that appropriate signage and orientation boards are made available to assist service users with dementia. This was also recommended at the last inspection. The registered person should ensure that service users money managed by the home is stored individually and not pooled. 2. 3. 4. OP11 OP19 OP22 5. OP35 Hillview Nursing Home DS0000054819.V335740.R01.S.doc Version 5.2 Page 29 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.V335740.R01.S.doc Version 5.2 Page 30 - 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!