Care Home: Hilderstone Hall Nursing Home

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What the care home does well We found that Hilderstone Hall offers a genuine commitment to care with a highly professional, yet an open and personable approach, which reflected the homeliness of a confident relationship between carer and resident. A quote from a relative in a returned survey stated: "Before my mother went into Hilderstone Hall my sister and I researched carefully. Now we have experience of this many more questions have arisen which should have been asked at the time. But we have not regretted the final choice of care home". Through the process of inspection we considered that the establishment of a professionally accountability towards effective assessment, detailed care planning and review of resident`s needs were meaningful and robust, formulating an excellent standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike.The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. We recognised the maintenance of good staffing levels, with in-depth staff training and supervision established in safeguarding the interests of residents. The support services were found to contribute to the team approach, and are recognised for their efforts. Policies and procedures were found to be reviewed regularly, and we found evidence of a willingness to seek advice from other health professionals in order to maintain a service which encourages best practice. Overall we consider the attitude in meeting caring and organisational demands is commendable, with forward thinking, planning and application contributing to a good service. What has improved since the last inspection? We found that residents and relatives are actively involved in the planning of care. We examined and confirmed that care files have been re-organised to provide a more Person Centred Care (PCP) approach, allowing greater detail to be recorded of residents` wishes around activities and social life During the course of our inspection we established that there have been substantial improvements to the environment, health and safety, redecoration and provision of new equipment. A Registered Nurse has been appointed as Clinical Manager to support the home manager. What the care home could do better: The achievements in establishing a high standard of care have been recognised, areas of detail outlined through recommendations will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service. CARE HOMES FOR OLDER PEOPLE Hilderstone Hall Nursing Home Hilderstone Nr Stone Staffordshire ST15 8SQ Lead Inspector Keith Jones Key Unannounced Inspection 13th November 2008 09:00 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 Hilderstone Hall Nursing Home DS0000071920.V373245.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. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilderstone Hall Nursing Home Address Hilderstone Nr Stone Staffordshire ST15 8SQ 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) 01889 505468 01889 505062 www.barchester.com/oulton Barchester Healthcare Homes Ltd Mr. Andrew Frederick Paul Care Home 51 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (31), Physical disability (25), Physical disability over 65 years of age (25) Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/01/08 Brief Description of the Service: Hilderstone Hall is a country mansion which has been converted and extended for it’s present purpose. It located within the rural village of Hilderstone. The home stands within eight acres of landscaped gardens including a lake, and overlooks surrounding countryside. The home offers care, including nursing care, for up to 51 residents. Seventeen residents who require care associated with mental frailty are accommodated in the part of the home known as Hilderstone Manor. Members of staff are trained to meet the needs of residents, and specialist help is sought from other professionals when needed. As well as care and nursing care, the home offers recreational facilities including trips out, and has allocated activity co-ordinators. There is a visiting hairdresser, chiropodist, optician and visiting clergy with regular church services offered. All single rooms have en-suite facilities. There are two double rooms available for married couples or siblings wishing to share. There are large spacious communal rooms, which overlook extensive gardens, part of which is specially adapted to the needs of very frail residents. The full range of fees were not detailed in the service’s Statement of Purpose or Service User Guide’ documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We conducted this unannounced inspection with the Registered Manager and senior nursing staff on duty, whose input contributed this report. Our inspection of the building allowed us free access to all areas and open discussion with residents, relatives and staff. There were 42 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of residents with health care needs. To do this we looked at (case tracked) three residents’ files from referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of residents, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and six survey forms returned by residents. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. What the service does well: We found that Hilderstone Hall offers a genuine commitment to care with a highly professional, yet an open and personable approach, which reflected the homeliness of a confident relationship between carer and resident. A quote from a relative in a returned survey stated: “Before my mother went into Hilderstone Hall my sister and I researched carefully. Now we have experience of this many more questions have arisen which should have been asked at the time. But we have not regretted the final choice of care home”. Through the process of inspection we considered that the establishment of a professionally accountability towards effective assessment, detailed care planning and review of resident’s needs were meaningful and robust, formulating an excellent standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 6 The overall management style demonstrated a professional approach in maintaining an environment conducive to the care of the elderly. We recognised the maintenance of good staffing levels, with in-depth staff training and supervision established in safeguarding the interests of residents. The support services were found to contribute to the team approach, and are recognised for their efforts. Policies and procedures were found to be reviewed regularly, and we found evidence of a willingness to seek advice from other health professionals in order to maintain a service which encourages best practice. Overall we consider the attitude in meeting caring and organisational demands is commendable, with forward thinking, planning and application contributing to a good service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4, and 6. The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. EVIDENCE: The services Statement of Purpose/Service Users Guide have been updated to reflect the change in ownership of the home and other changes. We were told that an audio version of these documents is being prepared to complement the package. The services AQAA told us that the Statement of Purpose represents the foundation on which the home operates upon, offering potential residents and their relatives the opportunity to make an informed choice about where to live. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 9 It was pointed out that the fees charged by the home should be included within the Service User Guide to assist people to make an informed choice. The service has recently introduced a specialist brochure to assist prospective residents and their families chose a home for residents challenged with a dementia. We followed through Case tracking of three individual residents clearly identified that the Home Manager, or clinical manager, at the point of reference, conducts the pre-admission assessment, and found it to be comprehensive, providing a solid foundation for progressive care planning. Our examination of care records showed that this assessment is produced with the full involvement of residents and family, allowing them to influence the direction of care, initiating the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. Following an assessment the senior assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective resident. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. From our discussions with staff and residents it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. At all times relatives are involved in the process. No intermediate care is provided by the home. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and care needs are met. Residents are respected and their privacy is maintained. Medicine administration systems are safe and secure. EVIDENCE: We found that the care records clearly showed that this standard is well met, maintaining a high quality process of assessment. The pre-admission assessment represented the foundation for a well-considered and detailed care planning process, in association with Social Services reports if available. We identified that Person Centred Planning (PCP) is an established process of care. Each resident’s health, personal and social care needs are fully assessed in an individual plan of care that is reviewed monthly, including residents’ and relatives’ views, to reflect their changing needs, reinforced through a thorough daily report. Our examination of care records showed that risk assessments were carried out on an individual basis and frequently reviewed. A resident’s comment from the surveys sent out stated: Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 11 “The staff at Hilderstone Hall are excellent. They are friendly, caring, conscientious and always helpful”. The General Practitioner (GP) of choice service is supportive; through this service, arrangements are made to provide professional support, as stated by a resident: “GP always available on request. If paramedics and 1st responders needed, no time is wasted to call out”. A physiotherapist, occupational therapist and dietician had been provided for those residents whose records were examined. Care staff maintain all aspects of resident’s personal care, overseen by the trained nurse on a daily basis. We found internal access was facilitated with ample fittings of hand and grab rails in adequate, well-lit and airy corridors, facilitating wheelchair access throughout all areas of the home. The Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. We found that the administration of medicines adhered to procedures to maximise protection to residents. The storage was secure with satisfactory added security for controlled drugs (CD). We examined the three case tracked residents’ medicine administration, and found that all medicines prescribed were appropriate for their situation. It is stated in the service’s Statement of Purpose and AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of residents. This was confirmed, and that relatives and residents meetings had been held on a three monthly basis. In our discussions with residents and staff it was recognised that diverse needs were accommodated within the planning of care. Dietary, religious and personal matters were identified, along with the diverse physical needs. Our case tracking confirmed that the policies were implemented, with all residents we talked to being complimentary of the degree of respect given, by each and every member of staff. Individual spiritual persuasions were documented and respected at all times. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 12 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 The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Resident’s rights to live a meaningful life are central to the homes aims and objectives. Residents are offered opportunities to exercise choice and control over their lives. Residents are offered a healthy, well balanced diet. EVIDENCE: From talking to residents and staff we confirmed a continuing daily routine that is flexible and non-institutionalised, offering choice for meal times, personal and social activities including recognition of varied religious needs. Our discussions with residents and staff clearly identified a relaxed and informal atmosphere in which their needs were recognised. The Home employs two Social Life Coordinators who cover seven days a week, to ensure social activities as an integral part of care, as evidenced in examination of records and discussion with staff. Weekly activity records, and regular residents/family meetings are established. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 13 The Manor Dementia Care setting has a planned programme of activities to meet the needs of residents who are often included in group activities around the home, live entertainment, parties and bingo. Barchester’s ‘Fitness for Care’ initiative, have been developed to maximise the ‘feel good’ value of the beautiful grounds and external facilities. Relatives and friends are encouraged to maintain social links as part of the planning of care. Comments received from residents confirm their appreciation and involvement with the progress of their health and social status: “More than satisfied. The activities are fun, various ideas. A hard working practical and committed team of two”, “Is limited in what he can participate in, but he is invited by staff encouragement”. Since our last inspection there have been many changes in the management of standards of catering at Hilderstone, offering a service, to which most residents spoken to were somewhat circumspect of the quality, choice and quality of meals. Nevertheless we found the variable menu offered a wholesome varied choice. A menu for the day was inspected and seen to offer a wide choice of meals throughout the day. During the inspection a choice of lamb hotpot or grilled trout was on offer for lunch, served in impressively furnished and spotlessly clean dining rooms. The quality and quantity of the food offered on the day was observed to be of a good standard. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of residents. Various comments received from residents and family members: “The catering services are one issue of contention, things are now improved, but my mother finds the choice limited”, “Not enjoying the food as much as previous years”. However most of the residents spoken with in the course of inspection were complimentary of the service and quality. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 14 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. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a meaningful complaints policy. Residents are given opportunities to freely express any concerns, are protected from abuse and their human rights are promoted. EVIDENCE: Through the course of inspection we confirmed that residents’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy and records of complaints dealt with were examined, which evidenced handling of resident’s and families concerns in a meaningful and effective manner. From discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. No complaints had been received by us since our last inspection. The one allegation received by us had been dealt with satisfactorily by the Registered Provider. The overall policy of openness and transparency was acknowledged. We were informed that all residents had received information on the procedure to complain, including reference to us. This process was evidenced on examination and case tracking as previously reported upon. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 15 Discussion with the Care Manager confirmed that there continues to be a satisfactory protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. A new training system has been established, allowing staff to access “e-skills” training, including management of abuse through a computer terminal. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 16 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): 19,21,22,24, and 26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Hilderstone Hall provides a safe, well-maintained, clean and comfortable environment for the people who use the service. EVIDENCE: External access is satisfactory for visitors, with adequate parking. The home has extensive grounds including two formal garden areas and two lakes. These are well maintained by the grounds team and are accessible for residents to enjoy walks in the gardens with their families, staff or alone. These residents have risk assessments for this activity. We were informed of plans to introduce an ornamental and themed garden linked to activities in progress, including access to the two lakes in the grounds. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 17 Bedrooms were well maintained to meet residents’ personal preferences. Each clearly identifying the persons name with a discrete yet stylish nameplate. There are adequate numbers of profiling variable height beds available. There was evidence of individual arrangements to meet needs, sleeping chairs, fridges, large pad telephones, oxygen supplies, etc. The nurse-call alarm system was satisfactorily tested and personal electrical equipment (PAT) where seen to be tested. On inspection bedrooms were highly personalised, with most displaying the resident’s own furniture and personal belongings. Overall the attention to detail has presented a homely and comfortable environment. Several residents we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. There are active plans to reorganise the The Manor wing, accommodating people with dementia care needs, to be renamed the ‘Memory Lane’ area. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. Large well-appointed lounges allow activities to be presented in a very pleasant area of the home with furniture and fittings of good quality. We were informed that social, cultural and religious activities tend to take place in the lounges. There are two pleasant dining rooms, spotlessly clean and fresh smelling. Plans are in progress to reorganise dining room facilities to enhance the ‘homeliness’ of shared facilities. There are plans for a review of baths and shower areas, beginning with an upgrade of bathroom B1. Adequate attention has been given to ensure maximum privacy within risk-assessed boundaries. The domestic services in the home were seen to be of a very high standard. The residents and relatives spoken to remarked that they find the environment always very clean and conducive. A comment from a resident’s survey: “ Main rooms are beautiful – lots more fresh flowers and a drinks dispenser available”. All clinical areas, the laundry room and the kitchen were seen to be clean and tidy, with all services and facilities complying with necessary regulation. There was evidence to confirm the progressive refurbishment programme presented in the services completed AQAA. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 18 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 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staffing levels ensure that suitably trained staff are provided to meet the needs of residents. Recruitment, appointment and training processes are consistent and robust, protecting residents from harm and abuse. EVIDENCE: We examined three weeks of duty rotas, which showed adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. The Manager is supported by a clinical manager and a satisfactory complement of Registered Nurses. It is recognised that there is a commitment to decrease the reliance on agency nurses. The administrative, catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of the residents, and two Social Life Coordinators covering seven days a week. We recognise that the management have established a comprehensive procedure for interview, selection and appointment of staff. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of residents, and all new team members receive a thorough Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 19 induction in accordance with Skills for Care, and alongside Barchester Healthcare’s induction policies. Three staff files were sampled and found to be well organised and up to date. Barchester Care are committed to a learning environment through their Learning and Development team, who have formed the training plan, based on personal centred training. Staff records displayed an account of training that includes the General Social Care Council’s code of conduct, obtained to complement existing guides. Records were available to demonstrate an ongoing process of supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Comments received from residents indicated: “Senior staff, carers and other staff are all excellent and dedicated”, “The staff are lovely people, very kind and very helpful” All staff receive training in care issues within the home from internal and external trainers. 70 of care staff are in receipt of National Vocational Qualification (NVQ) level II, with 15 undertaking NVQ training at the time of inspection. There was evidence of regular NVQ assessor visits and numerous certificates on file. Overall the evidence shows a comprehensive account of a meaningful and important schedule of training to meet internal and external demand. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 20 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): 31,32,33,35, and 38. The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team through good working practices promote the health, safety and welfare of residents. EVIDENCE: The Home Manager Andrew Paul commenced at Hilderstone Hall in April 2008, following the purchase of the home by Barchester Care. During this time he has fulfilled his managerial responsibilities, introducing new policies and organisational changes, and achieved Registration with us as a ‘fit person’ to Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 21 undertake those duties. To assist him he has appointed a Clinical Manager, who is a Registered Nurse, appointed to offer clinical leadership and support. A resident’s survey comment indicated that: “Andrew Paul is available and is approachable”. In our discussion with staff we were informed of their experiences during the transition of change, and the degree of support and guidance offered by the Manager through staff supervision, staff meetings and day to day contact. To assist the managers Barchester have a regional team of specialists available to promote high standards and quality assessment, including Clinical Development Nurse, Operations Director, Property Services, Hospitality Specialist, Interior Design and Business Manager. Monthly audits are carried out as directed by the Director of Quality and Care. Our examination of records showed appropriate risk assessments are in place for residents, through care planning and recording, staff selection and of the general environment, these are up to date and accurate. The services completed AQAA states that there has been extensive capital investment into health and safety, fire detection and prevention, energy systems, redecoration and provision of new equipment. We established this to be true, leading to discussions around establishing a full unit inventory of risk. The Providers with the Care Manager have developed a formal approach to monitoring quality across a wide range of activities. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were found to be well maintained, accurate and up to date, ensuring that the residents’ rights and best interests are safeguarded. We identified that residents are encouraged to be independent with regard to financial affairs with the assistance of their relatives. Small amounts of resident’s cash were efficiently handled through the Provider’s office. The accident book was seen and found to be in order for staff and residents. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of residents. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 22 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 X 3 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 3 X 4 X 3 STAFFING Standard No Score 27 4 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 X X 4 Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? None STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP1 OP16 OP22 OP24 OP26 OP38 Good Practice Recommendations To make sure that new people are fully informed about the home the Service User Guide should contain information regarding the up to date fees charged. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. To increase people’s comfort and safety action should be taken to upgrade and repair B1 bathroom to facilitate the recommended ratio of assisted baths to resident. To increase safety a full unit risk assessment inventory be established. To increase safety Control of Substances Hazardous to Health (COSHH) laminates should be displayed in all areas to complement existing procedure sheets. To increase food safety a service record should be consistently maintained of food, fridge and freezer temperatures. To ensure consistency in hygiene a record should be DS0000071920.V373245.R01.S.doc Version 5.2 Page 24 OP38 Hilderstone Hall Nursing Home maintained of cleaning in the kitchen area. Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Hilderstone Hall Nursing Home DS0000071920.V373245.R01.S.doc Version 5.2 Page 26 - 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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