Care Home: Hillcrest Care Home

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What the care home does well The acting manager, the Responsible Individual and a senior team of nurses have shown tremendous effort and commitment to improving standards at the service. They have worked long hours to produce much improved conditions and standards of care delivery and safety for people living at the service. In addition the care and ancillary staff teams have responded to the increased support, and were proud of what they had achieved in the improved quality of life for the people in their care. The people suffering from dementia were visibly relaxed and appeared happy and comfortable. The quality and presentation of food and organisation of meals on the dementia care unit were much better and people have already started to gain weight. The provider has demonstrated his commitment to improving the premises. He has responded promptly and a high standard of refurbishment is already underway. What the care home could do better: Evidence of the delivery of hygiene and bowel care needs to be improved. All mealtimes should be overseen and supported by senior staff. Care plan documentation and risk assessment records need attention to ensure that theyprovide a clear account of individual needs. Care plans must include evidence of people`s input and agreement, or that of their relatives. The accuracy of food records needs to be reviewed. Storage is already a problem and the opportunity to address this should be taken during the refurbishment activity. Serious shortfalls were found in selection and recruitment practices which must improve to ensure people are protected. Ongoing work with staff training and staff supervisions must be completed. The provider must continue to monitor the standards of care provided and ensure that the recent very serious shortcomings at this service do not recur. Random inspection report Care homes for older people Name: Address: Hillcrest Care Home Wear Street Jarrow Tyne And Wear NE32 3JN two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathryn Reid Date: 1 3 0 9 2 0 1 0 Information about the care home Name of care home: Address: Hillcrest Care Home Wear Street Jarrow Tyne And Wear NE32 3JN 01914890200 01914286343 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jaqueline Karen Wallace Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hillcrest Care Homes Limited care home 49 Number of places (if applicable): Under 65 Over 65 0 49 dementia old age, not falling within any other category Conditions of registration: 49 0 The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 49 Dementia Code DE, maximum number of places 49 Date of last inspection Care Homes for Older People Page 2 of 17 Brief description of the care home Hillcrest Care Home is a purpose built three-storey building located within the busy town centre of Jarrow. The building has 49 single bedrooms all of which have an ensuite bathroom. Access around the building is made easier by a passenger lift or there are two staircases, which are located at either end of the building. There are a number of communal areas, such as lounges, dining rooms and quiet areas. A fireplace with surround and easy chairs is located in the corridors of both the first and second floor and provides a popular place where service users can choose to spend their time. A staff call system, which is accessible to the service users, is provided in all parts of the home. The laundry and staffroom are located on the second floor of the home. There is a garden to the rear of the home and parking facilities are available for the convenience of visitors. The home is registered to provide care to 26 people who have varying degrees of dementia and 23 people who are elderly. Fees for the home vary further information is available from the home. Additional charges are made for toiletries, newspapers magazines, and hairdressing. Items, which are included in the cost, are listed in the home s terms and conditions. Care Homes for Older People Page 3 of 17 What we found: This is an overview of what the inspectors found during the inspection. This service was assessed as providing good outcomes for people at the last key inspection in October 2009. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visits to the home. This includes how the service dealt with any complaints or changes to how the home is run. Unannounced visits by one inspector were made on 7 and 13 September 2010. These visits were made to follow up progress and check compliance with a warning letter and requirements made following four visits in July 2010 when serious concerns were identified. The acting manager was in charge at both visits and the Responsible Individual also assisted on 7 September 2010. During the visit we talked with people who use the service and several staff of varying designations. We looked at information about people who use the service, observed how well they were being cared for and inspected other records which must be kept. We looked at how staff are selected and recruited to work at the home and checked on progress with their training and supervision. We also checked on progress with the refurbishment and upgrading work of the premises. At each visit in July 2010 we had raised serious concerns over care delivery. We had been particularly concerned over the quality of staff handovers and communications, the standards of personal hygiene care. nutritional care, the use of specialist equipment and the need to document and follow instructions and advice from muliti disciplinary professionals such as dieticiens. During these visits we found evidence of significant improvements to care delivery, in particular for people living on the first floor dementia care unit, where we had been most concerned. The atmosphere on the dementia care unit was calm and relaxed despite the major upgrading works going on in the middle of this unit which had split it into two halves. Tactile, colourful items such as handbags, cuddly toys and silk scarves were now attached to the corridor grab rails for people to touch and amuse themselves. Bedrooms and communal areas were no longer locked shut providing people with additional freedom and places to visit. Care Homes for Older People Page 4 of 17 People were well dressed and all were wearing socks or stockings and comfortable footwear. People seemed happier with positive and fun interactions taking place between themselves and with the staff. The larger communal rooms were pleasant and lively with suitable music playing to which people were singing and dancing. We examined the care delivery of three people in detail by looking at their care plans and care records, meeting with them, seeing what they ate and drank, speaking to the staff and looking at their rooms and any equipment which they required. There was a big improvement in peoples nutritional care and those we looked at had all gained body weight since our July visits. A new chef was providing good quality home cooking and had been made aware of individual dietary needs. The presentation and organisation of the meals were much better on the dementia care unit and it was clear that staff were attaching much more importance to mealtimes and peoples nutritional needs. Staff were aware of, and following advice and guidance about peoples care which had been provided by visiting professionals such as the GP or dieticien. A range of care charts including food and fluid intake, special diets, elimination and pressure area relief information has been temporarily introduced on both units. Specialist equipment, in particular electrical pressure relieving mattressess were now set correctly to correspond with peoples body weights. The standard of care plans and record keeping had been a cause for serious concern at the last inspection and a deadline requirement date to improve these has been set for 24 September 2010. We looked to see what progress had been made in this important area and found that a lot of work had been done to review and in most cases rewrite individual care plans. However the revised documents were not person centred and were lacking in specific detail of individual needs and preferences and peoples strengths and weaknesses in relation to their care. For example entries such as requires assistance with diet and fluids. Individual risk assessments and risk management plans were equally vague and lacking in detail. There was no evidence of the input and agreement of the person or their relatives or representatives to any of the care plans or risk assessments which were examined. We provided feedback on our observations which included the fact that staff working on care plans required support and supervision. We did see positive review of and additions to mental health care plans and there was good written guidance for staff on how to understand, deal with and manage peoples challenging behaviours. At both visits we found inadequate recorded evidence to show when and how frequently people were receiving baths and showers. Also what degree of hygiene care was being Care Homes for Older People Page 5 of 17 provided from which staff on a daily basis. This observation also applied to an absence of recorded evidence of bowel care. Staff and management planned to get together to decide how best to deal with this. We acknowledeged that some people were living in different parts of the home, new staff were being trained and that staff were keen not to add more time consuming paper work and checklists for them to complete. Changes to the recording of acute and short term problems such as wounds or infections had improved care delivery and staff communications and awareness of what peoples needs were. These records were all up to date and contained good information. The holding of vital care communications and information in diaries alone had also been reviewed and daily records were better recorded and will be examined again at the next visit. The organisation and delivery of the teatime meal on the ground floor felt somewhat chaotic during our second visit. The nurse in charge was not involved as she was carrying out a medicine round. Staff appeared under pressure and three people lodging from the upstairs unit were all demanding attention and requiring support. They ate in a small lounge but their meals were not presented on trays, they were not offered condiments, they had no napkins and did not receive sufficient assistance with cutting up and eating their meals. Again we acknowledged various factors and disruptions to staff routines. However, senior staff need to be involved and offer support during times when staff are under pressure. Dining tables on the dementia care unit were now well set with coloured table cloths, condiments, flowers and napkins. A trial period where the main meal was served at teatime and the light meal at lunchtime had just commenced and chef reported a significant reduction in wastage. The set rotational menus had not yet been altered to reflect this change which appeared to be working well. We saw that the lunch meal consisted of a selection of sandwiches, quiche, coleslaw and cake or ice cream and it appeared that everyone was having a bit of everything. Food bible booklets which consisted of coloured photographs of food were now in use to assist people with understanding and communications difficulties. We talked with the new chef who had relevant experience and qualifications. He described good communications with the staff and people living at the home about nutritional needs and food preferences. We identied that chef was making a significant amount of variations and changes to the set menus. For example every meal on the day of our visit had been changed from the menu plan. However these changes were not being recorded elsewhere. The need to keep full and accurate records of what food people had actually been offered and eaten was brought to chefs attention. The acting manager was unaware of this matter and we did acknowledge the current review of meal content and choices. The benefits and need for menus to reflect variations and choices for people who need soft or pureed diets were also discussed with chef. Care Homes for Older People Page 6 of 17 Good progress has been made with activities provision and a new coordinator had joined the existing staff. New memory lane activity plans were in place with evidence of involvement from people and their relatives. New, impressive looking individual door posters were being developed which included key photos and memorabilia of peoples lives. The acting manager was taking a key role in improving social and recreational care and had introduced doll therapy for some people, memory cards, relevant quiz questions and external entertainment and activities. The provider has given us detailed information about their proposals to improve the premises throughout and work was already well underway. It is planned that all work, which is to be carried out in stages, will be completed by December this year. At our first visit we saw that the external clinical waste bins were safely secured but the bins were open and overflowing with yellow bags. The garden area was pleasant and garden furniture was in use. We had previously raised concerns over cluttered internal stairwells where combustible items were being stored. This situation was worse on the 7 September 2010 visit but improved when we checked on 13 September 2010. The acting manager told us that approval for using these areas for storage and the disruption to fire exits had been agreed with the local fire safety officer. Upstairs we found that a previous end of corridor office had been converted into a small lounge. This and other areas awaiting refurbishment smelled slightly of urine and strongly of disinfectant. The dementia care unit was split by the upgrading works but staff and people living up here were coping well. All bedrooms were now open and accessible, clean and tidy. The dining room areas were also open and these areas were bright and cheery with sofas and chairs for people to relax on. Upgrading of one half of the dementia care unit was almost completed with a high standard of redecoration in all areas. All rooms including lounges and bathing areas were furnished to a good standard using durable, attractive, good quality fittings. Bedroom doors had been painted in varying bold colours and the bedrooms were welcoming and looked impressive. Lampshades, waste bins and soap and paper towel dispensers were due to be added. The main bathroom is a good size and was almost complete. This did mean that there were no operational bathrooms on this floor with one shower room in use at either side of the works. These areas were all small and cramped for space. Concern was raised over the storage of clinical waste, equipment and linen in these rooms. The amount of storage space overall could present a future problem and should be reviewed while upgrading the premises. The acting manager was in charge during both visits with adequate levels of support from registered nurses, carers and ancillary staff. Duty rotas appeared up to date with some ongoing use of first names only which should be avoided. The skill mix of care staff was Care Homes for Older People Page 7 of 17 satisfactory with improved regular input from nurses with mental health qualifications and experience. The use of agency staff was much reduced and a recent recruitment drive had been successful. The home was without administrative support and this reflected in some of the record keeping and the acting managers workload. Support from head office was expected the following day. A new deputy commenced during this inspection and the search for a new suitable manager was ongoing. On 13 September we looked at selection and recruitment following a declaration by the provider that requirements were not being met. We examined a selection of records for staff new in post. We saw a sample folder where all staff information would be held in an easily accessible format. However these were not yet in place for the newly appointed staff and the acting manager told us that staff files were not yet in good order. We looked at the files for three staff and found inadequate evidence indicating unsafe standards of staff recruitment. In particular interview procedures had been inadequately recorded with what looked like one person conducting the interviews. Detail of what was covered and identified, together with inadequate exploration of gaps in employment history were evident. References were inadequate with poor recording of verbal references taken over the telephone where the name of the person giving the reference had not been recorded. In one instance there was no available record of the reported verbal reference for a new nurse. Character references had been accepted where previous employers could have been contacted. Only one reference had been obtained for one carer. The arrangement with head office for communications regarding criminal record certificates was unclear with no record of whether the result of the check had been satisfactory. There was no record at all for one carer. The acting manager confirmed a POVA 1st check on 13 Augsut 2010 from her computer records but there was no supporting risk assessment and supervision plan until the criminal record certificate was obtained. Documentary evidence of relevant qualifications declared by the candidates had not been obtained or referred to at interview. Competency assessment records were unavailable for someone who was still under investigation from their previous post. Induction records were incomplete with no evidence of input or signature from the new employee. A fire safety questionnaire in one file was only partially completed. Requirements were made at the last inspection regarding staff training and supervisions, in particular the registered nurses where the previous manager had relied on the clinical nurse lead. A deadline requirement date of 24 September 2010 was given for staff to receive training Care Homes for Older People Page 8 of 17 in several key areas. The acting manager referred to training which was ongoing and a new approach from the organisations training department. Compliance with these requirements will be checked at our next visit. A new permamanet manager is now needed to progress what has been commenced. The acting manager is aware that she must begin to withdraw and increase the delegation of duties to others. A deadline requirment date of 24 September 2010 was given for staff to receive 1:1 supervision sessions. We saw at this visit that care staff were receiving 1:1 supervisons from a senior, experienced nurse who works for the organisation. Compliance with these requirements will be checked at our next visit. We saw evidence of a recent relatives and residents meeting held 25 August 2010 which included discussion about activities and food. The monthly monitoring visit had not been carried out for August as most of the management team had either been based at or in regular contact with the home. However shortfalls in some key areas such as food records. selection and recruitment and the calibre of new care plans had been missed. This demonstrated that a suitable and fail safe method of internal and external quality monitoring must be quickly re-established. What the care home does well: What they could do better: Evidence of the delivery of hygiene and bowel care needs to be improved. All mealtimes should be overseen and supported by senior staff. Care plan documentation and risk assessment records need attention to ensure that they Care Homes for Older People Page 9 of 17 provide a clear account of individual needs. Care plans must include evidence of peoples input and agreement, or that of their relatives. The accuracy of food records needs to be reviewed. Storage is already a problem and the opportunity to address this should be taken during the refurbishment activity. Serious shortfalls were found in selection and recruitment practices which must improve to ensure people are protected. Ongoing work with staff training and staff supervisions must be completed. The provider must continue to monitor the standards of care provided and ensure that the recent very serious shortcomings at this service do not recur. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that all service user 24/09/2010 plans clearly identify how each individual service users health and welfare needs are to be met. Put in place effective arrangements to ensure that all service user plans are reviewed at least monthly or sooner as dictated by changes in individual service users needs. Put in place effective arrangements to ensure that where appropriate, service user plans are revised to reflect individual service users changing health and welfare needs after consultation with the service user or their representative. This is to ensure that service users health, personal and social care needs are set out in an individual plan of care. 2 30 18 Undertake a comprehensive 24/09/2010 review of the training provided to current staff at the home and produce an accurate record of all training provided to individual members of staff. Ensure that as a minimum each member of staff receives training in: Understanding Page 11 of 17 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action dementia Managing challenging behaviour Safeguarding adults Mental Capacity Act and Deprivation of Liberties safeguarding. Ensure that all staff with responsibility for administering medication are trained to do so. Ensure that sufficient staff are employed at the home that are trained in first aid so that there is at all times a minimum of one person on duty who has received first aid training. So that staff will be trained and competent to do their jobs. 3 33 24 Ensure that effective 27/08/2010 arrangements are in place for monthly review of the quality of care delivery at the home. This is to make sure the home will be run in the best interests of the service users. 4 36 18 Ensure that all staff are appropriately supervised. Staff will be supported and their performance will be monitored 24/09/2010 Care Homes for Older People Page 12 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that all service user 31/10/2010 plans clearly identify how each individual service users health and welfare needs are to be met. Put in place effective arrangements to ensure that all service user plans are reviewed at least monthly or sooner as dictated by changes in individual service users needs. Put in place effective arrangements to ensure that where appropriate, service user plans are revised to reflect individual service users changing health and welfare needs after consultation with the service user or their representative. This is to ensure that service users health, personal and social care needs are set out in an individual plan of care. 2 8 12 Ensure that the personal hygiene and bowel care 31/10/2010 Care Homes for Older People Page 13 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action needs of individual service users are met. This will promote and maintain service users health. 3 19 23 Ensure that the refurbishment and upgrade of the home is successfully and safely completed. To ensure that all service users live in a safe, comfortable environment which has been designed and finished to meet their individual and collective needs. 4 22 23 Ensure that suitable and sufficient storage space is provided throughout the home. This will assist staff to access and keep specialist equipment to meet service users needs. 5 29 19 Implement and operate effective recruitment procedures based on equal opportunities. This is to ensure that people are safe and that their needs are met by people who are suitable, fit and able to do their job. 6 30 18 Undertake a comprehensive 31/10/2010 review of the training provided to current staff and Page 14 of 17 30/11/2010 30/11/2010 31/10/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action produce an accurate record of all training provided to individual members of staff. Ensure that as a minimum each member of staff receives training in: Understanding dementia Managing challenging bahaviour. Safeguarding adults. Mental Capacity Act and Deprivation of Liberties safeguarding. Ensure that all staff with responsibility for administering medication are trained to do so. Ensure that sufficient staff are employed at the home that are trained in first aid so that there is at all times a minimum of one person on duty who has received first aid training. So that staff are trained and competent to do their jobs. 7 33 24 Ensure that effective 31/10/2010 arrangements are in place for monthly review of the quality of care delivery at the home. This is to make sure the home will be run in the best Care Homes for Older People Page 15 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action interests of the service users. 8 36 18 Ensure that all staff are appropriately supervised. Staff will be supported and their performance will be monitored. 9 37 17 Keep sufficient records of the 31/10/2010 food provided for service users. This will allow for monitoring of individual diets and nutrition to ensure it is satisfactory. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/10/2010 1 8 Make sure that individual risk assessments are sufficiently detailed and reflect consent to care and treatment from either the person involved or their representative. The external clinical waste bins should be securely locked at all times The full names of staff on duty should be recorded on the the duty rotas. 2 3 26 27 Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 17 of 17 - 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. 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