Care Home: Hillcroft (Lancaster) Nursing Home

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What the care home does well What has improved since the last inspection? What the care home could do better: No requirements have been made following this site visit. CARE HOMES FOR OLDER PEOPLE Hillcroft (Lancaster) Nursing Home Westbourne Road Lancaster Lancashire LA1 5DX Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 6th March 2008 09:30 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 Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.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. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcroft (Lancaster) Nursing Home Address Westbourne Road Lancaster Lancashire LA1 5DX 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) 01524 63107 01524 389413 jackietowers@hillcroftnursinghomes.co.uk Hillcroft (Carnforth) Limited Mrs Elaine Fallowfield Care Home 20 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (10) of places Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 20 residents to include *up to 10 residents in the category of OP (Old age not falling within any other category ) *up to 10 residents in the category of DE (Dementia) 16th March 2007 Date of last inspection Brief Description of the Service: Hillcroft Lancaster is a Care Home with Nursing, situated close to the railway station and all the amenities of Lancaster centre. It provides full nursing care for 20 persons in ground and first floor accommodation. There is access for wheelchair and semi-mobile residents and a passenger lift is in place. All bedrooms are decorated and furnished to a good standard. There are currently two lounge/dining areas and a separate quiet lounge. There are adequate toilets and assisted bathrooms. Trained nurses are on duty at all times. The home is well maintained with well kept garden areas around the building. There is adequate parking space for visitors. The current range of fees are from £530.50 and are based on assessed needs. Further details over fees can be obtained from the registered manager of the home. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.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 excellent. This means that the people who use this service experienced excellent quality outcomes This site visit and was unannounced so the general manager, registered manager, staff and residents were not aware of the visit. The site visit forms part of the overall inspection for the home which makes sure people are being cared for properly and to make sure the home is a safe place for people to live in. As well as the site visit, judgements have been made about the service based on information supplied by the general manager. Comment cards were made available to residents, their relatives, GP surgeries, health and social care professionals and staff who work at the home. A very good level of responses were received. Comments made and feedback from the inspection was given to the general manager and registered manager, with discussion over any issues raised or areas needing further clarification. Care was taken to protect peoples’ identity. The site visit took place over one day and included - spending time observing staff on duty performing the day-to-day care tasks, taking time to sit and speak with residents, speaking with staff and speaking with the registered manager. As well as this, a number of records and documents were examined. We looked around communal rooms, a small number of personal rooms to see first hand if the home was a comfortable, clean and safe for people to live in. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. The site visit was enjoyable with everyone welcoming, friendly and cooperative during the visit. What the service does well: Hillcroft (Lancaster) continues to provide a pleasant and homely environment which has a relaxed and friendly atmosphere. The registered manager and staff try hard to make sure equal care is given to all residents, considering Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 6 their individual choices and preferences, and giving equal support to all, irrespective of their race, gender, disability, sexuality, age religion or beliefs. The registered manager works at the home on a full-time basis which gives an opportunity to talk with the residents and pick up immediately on any concerns or issues. Information provided by the home confirmed that they look to improve the service they offer on a continuing basis and welcome feedback from residents, relatives or visiting professionals. This information includes that comment cards are available at the reception, there is an open door policy for all and the quality assurance systems in place are used to monitor and make highlighted improvements to the service. Discussion with a relative confirmed that if any concerns are raised these are dealt with promptly. Residents spoken with and those who returned survey forms were very positive about the home and the care provided. Individual comments from residents included : “I love the staff and the home it is wonderful”, “the staff are all excellent”, “Matron Elaine talks to me every day and all the staff are wonderful”, “It is a lot better since Hillcroft came. It is lovely”, “I am very happy – I like living here”, “It is excellent. There is always staff about. They are all kind and caring”, “they spend a lot of time with me and listen when I want to talk” and “I love this home”. Professionals who visit the home commented : “Hillcroft offers an excellent service and is run by well trained and caring team of professionals”, “my experience of working with staff at Hillcroft has shown that care is patient centred at all times – individual needs are met”, (the home) “deals compassionately & thoughtfully with extremely complex needs” and “the patient is at the centre of the process i.e. caring for the patient is central to their ethos”. There is equal consideration given to all prospective employees, with both male and female staff being employed. The home has a thorough recruitment procedure to make sure that only staff who are suitable to work with vulnerable people are employed. As a company, there is also a bank of staff who are trained to work at any of the homes which means that staffing absences can be covered by people who know the home and are known to the residents. Training and development programmes are offered to all members of staff. The home has a very low turnover of staff with a number of staff having worked at the home for sometime. The home employs a number of qualified nurses to undertake formal nursing care. In addition, information from the home stated that 57 of the care staff are trained to National Vocational Qualifications (NVQ) Level II. This means that residents are cared for by suitably qualified and experienced staff. The carers were friendly and understood the personal needs of each resident. At the time of the visit the inspector again saw friendly and caring exchanges between the staff on duty and the people living at the home, with each Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 7 resident being treated as individuals and given the time and attention needed. Staff spoken and those who returned survey forms all indicated they felt supported by both training and the management. Individual comments from staff included : “matron is always at hand to give support and advice on anything”, “there is enough staff at Hillcroft for residents and there is a high quality of care because of this”, I find the management caring and understanding” and “I think this home is run well and good to work at”. Whilst all the residents have a range of differing care needs, they are encouraged to maintain their lifestyles as much as they are able to do so. Visitors to the home are always made welcome and are able to visit at any time. Relatives commented : “general nursing care is excellent”, “the staff are friendly and kind which is in the end on of the most important assets a home can provide”, “when I visit I feel part of a family, not just a visitor”, “everyone does their best and appear to work well together, creating a pleasant atmosphere”, “it has the feeling of a home, rather than an institution, and most importantly, it does not smell”, “this is the fifth care home in which my relative has lived in the past six years and it is by far the best” and “I don’t think the home can improve, it is a lovely place”. Information supplied by the home confirms that there are a range of policies and procedures which ensure residents are provided with the care they need and respects their rights irrespective of their race, gender, disability, sexuality, age, religion or beliefs. The home is well maintained and homely with communal rooms being accessible to the residents. For the bedrooms upstairs there is a passenger lift for the residents to use. There are a range of aids and adaptations for use within the home to help maintain residents’ independence and dignity. Those residents’ rooms seen during this site visit were well maintained and homely. Residents are also encouraged to bring in treasured personal items to personalise their rooms. Communal rooms are well maintained and provide a homely and comfortable environment for the residents to use. What has improved since the last inspection? The registered manager has achieved the Registered Managers’ Award. As a result of its consultation with residents and their families, the home have introduced a “Hillcroft Newspaper” – which tells residents and their families about the Hillcroft group in general, forthcoming activities and events, and encouraging contributions from all. The Hillcroft group are also developing a website so that people can find out about its facilities and services “on-line”. The home continues to be maintained to a very good standard, with the external garden areas having been developed for use by the residents and their relatives. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 8 Training of staff in the home continues, with a new trainer being employed by the company. The company has also employed the services of a consultant dietician to review and improve the nutrition to the residents in the home. Medication systems in the home have been reviewed and improved so that residents are now safeguarded by more robust systems and trained staff. Staff have been trained in the new Mental Capacity Act so that they can better safeguard the rights of the residents in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The system for assessment of prospective residents in the home continues to be very detailed and comprehensive and enables a judgement to be made as to whether the home can meet identified needs. EVIDENCE: Information from the homes states there is a good assessment procedure in place. They evidence this by noting they have a full occupancy and a waiting list. The company are planning a new web site for information about both this home and the other Hillcroft homes and the services they offer. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 11 An assessment for the most recently admitted resident was examined and found to contain a lot of information about their needs from a range of professionals. From previous inspections, it has already been confirmed that the home’s own assessment is carried out by the Head of Nursing or the Manager of the home. There is also in place an admissions procedure which outlines for staff how people who are admitted to the home need to be given time, information and made to feel comfortable Information from surveys suggest that good information has been provided. All residents confirmed they had received a contract from the home. At the last inspection it was recommended that the home review its contracts in line with the Office of Fair Trading guidance. The home confirmed that all contracts have been reviewed. Discussion with members of staff confirmed that care is taken when a new resident is being considered for admission to the home, they are supported to visit the home, have a day’s stay and this gives them an opportunity to experience first hand the home. Individual comments include – “The matron and staff visited me in hospital several times over a number of weeks before I cam and told me everything I needed to know” and “Elaine (Matron) came to see me in hospital and gave me lots of information” This home does not provide an intermediate care facility. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Excellent person-centred care is provided to the residents which means their health and personal care needs are met and residents are treated with dignity and respect. EVIDENCE: From information provided at the time of assessment, care pathways are produced. Each resident has their own individualised care pathway plan of care which provides detailed information over all the areas to ensure residents have a good quality of life. Whilst these are comprehensive, the registered manager was advised that these still remain more nursing focussed and the home should look towards providing a better balance between nursing and social needs. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 13 The care pathways are reviewed either monthly or as residents needs change, and means that any changes can be immediately incorporated into a new care pathway document to be used by staff. Four care pathways were examined during the site visit and found to contain extensive information on health and personal care needs. The care pathways were well organised and user friendly and enabled information to be found quickly and easily. Regarding their healthcare needs, individual comments from residents include “Dr W my GP is very good. He visits at least once a week”, “my GP visits every week and whenever I need him” and “If I need the GP Elaine or nurses arrange a visit” As mentioned in the previous inspection report, some care pathways noted “monitor triggers” but there is no evidence of why, what these may be or whether any monitoring has taken place. This was discussed with the registered manager who confirmed that they are now recording on separate sheets where a residents behaviour or needs indicate there is a need to try and understand specific behaviours. However, discussions with staff confirmed that there was a good understanding of those residents who needed additional support and how this was to be given. Survey forms received confirmed that people are satisfied with the care they receive, and comments included – “Matron Elaine talks to me every day and all the staff are wonderful”, “General nursing care is excellent”, “my relative is clearly loved by the staff and they look after him well. He is always clean and well groomed”, “I am always kept informed of any changes in my relatives condition” , “passing on important information is efficiently done”, (care) “is excellent” and “I am satisfied that the home does its best to keep up with special needs my relative needs”. Survey forms from healthcare professionals and GP’s note : “deals compassionately & thoughtfully with extremely complex needs”, “Hillcroft offers an excellent service and is run by well trained and caring team of professionals”, “they have tried to individualise service to resident I have placed there”, “evidence of good care planning and documentation”, (medication) “is carried out well and staff ensure medication is administered in the appropriate way at all times”, “the service provides individual care to meet the needs of all residents whenever possible”, “My experience of working with staff at Hillcroft has shown that care is patient centred at all times – individual needs are met”, have “Patient focussed care”, “highlight problems to mental health team/medics” and have an “excellent approach to challenging behaviour”. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 14 A healthcare professional also commented “at meetings, they are well prepared with matron and staff member who knows the person best present, and so can answer any questions and provide useful information for a review, etc.”. Professionals also confirmed that the home “always” respects the residents’ privacy and dignity and meets different needs. Staff comments confirmed they are provided with good information, from care pathways, handover meetings and general support and advice from other staff to ensure the care they provide is based on needs and wishes of the individuals residents concerned. Two visiting relatives were spoken to and both were very positive about the care their relatives were receiving. They confirmed they were always consulted and kept informed and if there were any changes they were notified immediately. The requirements regarding medication systems made at the last inspection were found to be met at this visit. Medication records seen were accurately maintained. Stocks were held securely and safely and were clean and tidy. Drugs records were accurately maintained. One relative confirmed that he was pleased that the home had had a medication review on their relative and their medication had been reduced which had resulted in them being “a lot better”. The care pathways also include information to ensure residents dignity and privacy are maintained, for example, providing personal care by same sex carers. Care staff were able to talk about practical ways they maintained the privacy and dignity of the residents and, for a very small number, support them to maintain their current level of independence. Observations of staff on duty confirmed that there is a high level of respect and empathy towards the residents, with day to day care tasks being done sensitively, seeking the view of the resident concerned and a number of very positive and good humoured interactions were seen. Staff were also seen moving residents appropriately, taking care to ensure safe practices i.e. the use of footplates. It has previously been confirmed that the home has policies and procedures for residents who are dying and when death occurs. Qualified staff at the home have been trained in Liverpool Care Pathways (which ensures that an intensive multi-disciplinary care input is provided (including the resident, their relatives and their own GP) when death is close so that unnecessary interventions are stopped and only the necessary (e.g. pain relief) interventions take place. This ensures that the resident is provided with their chosen level of input, according to their personal and religious preferences, which is dignified and pain free. Relatives are welcomed and supported by the manager and staff during these Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 15 circumstances and are able to spend as much time as they wish with their relative. The registered manager confirmed in the written information provided that all staff are now trained to support people as required in the Liverpool Care Pathway scheme. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Activities, social contact and meals are good which means the residents are provided with a good quality of lifestyle. EVIDENCE: Survey forms from residents indicated they felt a good range of activities were provided for them to take part in. Residents commented – “always activities to take part in – I enjoy the organ player when he comes and singing”, “there is always something on. I enjoyed going out for dinner and Blackpool” and “I don’t like to join in much but there is always something on”. On admission, the home ask the resident or their relatives to complete a social history information form so that this can be used to plan activities and things of interest. At the site visit, activity records were examined and found to contain a range of things for people to take part in, including : skittles, music, dance, hand Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 17 massage, nail care, reflection and reminiscence, memory box, games, craft work (cards made by residents on display on the mantelpiece), reading newspapers to individuals. In addition, external activities are provided – outings, small groups go out to the pub for lunch, line dancing, jive and other dancing, watching sport on TV. 1 resident goes to mass every week, the local minister and the priest from the Catholic church visit to provide a service and communion. On the day of the visit, some 1 to 1 work was seen (reading newspapers with residents), hand massages, sitting talking with residents and one resident was celebrating his birthday. During the site visit, one resident asked to go out and a member of staff was allocated for this. Outside in the patio area, there is a greenhouse where the residents (with help from staff) are growing tomatoes, a relative is working on planting shrubs in the garden area and a gardening group has been set up. A visiting relative said that he was very pleased that the registered manager is organising a party for him and his wife to celebrate their golden wedding anniversary in a couple of weeks time. This relative felt the home should be highly commended about the way they “include the relatives in whatever is going on”. He said that at Christmas he couldn’t believe how much he had enjoyed spending Christmas day with his relative and being part of the celebrations. He said the home had brought in extra staff and “had really pulled all the stops out” to make the day special for all the residents. The staff at the home are always looking for other activities to do and welcome suggestions, particularly as they are now beginning to accommodate younger people with dementia. This became apparent when a comment from a relative about having music and TV more appropriate to the older generation was discussed. The registered manager said that the staff make sure that the younger residents are offered a choice of what to listen to and are asked their preferences. Feedback from healthcare and social professionals include : “good rapport with relatives”, (the service) “creates a calm, homely living environment suitable for client group” and they “try to provide an environment best suited to each individual within the constraints of the nursing home. Individuals are encouraged and supported to live in the way they choose e.g. if private and quiet individuals are supported to live quietly in their own room with opportunities to socialise available. The Hillcroft group have recently appointed the services of a consultant dietician who is reviewing all the residents to ensure an appropriate diet is provided. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 18 The menus were seen for the home. As with the other homes in the Hillcroft group, the catering side is run and managed by a senior chef who, along with comments and suggestions from resident meetings (usually at the other homes) and the newly appointed consultant dietician plans a four weekly menu. It has already been confirmed that the home will meet cultural, vegetarian or religious dietary needs and this would be found out at the point of assessment and relayed to the chef in the home. These menus were seen and evidence that a very good range of nutrition is provided. The meals were seen during the site visit and provided a good quantity and quality and were presented well. Survey forms from residents, relatives and staff all confirm that the meals provided are enjoyed. Comments include : “I find the meals lovely and hot”, “there is always a choice – meals are very good”, “meals – very good”, “good food”, “the food is generally of a high standard with variety”, “the little treats they provide sometimes, such as ice cream, cold drinks, etc. is a nice touch”, “the food is excellent, and they cater for individual tastes” and “great meals”. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Concerns can be voiced and staff are trained in safeguarding adults which means that residents are protected. EVIDENCE: Information from the home state that they have systems in place to ensure complaints and concerns are acted upon. The home have not received any complaints or safeguarding issues, neither have we. The complaints procedure was seen on display, although the registered manager was advised that the location may mean some visits did not see it. Residents confirmed they knew who to speak to if they were not happy. Individual comments included : “know who to speak with if not happy”, “I would speak with the nurse if not happy”, “Elaine is always ready to listen if I’m not happy and all the staff. I am very happy here”, “Matron talks to me every day and I know I can tell her if I am not happy. But I am very happy – I Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 20 like living here”, “they spend a lot of time with me and listen when I want to talk” and “I ask Elaine or nurses, but I know all the staff will help - I tell the staff but I have nothing to complain about”. Relatives all confirmed that they know how to make a complaint and the service has always responded appropriately if any concerns have been raised. Individual comments include : “complaints – not applicable as yet” and “fortunately at Hillcroft I have not had any concerns about my relative’s care”. One relative spoken with told of a recent concern that he had had and, after discussing with the registered manager, was very satisfied about the way it was dealt with. Two visiting relatives also confirmed they had been given a copy of the complaints procedure and one was seen in the home’s Statement of Purpose and Resident Guide folder kept in the main reception. Health and social care professionals all confirmed that the care service always responds appropriately if they have raised concerns, although one commented “I have not had to raise any concerns about the service provided”. Staff also confirmed that they knew what to do if a resident or relative raised a concern. Training in safeguarding adults is covered in the home’s induction and also in the National Vocational Qualifications training. The home also has a policy and procedure on safeguarding adults. Discussions with staff on duty confirmed that there is a good understanding of what would constitute abuse and the importance of safeguarding residents in the home. Staff spoken with confirmed that any incident or concern would be reported to the manager of the home or the general manager. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: Information from the home confirm that they ensure the home is safe and well maintained by “comment cards, up to date certificates and monitoring records. Risk assessments, health and safety records, equipment checks, audits, meetings, accounts, budgets, suppliers lists, staff training and maintenance records”. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 22 Survey forms from residents all confirm the home is well a nice place to live, and is kept clean and tidy. Individual comments include : “home always fresh and clean”, “I find the surrounds comfortable”, “It is a lot better since Hillcroft came. It is lovely” and “I love my room”. Relatives commented : “The nursing home is clean, warm and comfortable”, “the residents are always clean and tidy (as is the building)”, “very clean conditions” and “it has the feeling of a home, rather than an institution”. A relative spoken with said they “could feel how nice the home was the minute they walked in the door”. Both care and ancillary staff confirmed that the home is clean, tidy and warm and that changes have been made to the environment to make it a better and more effective place to work in. Healthcare professionals have raised no concerns about the environment. A sample of personal rooms were seen, along with communal rooms. All the communal rooms are well decorated, furnished to a high standard and providing a pleasant environment for the residents to live in. Individual rooms have been personalised with treasured possessions to make them familiar and homely. There is a secure garden which is accessible by residents, although this is generally with staff support. There is a dedicated housekeeper and maintenance handyman to ensure any requirements made by the fire department and environmental health are addressed promptly. Staff confirmed that any maintenance issues are always dealt with promptly. There are no CCTV cameras in use in the home. Information from the home confirms that there is an policy for preventing infection and managing infection control in place, the home have used the Department of Health’s guide “Essential Steps” to assess current infection control management and that all the staff have had training in the prevention of infection and the management of infection control. Staff spoken with were aware of how to manage and prevent infection and confirmed that they have had infection control training. One relative commented “most importantly, it does not smell” Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The level and calibre of staff is very good. Residents are safeguarded as their care is provided by a staff team who are vetted, qualified and competent. EVIDENCE: Information provided by the home states that there are sufficient staff, who are trained and experienced on duty to meet the needs of the residents. On the day of the site visit there were 6 carers and a qualified nurse on duty for 20 residents, with an additional member of staff coming on duty from 12.30 to 6.30 p.m. to assist with activities, etc. Survey forms from residents were positive about the staff in the home and were able to confirm that there appear to be sufficient staff on duty, individual comments include : “staff helpful and friendly”, “staff usually available when needed”, “I love the staff”, “the staff are all excellent”, “all the staff are wonderful”, “there is lots of staff and if I need anything they are always there” “all staff very good”, “there is always a lot of staff on duty” and “there is Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 24 always staff about. They are all kind and caring”. One comment card said : staff not always available for toileting needs” which was discussed with the registered manager who said she could not understand this as there were more than enough staff on duty at all times but would speak with residents to make sure people are not waiting unduly. Relative’s comments about the staffing were a little more reserved, with all stating that staff “usually” have the right skills and experience to look after people properly. Individual comments included : “everyone does their best and appear to work well together, creating a pleasant atmosphere”, “the staff are friendly and kind which is in the end on of the most important assets a home can provide” and “most of the carers are naturally very young and whilst they are inexperienced sometimes there is a good training scheme for them all. Staff felt that there are usually enough staff to make sure people are looked after well – individual comments included : “there is enough staff at Hillcroft for residents and there is a high quality of care because of this”, “usually the staffing levels are fine – just the odd sickness” and (we have) “friendly and approachable staff”. The company have a dedicated bank staff system so that should there be staff absences these can be covered by experienced and trained staff who know this home and are familiar to the residents. Visiting health and social care professionals indicated that managers and care staff “always” have the right skills and experience to support individuals’ social and healthcare needs. At present, 16 female and 3 male staff are employed. 57 of these staff have achieved NVQ Level 2 or above, with the remaining 31 working towards this qualification. Two staff spoken with confirmed they are about to start their NVQ Level III in March 2008. The home has confirmed that all staff who have worked in the home in the last 12 months have all had satisfactory pre-employment checks. Information from the home provided a detailed breakdown on the training provided to all levels of staff. The registered manager also makes sure that articles of interest about care are made available to staff to read. At the site visit, staff had been given a newspaper article about ‘neglect in care homes’ for them to read. The Hillcroft group have also appointed another trainer to support the training programme. There is a training programme for staff to access during the next 12 months and the home have confirmed that this will also include training qualified staff on the new Mental Capacity Act. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 35 and 38 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents live in a home that is very well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The registered manager has now achieved the Registered Manager’s Award. Comments from both residents, relatives and staff confirm that they have confidence in the management of the home, and include : “Matron Elaine talks to me every day, the home it is wonderful”, “I love this home”, “I am very happy – I like living here”, “Well managed home with caring staff”, “when I visit I feel part of a family, not just a visitor”, “matron is always at hand to Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 26 give support and advice on anything”, “I find the management caring and understanding”, ““I think this home is run well and good to work at”, “I don’t think the home can improve, it is a lovely place” and “this is the fifth care home in which my relative has lived in the past six years and it is by far the best”. It has already been confirmed from residents’ survey forms that the registered manager is always on hand and visits and speaks with people on a daily basis. Staff spoken to also felt it was very positive that the registered manager works a lot of the time “hands on” which means they are able to speak with her, obtain guidance and also discuss any areas of concern. Visiting professionals commented - “well managed home with caring staff”, “the patient is at the centre of the process, i.e. caring for the patient is central to their ethos” , “appears to be running extremely well - I could not identify any area for improvement” and “Hillcroft offers an excellent service and is run by well trained and caring team of professionals.” Information supplied by the home confirmed that there are the full range of policies and procedures which are reviewed and staff confirmed they are available to them. The home have stated that they are committed to improvement. Effective quality assurance and quality monitoring systems are in place to continuously monitor all policies and procedures. Relatives meetings and staff meeting minutes were seen on file. Residents meetings are not currently held due to the needs of the people who live at the home. Relatives spoken with confirmed they knew about the relatives support group. The Hillcroft company have produced a “Hillcroft Newsletter” which tells residents and relatives about events and activities which have taken place and also ones planned for the future. This was introduced in December 2007 and appears to be receiving good feedback. The company are also looking to develop a website for people to access information about the Hillcroft homes. The registered manager stated that, at present, the home does not hold or manage any personal monies for residents. In line with the other homes in the Hillcroft group, there are formal systems in place regarding residents’ finances, including residents having their own personal accounts, clear information being provided on fees and charges and, as a company, maintaining exacting and significant financial procedures which are audited to ensure the resident’s financial interests are protected. At this site inspection, the registered manager confirmed that these financial arrangements remain in place. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 27 Information from the home confirms that all the required maintenance and servicing of equipment and facilities takes place, including fire safety and fire detection. A selection of health and safety records were seen and found to be accurately kept, with monitoring done on a regular basis. Staff confirmed they are provided with supervision regularly throughout the year. A selection of certificates were seen during the site visit, including the home’s public liability insurance certificate which was seen on display. From discussion with the registered manager, the company have a proactive approach to the health and safety of its residents and staff and take prompt action should any areas of concern be identified. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard OP7 Good Practice Recommendations Residents (or their representative) should be involved in their care pathways and these documents should evidence that involvement Care pathways should provide more information over behavioural or other management triggers so that staff are clear about what support is required by the individual resident concerned. The activities programme should continue to be developed so that a range of activities based on individual likes, interests and abilities are provided The home’s current abuse policy and procedure should be reviewed so that it reflects current local protocols in safeguarding adults and the document No Secrets 2. OP7 3. OP12 4. OP18 Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 30 5. OP12 Whilst care plans are comprehensive, these still remain more nursing focussed and the home should look towards providing a better balance between nursing and social needs. Hillcroft (Lancaster) Nursing Home DS0000066641.V353629.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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