Care Home: Hillcroft Nursing Homes

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well What has improved since the last inspection? Not applicable as this has been the first inspection visit since registration in June 2007. What the care home could do better: Some concerns were raised over staffing levels which was discussed with the general manager and registered manager. The registered manager confirmed that she will undertake a review of the staffing levels to ensure that residents are supported and supervised according to their needs. There needs to be ongoing observation of care practices so that staff can be confident that the care and input they provide is based on good practice and ensures the resident is put first. The development of activities should continue for all the residents in the home. The outdoor area should be developed so that it provides a pleasant area for the residents to view. The current general lounge/dining area is situated where there is a bit of a thoroughfare. The general manager confirmed this is something they are looking to relocate so that people can enjoy their meals without being too disturbed. The TV in the general lounge is not sited in a place where most people can see it. The doors to individual rooms on the EMI unit are the same so some thought should be put into how residents can identify their own room. CARE HOMES FOR OLDER PEOPLE Hillcroft Nursing Homes Throstle Grove Slyne With Hest Lancaster Lancashire LA2 6AX Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 6th December 2007 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 Nursing Homes DS0000070276.V350350.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 Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcroft Nursing Homes Address Throstle Grove Slyne With Hest Lancaster Lancashire LA2 6AX 01524 825328 01524 825393 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) Hillcroft (Carnforth) Limited Mrs Tracey Anne Cooke Care Home 36 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (16) of places Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of either gender 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 16) Dementia - Code DE (maximum number of places 20) The maximum number of people who can be accommodated is: 36 Date of last inspection Not applicable as newly registered service Brief Description of the Service: Hillcroft (Slyne) is situated in a quiet country area just north of Lancaster. The home is built over one floor, although there are two separate units – one general nursing and the second for people who have a diagnosis of dementia. Each of the two units has their own quiet room which can be used for private meetings with family members or friends. Each unit has a lounge, kitchen area and dining area. There are ample places so that people can have a choice of where to sit and who to sit with. Residents rooms are all single and have ensuite facilities. The environment is furnished to a high standard and, in addition, there are a range of facilities and equipment in the home to meet assessed needs and also to maintain residents’ independence. Outside there are garden areas which are currently to be developed. Residents are encouraged to retain links with the families and friends and contacts in the local community. The home employs a range of people, including nursing, care and ancillary staff. Hillcroft Slyne is a no smoking home. The home forms part of the Hillcroft group of homes, which currently total five. As well as the registered provider, there is a general manager (Mrs Sue Young), both visit the home on a regular basis to assess the service provided. The home’s manager (Mrs Tracey Cooke) is registered with us The current range of fees are from £590.00 per week but actual fees are based on the assessed need. Further details over fees can be obtained from either the general manager or registered manager of the home. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first site visit since the home was opened and registered with us in June 2007. The sit visit was unannounced so the general manager and registered manager, staff and residents were not aware of the visit. The 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 and registered manager. Comment cards were made available to residents, their relatives, GP surgeries, healthcare professionals and staff who work at the home. A good level of responses were received. Comments and issues made were discussed with the general and registered managers, although care was taken to protect peoples’ identity. The site visit took place over one and a half days 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, speaking with relatives and speaking with the registered manager. As well as this, a number of records and documents were examined. We also enjoyed a meal sat with the residents, which provided a first hand view of the mealtimes in the home. The home’s registered manager was available during the inspection to answer questions and provide additional information. 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 visits. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 6 What the service does well: This is a newly registered service so the provider, general manager and registered manager has had the opportunity to use their previous experience and expertise of the other homes in the Hillcroft group to ensure the environment, facilities, staffing and staff training are suitable for the service to be provided. The home is built over one floor which means all areas of the home are accessible to the residents, although there are two separate units – one general and one for people who are needing additional support due to their dementia. The environment is to a high standard, with individual rooms having their own ensuite and all rooms decorated and furnished in a comfortable and homely way. Comments gained during this inspection note that people are generally satisfied with the service provided. Information provided by the home confirms that residents are supported to lead purposeful and fulfilling lives, with any religious beliefs followed. Individual comments about the service included : • • “manager relates well to all employees, cares about all residents. Helps staff with problems” “I also admire all the hard work Matron puts in to keep the home running smoothly and if I had a problem I wouldn’t hesitate to go and see her” “the matron at the Slyne Hillcroft is very approachable. Her door is always open. She is very caring and supportive” “I also feel very supported by my manager. Being part of a happy team also helps” “I am very impressed with the standards at Hillcroft the staff deal very well with the problems of individual residents and show great patience” “we cannot believe the vast improvement you have achieved to mum’s quality of life since she has been with you” “cared for with love and understanding” “absolutely great” “our relative has come on in leaps and bounds” DS0000070276.V350350.R01.S.doc Version 5.2 Page 7 • • • • • • • Hillcroft Nursing Homes • “we could not wish for our relative to be in a better place”. As a group, Hillcroft welcomes input from relatives, friends and other professionals and sees the service working in partnership. Their long-running relatives support group is evidence of this and it was pleasing to hear that relatives at this new service have been included in this group. There is an ongoing monitoring and assessment of the service which the general manager and registered manager welcome as it provides an opportunity review and improve as necessary. What has improved since the last inspection? What they could do better: Some concerns were raised over staffing levels which was discussed with the general manager and registered manager. The registered manager confirmed that she will undertake a review of the staffing levels to ensure that residents are supported and supervised according to their needs. There needs to be ongoing observation of care practices so that staff can be confident that the care and input they provide is based on good practice and ensures the resident is put first. The development of activities should continue for all the residents in the home. The outdoor area should be developed so that it provides a pleasant area for the residents to view. The current general lounge/dining area is situated where there is a bit of a thoroughfare. The general manager confirmed this is something they are looking to relocate so that people can enjoy their meals without being too disturbed. The TV in the general lounge is not sited in a place where most people can see it. The doors to individual rooms on the EMI unit are the same so some thought should be put into how residents can identify their own room. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 8 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 Nursing Homes DS0000070276.V350350.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 Nursing Homes DS0000070276.V350350.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service.” Information provided to the prospective resident means they can be sure about the service and what to expect. The home undertake a thorough assessment so that it can be confident staff are able to meet identified needs. EVIDENCE: The home (in line with the other homes in the company) has a care plan system called “Care Pathways”. This means that following the initial enquiry from either Social Worker, Health professional or relative the manager or the head of nursing undertake a personal visit to meet the prospective resident and complete a “care menu”. It is from this initial information that a care pathway menu is completed and an initial care pathway plan put in place. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 11 The care menu is in the format of a comprehensive list of identified needs, which outlines the individual person’s needs and how staff are to meet these. The home state that they encourage people to look round at any time, and an appointment is not needed. In addition, a trial period is offered. This means that the prospective resident (and their family/friends) can spend time to see first hand what the home can offer. Detailed personal information over specific social needs are obtained as the home ask relatives to complete a social history/information document. This means that specific wishes can then be met. In addition to this there is evidence of healthcare professional and Social Services assessments. Where a resident has been admitted from the specialist assessment hospital there is the arrangement for the people place to be kept open for 12 weeks. Support and guidance is available from the specialist consultant and, before a final decision to discharge is taken, a review of the placement is made to ensure the resident has settled and the home is able to meet the identified needs. There is also in place an admissions procedure that outlines for staff how people who are admitted to the home need to be given time, information and made to feel comfortable. The home also involves relatives in the move and works hard to keep them involved. The general manager has previously confirmed that the company has a formal system so that all new residents are provided with a breakdown of their individual fees, along with what the home provides and a letter giving full details over the home’s Terms and Conditions is sent when an offer of a place at a Hillcroft home is made. This letter gives information over what is supplied, facilities, responsibilities for fees and any arrangements for any additional fees, e.g. for sundry items. This is in addition to the Individual Service Agreement sent by Social Services. A general statement regarding this is included in the home’s Service User Guide. Comment cards received confirmed that contracts are provided by the home. Feedback from comment cards was passed onto the registered manager – one indicated that the home could provide more specific information (e.g. weight monitoring, daily routines, staffing ratios, options to pursue hobbies, religion, etc.). This was discussed with both the registered manager and general manager who confirmed that some of this information is included in the pack sent out to prospective residents. However, it may be that as part of the admissions process, the home could verbally inform relatives that specific information over daily routines, weight monitoring, etc.) could be gained from the key worker or named nurse. This home does not provide an intermediate care facility Hillcroft Nursing Homes DS0000070276.V350350.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Generally a very good quality of care is provided to the residents which means their health and personal care needs are met and people are treated with dignity and respect. EVIDENCE: The care pathway system is used in this home and, following the completion of a care menu at the time of assessment, a care pathway will be set up for the new resident. All the residents have their own care pathway which is reviewed, either monthly or as needs change. This system enables any changes to be immediately incorporated into a new care pathway document. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 13 The four care pathways examined evidenced that there is good written information which provide all levels of staff with the individual residents’ needs and how these are to be met, including specialist monitoring charts. There was good evidence of healthcare monitoring and intervention by GPs, Consultants, etc. The home also has the input of a dedicate GP surgery who attend the home on a weekly basis. This means ongoing healthcare needs can be better monitored. However, there is evidence that prompt action is taken should a healthcare issue be noted in between these visits. The care pathways also include risk assessments and the outcome of these. A small number of residents were also spoken with and a number of residents were observed over a period of time. It was clear that people are treated with dignity and respect. Individual relatives/friends spoken with were generally positive about the care provided, although a couple of individual comments were discussed further with the registered manager. GP’s who completed comment cards indicated that the service respects individuals’ privacy and dignity. Both qualified and care staff were spoken to about individual care needs and all were well informed and had a very good understanding of the care needed by each of the residents spoken about. Feedback from two GP surgeries indicate that the home always seeks advice and acts upon it to manage and improve individuals’ health care and that needs are met by the home. Medication administration was observed during the inspection site visit and no concerns were raised regarding this area. The registered manager confirmed that the new system in place has a number of issues which are being addressed by Boots the Chemist. One GP surgery commented that the home always enables medication to be self managed or managed appropriately Although not assessed during this site visit, the home, along with the other four homes in the group, operates the Liverpool Care Pathway Scheme for people who are dying and when death occurs. Information provided by the home states that all staff have been trained in its use. The scheme 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 circumstances and are able to spend as much time as they wish with their relative. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Activities, social contact and meals are good which means the people are supported to enjoy a good quality of lifestyle EVIDENCE: Due to the needs of the people at Hillcroft (Slyne) only a small number of people were able to make comment on their daily activities. However, those people who were able to do so confirmed that they are able to follow their own routines and preferred activities. Information provided by the home and also confirmed during this visit was that residents are free to follow their own religion – with a local minister and priest visiting the home on a regular basis. One relative commented - “mum is a Christian and her vicar visits and is welcomed. I am also told that a local minister visits too and also that hymn singing takes place on a Sunday morning”. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 15 Information provided by the home confirms that – “individual activities programme following the residents individual profile completed prior to admission by the resident or next of kin. Daily activities displayed on various notice boards. Relatives encouraged to join in and help in any way. Residents given as much choice as possible to maintain hobbies and interests as possible. Dedicated person to organise daily activities programme. Outside entertainers invited to the home. Residents given as much choice as possible.” Recreational Therapy (RT) files are also maintained for each of the residents, and notes down what has been offered and whether this has been enjoyed or not. The home has a dedicated RT staff for two hours every afternoon. Since opening, the home has organised several activities/outings for the residents and/or their relatives/friends including – Blackpool Lights Trip, Bonfire Party, Wine and Cheese afternoon and it is anticipated that over 40 relatives/friends will enjoy Christmas lunch with their relatives at the home. Whilst each unit has staff identified to provide recreational therapy, there is a need for some creative ideas to be brought in which are specific for people who have dementia and also activities for people who are at the later stages of their dementia (e.g. SONAS). Relatives generally felt they are kept in contact and are provided with information as needed. During the inspection, a small number of care practices on the general unit did not seem to be person-centred. The registered manager was advised of these and the need to ensure care practices are at a high standard. As with the other homes in the Hillcroft group, this home continues to have input of the Head Chef who has revised all the menus to provide an excellent standard of food. The menus are organised over a four week rota and include choices for each meal as well as provision for special diets. In addition to this, there is also a dietician employed by the home who is active in assessing the dietary needs of the menus and also of individual residents so that healthcare issues can be addressed with an appropriate diet and evidence of dietary monitoring was also seen. This is also important as there will then be less reliance on supplement drinks as the right level and consistency of food can be provided which will be reviewed and changed as needed Residents who were able confirmed they were very satisfied with the food provided and if they wished for something different this would be provided. One gentleman confirmed that his wife was still in her room having breakfast in bed and stated that he has a full cooked breakfast every morning which he enjoys. Other feedback was discussed with the head chef who is very keen to Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 16 ensure the meals provision is to a very high standard and welcomes comments to improve an already excellent service. A member of staff was observed giving one resident her lunch – this was done in a caring and kindly way, talking with the resident (who was not able to communicate) and making sure it was a social occasion, unhurried and responsive. As the resident was eating very slowly, the carer took the time to reheat the meal in the microwave so that it was still hot and palatable for the resident to eat. Discussions with staff confirmed that there is a good understanding of dietary needs and where people need support and encouragement. Monitoring of diets is also important and staff confirmed their involvement in this. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good 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 people are protected. Concerns can be voiced and staff are trained in safeguarding adults which means that the residents are protected. EVIDENCE: Information supplied by the home indicated there have been no complaints since the service opened in June 2007. The commission has not received any complaints or concerns regarding this home. The complaints procedure remains the same and is also contained in information provided by the home. A copy of the complaints procedure is also on display in the main reception area, along with a survey form which relatives and visitors are encouraged to complete. There is ongoing monitoring from the general manager who would ensure that any complaints are fully investigated and recorded and used as a basis to improve the service. Comment cards received from relatives and residents who were able to all indicated that they knew who to talk to if they were unhappy about any aspect of their care. Relatives also confirmed that if concerns are raised prompt action is generally taken. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 18 As one of the Hillcroft group of homes, there are robust procedures in place for recognising and responding to any safeguarding adult concern. Previous discussions with the Hillcroft group’s training manager confirmed that safeguarding adults is covered in both the home’s own 3 day induction programme and through other training. Safeguarding adults is also covered within the TOPSS and NVQ training programmes. Staff spoken to were conversant with different forms of abuse and what the procedure is if they suspected or had any concerns. No safeguarding adults concerns have been raised since the home opened in June 2007. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People live in a well-maintained and safe environment which provides a pleasant and homely place for them to live in. EVIDENCE: The home was clean, tidy, warm and providing a comfortable environment for the residents to use. Although not all areas of the home were viewed, communal areas and some rooms were seen. The home continues to maintain a high standard of facilities, with individual rooms being clean, well maintained and providing a comfortable private space for the people who use the service. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 20 Individual rooms have been personalised with treasured possessions to make them familiar and homely. Generally people who use the service do not have a choice of room but discussion will take place as needed. Advice was given that doors to individual rooms on the EMI unit could be better identified as currently they all look the same. The registered manager is to address this. Residents who were able, confirmed that they are very happy with their rooms, the communal areas and that the home is clean, warm and comfortable for them to feel at home and they can be used at any time. No concerns were raised over the cleanliness of the home. The dining area in the general unit was discussed with the general manager and registered manager who confirmed they are looking to relocate this. They were also informed of the fact that people cannot see the TV in the general lounge. These are to be addressed. Relatives who commented, along with residents who were able to say, all felt that the environment is very good indeed. Individual comments include - “the facilities are excellent, the interior and furnishings are very good indeed”, “hygiene standards are very high and I am very pleased with the laundry service. The bedrooms are very nice” , “I am very impressed with the standards at Hillcroft – both in the bedroom and living areas” and “home is always fresh and clean”. There is a pleasant garden area which can be accessed, although generally with staff support. The Hillcroft group are looking to develop the garden areas in the forthcoming months. There is a dedicated housekeeper and maintenance section to ensure any requirements made by the fire department and environmental health are addressed promptly. There are no CCTV cameras in use in the home. Staff spoken with confirmed that any repairs, etc., are done promptly. There is an infection control policy and procedure in place and training records evidenced that staff have accessed infection control training. Information provided by the home indicate that there is an infection policy in place for preventing infection and managing infection control, they have used the Department of Health guide “Essential Steps” and all staff have received infection control training. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The level and calibre of staff is generally satisfactory, although staffing levels may need to be reviewed to ensure people are fully supported. People who use the service are safeguarded as their care is provided by staff who are suitable to work with vulnerable people. EVIDENCE: Confirmation was seen that staff are recruited appropriately, with all the required checks taking place prior to commencement of employment. The home’s equal opportunities policy is reflected in their employment as there are both male and female staff, aged over 18, including overseas staff working at the home. Information from the home confirmed that no agency staff have been used in the last 3 months which means the residents are cared for by staff who are familiar to them and know their needs. However, a GP comment card indicated there is a need for more consistent nursing staff rather than using locum staff. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 22 The Hillcroft group have a dedicated Clinical Supervisor who organises training, including a formal 3 day induction training programme for new staff. More recently the Hillcroft group have set up a dedicated training room at their Lancaster home to enable staff to undertake their training courses in a more formal setting. In addition, a range of other in-house training and external training courses are accessed as training needs dictate. Staff spoken with, and training records seen, confirm that a range of training has been accessed. Information supplied by the home confirmed that currently 60 of care staff hold NVQ II or above. Staff spoken with confirmed that training is ongoing and spoke about what they had learned during the training and how they were putting this into practice when looking after the people who live at the home. Comments from residents and from relatives indicate that staff are generally experienced and skilled to meet their needs, although observations and comments noted as part of this inspection were discussed with the registered manager. Staffing, particularly in the evening, was raised as an issue and the registered manager confirmed that she intends to review the staffing levels to ensure that there are sufficient staff on duty to ensure residents are properly supervised and supported. Individual comments received regarding staff include - “they’re good girls” , “Aaron and the carer I call ‘Yoghurt’ is very good indeed”, “the staff are very warm and welcoming“, “having cheerful friendly staff is really important, I very difficult visiting a relative with dementia. On the whole I am very impressed with the staff. I am amazed by the younger members of staff, they bring the place alive. They appear so caring and warm and cheer up this visitor! They definitely deserve a special mention” and “some of the younger staff seem very good (kind, thoughtful and not institutionalised)”. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The residents live in a home that is well managed and provides a safe and comfortable environment for them to live in. EVIDENCE: The manager of the home was appointed to the post prior to the service opening in June 2007 and has experience in both management and as a qualified nurse. She is registered with us. Comments written in comment cards and also from speaking with people during the inspection all confirmed that the manager is very approachable, competent and deals with issues immediately. The registered manager has clear responsibilities and is not in Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 24 charge of any other home, although provides relief management cover for the other four homes on a rota basis with the other managers. Comments from staff and relatives included – “any problems are dealt with swiftly”, “manager relates well to all employees, cares about all residents. Helps staff with problems”, “I also admire all the hard work Matron puts in to keep the home running smoothly and if I had a problem I wouldn’t hesitate to go and see her”, “matron’s door is always open. Easy to talk to listen to everything you have to say”, “I am very impressed with the standards at Hillcroft the staff deal very well with the problems of individual residents and show great patience”. Written comment cards from relatives kept by the home included - “we cannot believe the vast improvement you have achieved to mum’s quality of life since she has been with you”, “cared for with love and understanding”, “absolutely great”, “our relative has come on in leaps and bounds” and “we could not wish for our relative to be in a better place”. A small number of comment cards raised issues that have been discussed with the registered manager. The relatives of the residents also have access to the established relatives support group. The support group is made up of both current relatives and relatives of people who no longer need services and provides both a support, information and social function. The group meets on a 3 monthly basis, with input from both one of the Directors, the General Manager and the manager of the home. There is a financial cost to these meetings which is met wholly by the company. Meetings are well attended. Two relative/friends were spoken with during this inspection and both felt the opportunity to attend the recent support group was of benefit and enabled them to ask questions direct to the provider. The General Manager confirmed that the established quality assurance systems in place continue to be used to review and improve this new service and include external and internal auditing, the use of ‘non-compliance forms’ which are used to identify issues so that appropriate action can be taken. Comment cards seen during this inspection noted that two concerns were raised, both these have been dealt with. A new newsletter has been produced so that residents and their relatives/friends can be kept informed of events that have occurred and those planned. It was confirmed that regular meetings take place between trained staff, care staff, handovers at the start of each shift, matron’s meetings, quality meetings. Information supplied by the home confirmed that there are the full range of policies and procedures which mean staff are support to know how to deal with differing situations. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 25 The registered manager has previously confirmed that no monies are held for people in the home. There are formal systems for both charges and payments and each resident has their own account to which sundry items are charged. For those people who do not handle their own financial affairs, these are managed by solicitors, families or a named representative. All expenditure is receipted and audited. Information supplied by the registered manager confirmed that regular maintenance and servicing takes place on equipment and facilities within the home. Discussions with staff confirmed that regular maintenance takes place, with prompt action being taken if any issues are raised. The registered manager confirmed the home has a fire assessment in place and regular fire drills take place. The home ensure that all accidents are recorded and, where necessary, these are followed up by the registered manager or general manager. The registered manager ensures that we are informed of any serious incidents/injuries and deaths are reported. The general manager undertakes a formal monthly assessment of the home as required by us. Information previously supplied by the Clinical supervisor confirmed that Skills for Care (TOPSS) induction and foundation training is accessed for new staff. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/a STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement Staffing levels must be reviewed to ensure residents are supported and supervised according to their needs Timescale for action 20/01/08 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. Refer to Standard OP12 OP10 OP19 OP14 OP19 Good Practice Recommendations The home should look to develop activities that are appropriate for needs and abilities, i.e. SONAS for those people in the later stages of their dementia Care practices should be observed so that staff can be confident that the care they provide is person centred. The outdoor area should be developed so that it provides a positive outlook for residents at the home Residents should be able to identify their own individual room door in the home to maintain independence and also aid privacy The lounge in the general unit should be reviewed so that residents can sit away from the general thoroughfare. The TV in the lounge needs to be re-sited so that residents can see it better. Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Hillcroft Nursing Homes DS0000070276.V350350.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!