Care Home: Hillfield Nursing Home

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What the care home does well Gets good information about the care and support needs of someone wanting to move into the home so that everyone is sure they can be met. Makes sure that staff have access to care plans that give them all the information they need to support a resident in the way they have chosen. Staff respect the privacy and dignity of people living in the home, speak to them in a sensitive and respectful way and make sure they receive good quality care and support. Supports residents and their relatives in a sensitive and understanding way when they are unwell or receiving end of life care. Provides people with a choice of nutritious food at all times of the day and night. Make sure that people who live in the home can join in activities of their choice, can get out and about in the local community and can see their relatives or friends when they want. Provide staff with training and supervision to help them do their job. An exceptional number of staff have achieved a National Vocational Qualification at a minimum of level 2. What has improved since the last inspection? The manager has completed Mental Health Capacity Act and Deprivation of Liberty training to support people when it may not be clear if they properly understand decisions they are being asked to make. There have been improvements in the control of medication in the home although some issues still need attention. Activities and social events are being promoted in a way that it is hope will meet individual residents choices and preferences. What the care home could do better: Make sure that the refurbishment of the home takes place as planned.Hillfield Nursing HomeDS0000070986.V377344.R01.S.docVersion 5.2Ensure that staff follow good practice guidance and the organisations policy and procedure for the safe ordering, receipt, administering and dispensing of medication in the home. Provide the Care Quality Commission (CQC) with a copy of an up to date wiring certificate for the home. Key inspection report CARE HOMES FOR OLDER PEOPLE Hillfield Nursing Home Grainger Park Road Elswick Newcastle Upon Tyne Tyne & Wear NE4 8RR Lead Inspector Elaine Charlton Key Unannounced Inspection 30th September 2009 09:00 DS0000070986.V377344.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillfield Nursing Home Address Grainger Park Road Elswick Newcastle Upon Tyne Tyne & Wear NE4 8RR 0191 2261891 0191 2722821 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) www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Lisa Jane Bamling Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 50 The maximum number of service users who can be accommodated is: 50 22nd April 2009 2. Date of last inspection Brief Description of the Service: Hillfield Home is registered to provide care for 50 older people. The home is situated in a residential area to the west of Newcastle upon Tyne. It is close to all local amenities, the town centre and main bus routes. Accommodation is provided over three floors. There are six bedrooms that could be used to accommodate a couple. All bedrooms are now used for single occupancy. None of the rooms have en-suite facilities but the home is undergoing a complete refurbishment which will provide 24 of the bedrooms with en-suite facilities. There are suitable lounge and dining facilities on each floor and a large conservatory leading on to the garden. Assisted bathing and toilets facilities are available around the home and there is one central passenger lift. The NHS contracts twenty four continuing care beds at the home. The home manager and hospital staff carry out the assessments for these beds. Hospital staff monitoring and review the medical care residents are receiving on a weekly basis. Continuing care fees are £379 plus £103 of free nursing care. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 5 Other fees for the home are between £379 and £539 per week. Information about the home is available in the service user guide that contains the statement of purpose and previous inspection reports. This is kept in the reception area of the home. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star – good service, this means that the people who use this service experience good quality outcomes. An unannounced visit was made on the 30 September 2009. A total of five hours were spent in the service. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 22/23 April 2009; How the service has dealt with any complaints and concerns since our last visit; The provider’s view of how well they care for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service; Arranged for a CQC Pharmacy Inspector to carry out an inspection of medication, and medication systems in the home. We have also reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager; Looked at information about the people who use the service and how well their needs are met; Other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; We looked around the building/parts of the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since our last visit. We told the manager what we found. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 7 What the service does well: Gets good information about the care and support needs of someone wanting to move into the home so that everyone is sure they can be met. Makes sure that staff have access to care plans that give them all the information they need to support a resident in the way they have chosen. Staff respect the privacy and dignity of people living in the home, speak to them in a sensitive and respectful way and make sure they receive good quality care and support. Supports residents and their relatives in a sensitive and understanding way when they are unwell or receiving end of life care. Provides people with a choice of nutritious food at all times of the day and night. Make sure that people who live in the home can join in activities of their choice, can get out and about in the local community and can see their relatives or friends when they want. Provide staff with training and supervision to help them do their job. An exceptional number of staff have achieved a National Vocational Qualification at a minimum of level 2. What has improved since the last inspection? What they could do better: Make sure that the refurbishment of the home takes place as planned. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 8 Ensure that staff follow good practice guidance and the organisations policy and procedure for the safe ordering, receipt, administering and dispensing of medication in the home. Provide the Care Quality Commission (CQC) with a copy of an up to date wiring certificate for the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hillfield Nursing Home DS0000070986.V377344.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 Hillfield Nursing Home DS0000070986.V377344.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to move into the home have their different and diverse care and support needs properly assessed so that everyone is sure they can be met. EVIDENCE: The organisation has standard formats for recording enquiries from people or their families who may wish to move into the home, pre-admission and admission assessments. Copies of assessments carried out by care managers are also obtained by the home and are available in residents’ records. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 11 Continuing care admissions are organised with hospital staff and are well managed. The home also uses a number of professionally recognised tools to assess a range of healthcare areas including tissue viability, continence, nutritional needs and mental capacity. We looked at the records for the person most recently admitted to the home. These had been fully and properly but did not include a photograph of the person. The manager told us that staff had recently been shown by the administrator of a sister home how to print photographs from the computer for this purpose and that they were in the process of updating both staff and residents photographs. The home does not provide intermediate care. Hillfield Nursing Home DS0000070986.V377344.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have their care, nursing and support needs met in a way that suits them, and by who they choose. They are can take control of their medication if they are able or are helped by staff to take their medication as prescribed. EVIDENCE: As well as the records for the person most recently admitted to the home we looked at the assessment and care plans for a resident receiving continuing care. We saw care plans in place that gave staff the right information to help them provide the care and support residents need. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 13 Continuing care records were particularly well detailed in the areas of both need and what interventions a person had received and from who ie., nursing staff, occupational therapy, speech and language therapy. Throughout the inspection staff were seen talking to, and helping, residents in a respectful, sensitive and professional way. There was humour as well and it was evident that both residents and staff knew each other well. Staff who work in the home come from a range of cultural backgrounds. For one resident this means that they can be spoken to in their own language and that other staff can be made aware of what the resident wants if they say particular words. We were told that because of this, staff have been able to identify meal time preferences for this person and include some culturally appropriate meals for them. The manager has just completed Mental Health Capacity Act (MHCA) and Deprivation of Liberty training which will be cascaded to all staff so that the process of carrying out capacity assessments can start. Nurses and other healthcare professionals from Newcastle General Hospital visit regularly to support and assess the changing needs of continuing care residents. One nurse we spoke to said she walks down from the hospital several times a week, or as often as a resident’s needs dictate. Daily records for residents receiving continuing care were exceptionally good. We also saw that attention had been paid to the needs of a resident who spent most of their time in their bedroom, because of the health, and that they had been provided with a bedroom where they could see the comings and goings in the corridor and that was close to the nurses’ station. Residents’ relatives and friends are supported and helped to spend time with them when they are unwell or receiving end of life care. This is done is a sensitive, professional but informal way. Some improvements in the handling of medication have been made since the last random pharmacist inspection. There was no evidence of any medicines being out of stock and surplus and expired medication is now promptly disposed of. Medicines storage within the home is generally secure and well managed. The medicines fridge was badly iced up at the time of the inspection and was not functioning properly. The temperature record confirmed this and we were informed that a replacement fridge was being obtained. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 14 Administration of medicines was observed on the ground floor and followed good practice guidance although the nurse signed the administration records before the service user had been observed taking the medicines. Some medicines should be given on an empty stomach and at a different time from other medicines but this practice is not always observed with weekly bisphosphonates. Some photographs of service users were missing and this increases the risk of medicines being given to the wrong person, particularly when a new member of staff is handling medication on their own. The current medication administration record charts (MARs) were looked at. There were a few gaps in the administration records. For one person lansoprazole and thyroxine had not been recorded for the morning of the inspection but were not in the monitored dose pack and had been administered. It was noted that 13 earlier daily doses of thyroxine had also not been recorded but appeared to have been administered along with the other daily medicines. Handwritten entries on MARs were usually signed by a second person to confirm accuracy but sometimes entries did not include the signature of the person making the entry, the date of the entry or the quantity of medicine received into the home. Some service users are prescribed medication with a variable dose but the actual dose given on each occasion is not always recorded. This makes it difficult to check the stock of medication remaining against the number of doses administered to help confirm that people have received their medicines as prescribed. The controlled drugs cupboard appears to meet safe custody regulations and there were no discrepancies between controlled drugs held in the home and the relevant entries on MARs and in the controlled drug register. Controlled drug stock checks are regularly carried out. We noted that supplies of a controlled drug given to a service user on discharge from the home were not fully recorded and did not include the appropriate staff signatures and date. Regular audits of the medication system are carried out and this helps to identify any medication problems promptly, and to confirm that staff are closely following the home’s medicines policy. All staff handling medicines have received appropriate training. Additional medication training and competency assessments are currently underway. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are supported to take part in activities and social events, to stay in touch with their relatives and friends and to receive a nutritious and varied diet promoting their different cultural backgrounds and choices. EVIDENCE: An activities board is displayed in the entrance hall of the home and includes information about events such as gardening, home baking sessions, cards/games, music sessions and ladies pamper sessions. During the inspection residents on the ground floor were taking part in a ‘Guess Who’ session. Staff said they regularly enjoyed using this DVD and that it also prompted conversation about events. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 16 One lady was having her hair set by one of the carers. The carer said she really enjoyed her work and was waiting to start working towards a National Vocational Qualification (NVQ) at level 3. Two other residents were spending time separately reading the daily paper and doing a crossword. Family visits, involvement and support are welcomed and encouraged. We spoke to a visitor who was planning to bring knitting and crocheting equipment into the home for his wife and others to use. The manager had been to a meeting the previous day about a new approach that Southern Cross is introducing to how activities are carried out and promoted involving all staff. Her feedback from the meeting was extremely positive and had staff coming up with lots of ideas about what people might like to do, where in the local community they could get out to and about the provision of a greenhouse in the garden. Members of the staff team are all going to take time to do activities with residents and this will not be the sole responsibility of the Activities Coordinator. Staff were speaking to relatives about getting photographs of residents and things/times they enjoyed to put together picture books and prompt discussion. Relationships between staff, residents and their relatives were seen to be warm, friendly and supportive. The home follows the ‘Nutmeg’ system for the planning of menus to make sure that they are both nutritious and well balanced. We looked in the kitchen during the morning and it was well organised and clean. Regular checks are carried out and recorded on refrigerator and freezer temperatures, and staff have a schedule for daily, weekly and monthly cleaning tasks. They record when these have been done so that there is a clear audit trail. Chef told us that supplies are regularly received and are of a good quality. The lunchtime choices on the day of the inspection were roast lamb or cheese and broccoli bake with cauliflower and sprouts followed by rice pudding. At team time residents were being offered tuna and tomato pasta or sausage casserole. We sampled the broccoli bake. It was creamy, tasty and appetising. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 17 People are able to have alternatives if they wish. There is an extensive vegetarian menu for residents and we were also told about some culturally appropriate choices that have been introduced for people from different backgrounds/minority groups. There is a mix of staff from culturally different backgrounds in the home and this means that they are able to speak to some residents in their own language. This has helped with menu planning and to let staff who do not understand a particular language to identify what a person wants, or needs, when they say specific words. During the inspection one lady, who was celebrating her birthday, was taken out by relatives for lunch and chef was making a birthday cake for teatime. The manager took time to telephone the lunch venue for the party and to make sure that they were open and serving meals so that no one was disappointed. For another lady who is reluctant to go out the manager asked staff to check with her whether this was because she had felt sick on a previous outing and whether she would like them to approach her GP about getting some medication to stop this. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected through policies, procedures and staff training that promote the acceptance, recording, investigation and reporting of concerns, complaints and allegations. They know they will be listened to and taken seriously which promotes their health and well being. EVIDENCE: The organisation has robust complaints and safeguarding policies and procedures in place. There is also a whistle blowing policy that encourages staff to speak up if they witness behaviour or practice they know is unacceptable. The complaints procedure is displayed in the entrance hall to the home and is included in the service user guide. There is also a book of ‘thank you’ cards and letters for people to look at. There is a complaints register in place and the home reports incidents/events to CQC when necessary. All staff are required to have a Criminal Records Bureau (CRB) check carried out at an enhanced level before they are able to work in the home. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 19 Care workers are employed in accordance with the General Social Care Council (GSCC) code of conduct and nurses are required to provide evidence that their registration with the Nursing and Midwifery Council is current and they are able to work with vulnerable people. The manager carries out regular checks to make sure that nurses Personal Identification Numbers (PINs) are up to date and current. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where they can spend time in private or with others but that is in need of updating and refreshing. Staff try to maintain good levels of hygiene but this is sometimes compromised by the fabric and condition of the home. EVIDENCE: We walked around the home with the manager who outlined the plans for the upgrading of the premises. Work is due to start on the top floor during October 2009. The home will be totally refurbished and 24 bedrooms will be provided with ensuite facilities. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 21 When building work on each floor is finished, decorators will move in and then new furnishings will be provided. Current ‘nurse stations’ on each floor are to be made into offices so that information can be securely kept and give people a space where they can hold private and confidential conversations. There were no odours apparent in any areas of the home. The laundry, although extremely hot, was seen to be very well organised. Washing machines can be programmed to carry out a number of different wash cycles including boil and sluice washes. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected through recruitment and selection procedures that are properly followed, staff training and supervision that helps them to do their job. EVIDENCE: The organisation has policies and procedures in place for the recruitment and selection of staff. The records we saw showed that these are regularly and properly followed. We looked at the files for three staff most recently recruited to work in the home. These are kept in a standard way, were tidy and easy to use. All three staff had previously worked in other homes owned by the organisation. Checks are carried out and recorded to confirm a person’s identity, that they are able to work in this country, that they are able to work with vulnerable client groups and have the required skills and experience. We saw evidence of the induction process and staff training. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 23 The manager has recently completed training on the Mental Health Capacity Act 2005 and Deprivation of Liberty legislation. This information/training is to be cascaded to all staff. Training in the mandatory areas of fire safety, first aid, safeguarding adults, health and safety and moving and transferring is up to date. All staff have completed the organisations safeguarding adults training and 50 have also completed the Newcastle City Council protection of vulnerable adults course. The manager is waiting for new dates for the remainder of the staff to attend the Newcastle training. Almost 100 of the care staff have completed an NVQ at a minimum of level 2. This is an excellent achievement. All the staff we met and spoke to were helpful, pleasant and keen to take part in the inspection. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in an open and inclusive way and in their best interests. They are protected through systems, policies and procedures that are regularly review and properly followed promoting their health and well being. EVIDENCE: The home is run by a manager who is qualified and experienced and has completed her registration with CQC. Her enthusiasm, and that of her staff, is infectious and promotes a stimulating environment for the people who live there. Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 25 The home’s registration and insurance certificates are up to date and properly displayed. The organisation has a computerised system for the management of money held on behalf of residents. Records are clear and up to date and show how much money each resident has access to and how much interest it has earned in the bank. Communal receipts are kept for things like the hairdresser but these do list which resident has had their hair done and what this involved. For example: wash and set, cut etc. There are guidelines in place so that staff know how they should record a resident’s property that they bring into the home with them. A new accident reporting system has been introduced. Each event/incident is logged on the compute by the administrator and the manager then has to check and validate the entry. She also completes a monthly audit sheet for complaints, accidents, and pressure area care. We check the fire log and maintenance/servicing records for the home. The fire log had been regularly and properly completed with the exception of a period of holiday for the handyman. The manager had already identified this gap and the need for another member of staff to do the checks in the absence of the handyman. There was no certificate in place to confirm that the five year wiring check had been carried out in the home. We were shown the programme of supervision. This clearly identifies which staff have supervisory responsibilities and who they are responsible for. The manager holds regular staff and relatives meetings, and an ‘open door’ surgery on the last Tuesday in each month when she is available until 18:00 for anyone who may want to call in and see her. There is also a monthly newsletter to keep people up to date with what is happening in the home. During a recent monitoring visit by the local authority the home achieved 10 out of 14 standards. Four recommendations were made. It is however anticipated that by the time the refurbishment is complete the recommendations will have been met. Hillfield Nursing Home DS0000070986.V377344.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Medication must be given as prescribed and a record made at the time that it is given. This will help to safeguard the health and welfare of people living in the home. Previous timescale of 7 July 2009, not met. 2 OP9 13 Best practice guidance and the provider’s policy must be followed when recording all medication. This will help to safeguard the health and welfare of people living in the home. 3 OP19 13 CQC must be provided with dates for the expected start and completion of the refurbishment of the home. This will mean that we can be sure the facilities in the home Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 28 Timescale for action 30/11/09 30/11/09 31/10/09 will improve for the comfort, safety and well being of the people who live and work there. 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 OP8 Good Practice Recommendations Staff should have access to original copies of recording sheets so that when they are photocopied the quality is not compromised and they remain clear to read and understand. The medicines refrigerator should be regularly defrosted and a record made of this. All staff handling medicines should be trained how to use the maximum/minimum thermometer. All handwritten entries on the MAR made by nursing staff should be fully completed including a signature of the person making the entry, the quantity of medication, the date, an explanation for the amendment and a witness signature to confirm that they are complete and correct. A photograph of each resident should be kept with the MARs, and their care files, to assist in identification. When the does of a medicine is variable the actual dose administered must be recorded on the MAR and there should be sufficient detailed information with the MAR to fully describe any variable dose schedules to be followed. When controlled drugs are given to residents the controlled drug record must include the quantity of mediation supplied, the date of the supply and the signature of the nurse and a witness. 2 OP9 3 OP9 4 5 OP9 OP9 6 OP9 Hillfield Nursing Home DS0000070986.V377344.R01.S.doc Version 5.2 Page 29 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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