Care Home: Hillside Nursing Home

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What the care home does well Residents enjoy being cared for in a friendly, homely environment and are supported to live their lives as they wish within their abilities. Residents interviewed told us they liked living here and were well cared for. One resident interviewed stated, "The food is lovely, we have got a very good chef. You can get up when you want to. Staff are nice to my relatives, I have never had any complaints, if I did I would speak to the Matron. I like living here, I have a nice bedroom, I have moved to another one, I helped to choose the colours , it`s nice". Families were also happy that their relatives were being well cared for. Relatives interviewed stated, "I`m quite happy, things have got better over the last few months, I think they look after everyone well" and "Things aren`t so bad, the new manager has picked up on a couple of things already, staff are doing so much, involving families. On bank holiday Monday we were decorating cakes. Residents enjoyed sing a long with Ken". Relatives and residents interviewed were very happy with the food served in the service. One relative interviewed stated, "The food is brilliant, I can`t complain, they really do nice meals, they do ask residents if they would like something different". Staff enjoy working in the service, many like the friendly and homely environment.Staff interviewed stated, "I like working here, everyone is nice to the residents" and "I love it". One relative interviewed stated, "I get on very well with the staff, they are so caring". What has improved since the last inspection? The assessment process has improved in that some more information has been accessed for prospective residents. A complaints log has now been introduced. The service now has a copy of the local Adult Protection Procedures. Two staff now evidence the destruction of any medication, which is good practice. Medication is now recorded when carried forward. This makes it easier to audit. The resident bedroom is now free of other peoples wheelchairs, which promotes privacy. Staff were observed to converse with residents during their mealtimes, which makes it more of a social occasion. The outside kitchen store floor has been redecorated. The kitchen freezer has been repaired. The service has gone through some major refurbishment in the past year. Bedrooms have been refurbished with two providing en suite facilities therefore providing more choice for residents. Many of the other bedrooms have been redecorated and carpets replaced. Residents have been able to choose colours where they are able to. What the care home could do better: The assessment process for new residents is better but it still needs to be improved to ensure more detail is included with regard to their nursing needs. The assessments need to be signed and dated by the person carrying out the assessment. Further intervention is needed to make sure that where residents nursing needs have become more challenging that specialist advice is followed. One resident has become more difficult to manage and it may be that they need to be re assessed in regard to their changing needs. Care plans need to evidence all of the residents individual and changing needs. One resident who had an infection did not have a care plan in place to manage this. The privacy and dignity of residents has been compromised as they have not been sleeping in their own bedroom at night. One resident has been sleeping in the sitting room all night for some months. As this is the only public room for residents use it means this is used by residents all day and evening. Recently, another resident also spent the night in the sitting room. This needs to be resolved so that residents dignity and privacy is upheld. The new manager told us that she will be looking into this. The service needs to demonstrate that decisions made to administer medication covertly to residents is in their best interests and are kept under review. Where residents sustain a bruise without obvious cause it needs to be recorded on the accident record book. This will enable the manager to closely monitor any such resident. The manager needs to make sure the resident who has an eye disease is checked out at the hospital if necessary to ensure the correct course of management is followed. The service have not followed the adult protection procedures when concerns were raised in the service. The service does have a copy of the local adult protection procedures and most of the staff have also attended recent training in this area. The Commission alerted the safeguarding team and the new manager is to carry out a full investigation and report back to the safeguarding team and the Commission. If the service do not follow the procedures it means that residents may not be protected and could be at risk. CCTV has been fitted inside the service and it is considered to be intrusive and excessive. A Privacy Impact Assessment has not been carried out. This would show how it impacts on the residents who live there. Relatives, staff, visitors and health processionals would be under surveillance during their visits also. Residents may be at risk as staff have not had a full induction nor have they been provided with full mandatory training. Staff should be provided with 3 days paid training each year. The service also needs to provide all staff with deprivation of liberty training and equality and diversity training. This will ensure the service provides a well trained, confident and skilled team of staff.Staff files were not complete therefore the new manager needs to audit them to ensure all pre employment checks are in place. The new acting manager needs to apply to the Commission to be the registered manager. The service needs to canvass the views of the residents and their representatives to ensure it is being run in the best interests of the residents. Key inspection report Care homes for older people Name: Address: Hillside Nursing Home 30 Dover Road Southport Merseyside PR8 4TB     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret VanSchaick     Date: 2 7 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Hillside Nursing Home 30 Dover Road Southport Merseyside PR8 4TB 01704566312 01704566312 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Veatreey Development Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing code N, to people 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 The maximum number of people who can be accommodated is: 16 Date of last inspection Brief description of the care home Hillside is a large detached house, which has been converted into a care home for 16 older persons. It is situated in a residential area of Southport with easy access to local amenities and public transport to the town centre. The service provides accommodation over 3 floors with lift and stair lift access to each floor. Hillside has 12 single bedrooms and 2 double bedrooms. There are two en suite facilities. There is a lounge but no dining room. The service has equipment and aids to help residents who are less independent and a call system with an alarm facility, which operates Care Homes for Older People Page 4 of 36 Over 65 16 0 Brief description of the care home throughout the service. There is a large enclosed garden at the rear of the premises with ramp access. There is parking facilities in the front garden. Veatreey Development Ltd own Hillside. A proposed manager Ann Nabilisi has been appointed. Weekly fees are between £389-£489 Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A site visit took place as part of the unannounced inspection. It was conducted over two days for the duration of 12.5 hours. 8 residents were accommodated at this time. The Commission pharmacist Stephanie West was also present during part of this inspection. As part of the inspection process many areas of the service were viewed including residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and two relatives. The inspection was conducted with Mrs Ann Nabilisi (acting manager). During the inspection process two residents were case tracked (their files were examined and their views of the service were obtained). All of the key standards were assessed and re commendations and requirements from the previous key inspection in May 2009 were discussed. Some were addressed. Care Homes for Older People Page 6 of 36 Satisfaction forms Have your say about..... were distributed to a number of residents and relatives prior to the inspection and to staff during the inspection. A number of comments included in this report have been taken form surveys and interviews. An AQAA (Annual Quality Assurance Assessment) was completed by the manager of a sister service prior to the visit. The AQAA consists of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including the staff numbers and training. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? The assessment process has improved in that some more information has been accessed for prospective residents. A complaints log has now been introduced. The service now has a copy of the local Adult Protection Procedures. Two staff now evidence the destruction of any medication, which is good practice. Medication is now recorded when carried forward. This makes it easier to audit. The resident bedroom is now free of other peoples wheelchairs, which promotes privacy. Staff were observed to converse with residents during their mealtimes, which makes it more of a social occasion. The outside kitchen store floor has been redecorated. The kitchen freezer has been repaired. The service has gone through some major refurbishment in the past year. Bedrooms have been refurbished with two providing en suite facilities therefore providing more Care Homes for Older People Page 8 of 36 choice for residents. Many of the other bedrooms have been redecorated and carpets replaced. Residents have been able to choose colours where they are able to. What they could do better: The assessment process for new residents is better but it still needs to be improved to ensure more detail is included with regard to their nursing needs. The assessments need to be signed and dated by the person carrying out the assessment. Further intervention is needed to make sure that where residents nursing needs have become more challenging that specialist advice is followed. One resident has become more difficult to manage and it may be that they need to be re assessed in regard to their changing needs. Care plans need to evidence all of the residents individual and changing needs. One resident who had an infection did not have a care plan in place to manage this. The privacy and dignity of residents has been compromised as they have not been sleeping in their own bedroom at night. One resident has been sleeping in the sitting room all night for some months. As this is the only public room for residents use it means this is used by residents all day and evening. Recently, another resident also spent the night in the sitting room. This needs to be resolved so that residents dignity and privacy is upheld. The new manager told us that she will be looking into this. The service needs to demonstrate that decisions made to administer medication covertly to residents is in their best interests and are kept under review. Where residents sustain a bruise without obvious cause it needs to be recorded on the accident record book. This will enable the manager to closely monitor any such resident. The manager needs to make sure the resident who has an eye disease is checked out at the hospital if necessary to ensure the correct course of management is followed. The service have not followed the adult protection procedures when concerns were raised in the service. The service does have a copy of the local adult protection procedures and most of the staff have also attended recent training in this area. The Commission alerted the safeguarding team and the new manager is to carry out a full investigation and report back to the safeguarding team and the Commission. If the service do not follow the procedures it means that residents may not be protected and could be at risk. CCTV has been fitted inside the service and it is considered to be intrusive and excessive. A Privacy Impact Assessment has not been carried out. This would show how it impacts on the residents who live there. Relatives, staff, visitors and health processionals would be under surveillance during their visits also. Residents may be at risk as staff have not had a full induction nor have they been provided with full mandatory training. Staff should be provided with 3 days paid training each year. The service also needs to provide all staff with deprivation of liberty training and equality and diversity training. This will ensure the service provides a well trained, confident and skilled team of staff. Care Homes for Older People Page 9 of 36 Staff files were not complete therefore the new manager needs to audit them to ensure all pre employment checks are in place. The new acting manager needs to apply to the Commission to be the registered manager. The service needs to canvass the views of the residents and their representatives to ensure it is being run in the best interests of the residents. 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. Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process for new residents needs to be improved. Evidence: The service has only had one short term admission since the last inspection. We looked at their pre admission details. The documentation showed that this resident was assessed for their needs but there is no signature of the assessing nurse nor date of the assessment. The assessment covered admission date, personal details, religion, previous medical history, dietary needs, oral care, nurse and carer input needed, skin care, communication, continence, sight, hearing, sleep pattern, falls history and suitability of bedroom. The assessment could have been more detailed. In particular in reference to the history of the residents illness and how it affects them. This resident was admitted for Care Homes for Older People Page 12 of 36 Evidence: palliative care. Areas identified as part of their medical history included breathing difficulties, yet there was no further information on the assessment in regard to this. Other areas that needed to be included were medication use and religious needs. We also looked at another residents pre admission assessment who had been admitted approximately 3 years ago. This assessment had been brief and did not include all of the identified needs of the resident. The newer assessment did show some improvement. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not having all of their care needs met. Further intervention by the new acting manager needs to address this to ensure residents are being provided with optimum care relevant to their individual needs. Evidence: We looked at two residents care plans to see if their identified needs had been addressed. The new acting manager was in the process of moving individual care plans into seperate folders so that residents will have all information relating to their care held on their individual file rather than collectively in one large file with other residents. This ensure residents confidentiality is promoted. Relatives interviewed told us that they were happy with the care provided. Relatives interviewed stated, I think they look after everyone well and Mum sees the Dr, they are on the ball with that and a chap comes once every 6 weeks to do their chiropody and they have the optician. The care plans had been reviewed regularly with dates recorded. It is easy to find Care Homes for Older People Page 14 of 36 Evidence: information. Not all of the identified needs have been recorded on the care plan. One of the residents had an infection as recorded on the daily evaluation records but a care plan had not been in place to show how staff will manage this. Another resident who has been having input from a consultant psychiatrist has instructions recorded that clearly states staff to contact them if there are any changes. Staff did not contact them and contacted another health professional who prescribed an increase in medication. The service need to ensure that when they seek further specialist advice for residents, that they follow it. The consultant should have been contacted. It may have been the same outcome for the resident and maybe not but the resident needs that specialist input at present because of their condition. We also discussed the implementation of a record to evidence the mood and behaviour of this resident so that when they are next reviewed by the consultant a clear picture shows of how they are throughout the 24 hour period, seven days a week. One of the residents had sustained bruising to two parts of her body. No accident record was made. We looked at the accident records and they show records have been made for other residents therefore all injuries whether observed or not should be recorded in the accident record. The acting manager can then monitor the residents more closely. There was a care plan form stating that a resident would be having regular checks at the hospital for retinopathy. There was no evidence that they had been carried out. As this resident has been in the service for 14 months the service need to follow this up to ensure the residents needs are being met. Risk assessments were in place for residents with regard to mobility, falls, nutrition and bed rails. We looked at medicines administration. Most medicines were administered by qualified nurses but people wishing to self-administer medication were supported to do so. Nursing staff carry out audits (checks) of medicines handling to ensure that should any shortfalls be identified they can be promptly addressed. The home has a policy for the use of home remedies so people living at the home can receive prompt treatment for minor ailments without a prescription. We looked at how medicines were recorded and found recent records of receipt, administration and disposal to be generally clear and accurate. Nursing staff had recently started to record the quantities of any medicines carried forward to the next months medicines records helping to ensure that medicines handling can be accounted for (tracked). Records showing the application of prescribed creams had also recently improved and peoples care plans were being updated to include information about where and when, they should be used. Care Homes for Older People Page 15 of 36 Evidence: We looked at how care plans supported the safe use of medicines. The acting manager explained that one person was given their medicine covertly (hidden in food) but that she had found a lack of information within their care plan about how this decision had been reached, or how it was kept under review. The care plan did not reflect the persons assessed needs with respect to medicines administration. The acting manager had found some guidance about covert administration and was planning to seek advice from the doctor. It is important the decision, action taken and the names of all parties concerned should be documented and reviewed at agreed intervals to ensure that peoples best interests are protected. We found there was information about the use of medicines prescribed when required helping to ensure they are correctly used, if needed. But, there was a lack of clear guidance for staff about the use of prescribed nutritional supplements. This needs to be addressed to ensure they are offered as prescribed, when needed. We found that medicines were stored securely. This helps to ensure that they are not misused or mishandled. One of the residents has been sleeping in the lounge every night therefore not giving them any privacy nor promoting dignity. Recently, another resident slept in the lounge also. Both slept on recliner chairs. This was discussed with the new acting manager. If this were a one off occasion it would not be such a problem, but for one resident it is every night, which should question why it should be happening at all. Staff sit in this lounge at night and another resident stays up late before retiring. The acting manager told us that she slept in the lounge because night staff were worried that she would wander at night and become anxious. She also has a history of falls. Discussion took place with the new acting manager who is going to try and resolve this situation so that the resident can sleep in their bedroom, which is on the ground floor. Care documentation needs to be updated to show that every effort is being taken to provide suitable sleeping accommodation for this resident. It may be that the resident needs further specialist input. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy being cared for in a friendly, homely environment and are supported to live their lives as they wish within their abilities. Evidence: Residents spoken with told us they were happy living at Hillside. Residents all sit together in the sitting room and spend their time either chatting, watching television or taking part in some of the arranged activities. Staff were noted to interact well with the residents and promoted a friendly, homely atmosphere. Activities that take place include beauty therapy, dominoes, musical afternoons, bingo, listening to music, hand massage, DVDs and snacks on Sundays. The service also had a fun day recently and invited families. One relative interviewed stated, Staff had arranged a family fun day for the residents but only four people turned up, which was disappointing, but they all had a wonderful time. Residents also participate in sing a longs with members of staff. Residents that are unable to participate in some of the activities are not excluded from any events. Residents who prefer not to take part have their wishes accommodated. During the visit we observed staff carry out beauty treatments on residents. Residents enjoyed having a fuss made of them. In particular time was being spent with some of the residents who were unable to communicate Care Homes for Older People Page 17 of 36 Evidence: their needs. Staff were spending time on a one to one basis interacting with the residents. They were observed to be kind and caring in their approach. One resident interviewed told us that she was able to go out with her family regularly and stated, I go out a lot and I also do some drawing. At present the service does not have a hairdresser but the new manager is aware of that and is in the process of appointing someone suitable. The manager told us she was arranging a cream tea for residents and would be inviting their families to participate. Residents records show that any activities they have participated in is recorded. Some of the residents are taken out for walks locally and spend time in the garden weather permitting. One relative interviewed stated, Staff are doing so much, involving families. On bank holiday Monday we were decorating cakes, we had a sing a long with Ken. One of the residents has regular visits from her local Church and is provided with Communion. The new manager has carried out some research and realised that some of the residents belong to other churches and have not had any visits, so she is looking into this at present and hopes to arrange church representatives to visit with the individual residents agreement. Visitors are encouraged to visit when they wish to. It is open house and the service accommodate visitors when they are able to visit. Residents confirmed that their relatives could visit them at any time. One resident interviewed stated, My relatives come a lot, staff are nice to them. Residents who are able to are encouraged to make decisions about how they wish staff to support them. One of the residents interviewed stated, You can get up when we want to and they let me retire when I want to. I have also decided to move bedrooms. I have a new bedroom now, I had moved out of my old one so they could decorate but I prefer the one I am in now, I helped to choose the colours. Its very nice. Residents bedrooms showed that all had personal items in place, which made their room individual to them. Some of the residents are unable to make choices due to their conditions. One relative interviewed stated, Mum is unable to communicate with others but I am satisfied that she is happy here. Families are approached in regard to their care and their input is evident in care documentation. The chef sees the residents every day to ensure they are happy with the meals that are served. The chef stated, I know the residents very well, I know what they like to eat and I plan the menu around what they like. The menu is on display and residents Care Homes for Older People Page 18 of 36 Evidence: are also able to choose several options form 14 choices if they are not keen on the main course provided each day. The residents told us that they had enjoyed their lunches. One resident interviewed stated, We have a choice of meals and nice afters. I cant complain about the food, its very good and we get home baking. A relative interviewed stated, The food is brilliant. I cant complain. They really do nice meals. The menu board tells you one set menu but they do ask if they would like something different. Staff were observed assisting residents with their meals. Staff were interacting with the residents making it an enjoyable part of the day. Residents were able to have breakfasts in their room when they wished and other meals also if that was what they wanted. Lunch and evening meals are served at set times but there is also provision for those residents whose dietary meals are more complex, to eat when they feel like it . The service also caters for residents who have specialist diets. The dietitian has been accessed by the nursing staff when resident are nutritionally compromised. Families interviewed told us they felt their relatives were being provided with good care at Hillside. Relatives interviewed stated, Im quite happy, things have got better over the past few months. and Things arent so bad, the new manager has already picked up on a couple of things. Care Homes for Older People Page 19 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not protect the residents because they do not follow the safeguarding procedures. Evidence: A complaints procedure was in place and a leaflet format has been made available for residents use. A copy of the complaints procedure is in the service user guide. The new manager told us the complaints procedure is due to be updated. The complaints log was viewed and showed three complaints had been made. Two were upheld and actioned. One complaint was not dealt with promptly. There have been no new complaints recorded recently. Residents we spoke with were happy and none have had complaints to make. One of the residents interviewed stated, I have no complaints to make, if I was worried I would speak to the Matron. The service now has a copy of the local adult protection procedure and many staff have attended safeguarding training in the past few months as confirmed through interviews and staff files. When concerns were raised last month, the service did not follow the safeguarding procedures. There was also no record of the concern raised nor of any action that the Care Homes for Older People Page 20 of 36 Evidence: service took following the allegations. The reason for the safeguarding procedures is to ensure that residents are protected. That people can raise concerns, knowing that they will be listened to and and their concerns be dealt with correctly. This means that residents are not being safeguarded. Care Homes for Older People Page 21 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The use of CCTV fitted inside the service is intrusive and excessive and impacts on the daily life and privacy of the residents. Evidence: We carried out a tour of the service to include all of the residents bedrooms. The top floor of the service now provides four newly refurbished bedrooms with two providing en suite facilities. Some of the other bedrooms have been decorated as well including an empty one that is almost complete. Some of the newly refurbished bedrooms had no mirror in place, therefore this needs addressing. Residents were happy with the improvements and one of the residents told us she had moved out of her room while it was being refurbished and decided to stay in her new one. She preferred it and helped to choose the colour scheme. A relative interviewed stated, Mum is happy with her room, its lovely. Residents have access to the garden through the rear exit using a ramp facility. The rear garden was maintained and provided private sitting out areas for the residents and their visitors use. There is only one public room therefore residents eat there meals in here as well as using it as their sitting room. It is not large enough for a dining table to be in use. Instead residents have individual tray type tables for their meals. It would be of Care Homes for Older People Page 22 of 36 Evidence: benefit to the residents if a room was made available for residents to dine in, making it more of a social occasion than it is. A large television screen has been fixed to the wall of the sitting room and provides entertainment for the residents. Comfortable armchairs and recliners were in place for residents use. The sitting room is decorated to a good standard and provides a cosy and comfortable environment for residents. There were sufficient bathroom and toilet facilities for residents use. The bath on the first floor has damaged enamel, which needs repair. The flat roof on the ground floor has been redone. The maintenance person left two weeks ago and at present cover is provided by the sister service maintenance person. The kitchen was clean and organised. A cleaning schedule was in place. Fridges and freezers were clean and food covered and dated. The Food Services Agency diary was completed each day with fridge/freezer temperatures and hot food temperatures. Environmental Health had visited last year and recommended tiles on the window ledge be repaired. This has been done and provides an easier cleaning surface. The cooker in use is a small domestic one although the chef told us that he could manage the residents food using it. The fan above the cooker is not working. The fan needs to be repaired or replaced. Food stores were clean and tidy. The floor had been refurbished and was easy to keep clean. The fridge has now been repaired and there was evidence of plenty of food for residents including fresh fruit and vegetables. The laundry floor has been repaired and is now easy to clean, however the walls need repainting. The laundry service is satisfactory and sufficient equipment was in place. The home was clean and tidy during the visit. We were able to open the fire doors easily and the fire escapes looked well maintained. The call bell system was tested and worked well. CCTV has been reconnected inside the service. They are situated in the kitchen and the nurses office. We have already had to visit the service last September in regard to this. Following our visit the registered provider was advised to remove the CCTV from inside the service. He was advised that he could use the CCTV as a crime prevention measure outside the service as this would not breach the Care Homes Regulations. Care Homes for Older People Page 23 of 36 Evidence: A Privacy Impact Assessment has not been carried out by the registered provider in accordance with the CCTV code of practice. This should have been undertaken before any CCTV was installed inside the service. This impacts on the residents privacy, relatives and visitors privacy, staff privacy and visiting professionals privacy. Residents, relatives, staff and visitors to the service would not be able to have a confidential meeting in the nurses office, whilst the CCTV is in operation. On occasions residents access the kitchen therefore their privacy is not protected. There is no monitor in the service. Staff told us the monitor is in the registered providers home in London. During our inspection visit to the service we asked for the CCTV to be switched off as it was intrusive and excessive. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be at risk as staff have not had a full induction nor have they been provided with full mandatory training. Evidence: The staffing rota was viewed and showed sufficient staff were on duty. A chef is employed in the kitchen and a domestic covers the cleaning duties. Care staff manage the laundry. The AQAA told us that all of the care staff held the NVQ qualification but there was no evidence to confirm this. Some of the care staff have gained their NVQ Level 2 qualification in care but not all care staff, nor where the other care staff working towards this as mentioned in the AQAA. Staff working in the service told us they were happy working together with the new manager and deputy. Staff canvassed for their views commented, Excellent care of residents, the best I have seen in 13 years and Hillside is very caring and supportive to all residents and staff. Its like a home from home, we look after each other. Some of the staff interviewed and canvassed for their views told us they were very unhappy about CCTV being in place and told us that it was because the registered provider did not trust the staff. Care Homes for Older People Page 25 of 36 Evidence: One relative interviewed told us that she was very happy with how the staff cared for the residents. When interviewed they stated, I get on well with the staff, they sare so caring. Staff interviewed stated, I like working here, everyone is nice to the residents I love it here I enjoy it, the residents are very well looked after The care is brilliant and The residents are well looked after, we have enough time to look after them. The AQAA told us that all pre employment checks over the past twelve months have been carried out prior to commencement of new staff working in the service. Yet, we looked at four staff files and two of the files (both of whom have been employed in the past few months) did not have all the checks that we would expect to see in place before commencement of employment. Police checks have been carried out. Contracts were missing in some of the files. All files evidenced an application form. Not enough information was included in one of the senior staff files about their previous employment history. There was no reference from this employees previous employer either. There were no start dates on record on any of the staff files checked so we could not know if any references were sought prior to employment commencing. One of the staff started work with only one reference in place. Staff induction records were not completed, nor dated. Following discussion with staff the induction period lasts anything between 30 minutes to two weeks. For one new member of staff with no previous experience one day was provided, which is insufficient. The AQAA told us that the staff development programme met the National Minimum Standards but this was not evidenced during the visit. Staff training records did not appear to be up to date as the AQAA stated that almost all of the staff had attended basic food hygiene training and infection control training yet it is not evidenced in staff files. On further enquiry we have been told that many of the staff have still to do this training and that is why it has not been evidenced on staff files. Staff files did evidence some previous training attended to include manual handling and safeguarding. Some of the files evidenced previous training attended at their previous place of work. Staff interviewed stated, I attended a full day of training that covered manual handling, first aid and fire. I have not had infection control or COSH, I have had no fire training, no training in the last two years, I have not had fire training but I did Care Homes for Older People Page 26 of 36 Evidence: have a fire tour of the building and was shown all the exits, I had manual handling last year and abuse training last month. Im keen to do my NVQ and Matron is looking into it for me, I have not had first aid, fire, infection control and I have had no training. We discussed the training records with the new manager and she is in the process of checking out staff training records so that she knows what the individual staff training needs are. There has been no training with regard to equality and diversity or the deprivation of liberty act. Care Homes for Older People Page 27 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service need to canvass the views of the residents and their representatives to ensure it is being run in the best interests of the residents. Evidence: The acting manager had only been in post for three weeks when we visited the service. She has many years experience as a registered nurse and has held the acting manager post in nursing homes previously. She is knowledgeable about the care needs of the older person. She is supported in her role with a team of registered nurses. The manager is hoping to commence the NVQ in management qualification soon. She has not had an induction to the position and is at present familiarising herself with the service. Staff interviewed told us they were happy with the new manager. Staff interviewed stated, Im fine with the new manager, no problems, Ann seems lovely and The new manager is lovely, I definitely would talk to her if I was concerned, she is always there to talk to. The registered provider visits the service regularly. He does not Care Homes for Older People Page 28 of 36 Evidence: however complete a written report following his visits to the service. We viewed monthly reports that are written by registered nurses on a monthly basis but they are fairly basic and dont cover what we would expect. We would like to see reports from the registered provider that show what he looks at and whom he talks to during his visits. Discussion took place with the manager as to what should be looked at. There are no quality assurance systems in place in the service. None of the residents, relatives or staff are canvassed for their views. The views of the residents or their representatives are needed to be gained so the service can measure the success of how the service is run. It is necessary to find out what people think of how the service is run and that includes the views of residents, relatives, staff and visiting health professionals. There is no annual development plan for the service, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for the residents. The manager told us there was a staff meeting last month. Staff interviewed confirmed this and we viewed the minutes. Policies and procedures have been updated. The manager told us that none of the residents monies are held on the premises. A secure facility was available. A valuables book needs to be in place so that if any residents wishes any valuables can be kept and a copy of the record of items held would be issued to them. The manager told us that staff supervision had commenced. We looked at one of the staff files and it was evidenced. One of the staff interviewed stated, Jane has done an appraisal with me. The AQAA stated that all of the certificates and servicing had been carried out and was up to date. We looked at the evidence and found that all were up to date including, the lift, hoist, boiler, gas, electricity, fire and all other equipment in place. Safety records showed hot water outlets are checked at various points weekly and fire points also. The service have not been providing staff with full induction or mandatory training therefore a requirement has been made earlier in this report. Accident records show staff are completing the forms correctly and there was a first aid box in place. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that care plans evidence all of the residents changing needs. This is to ensure that all of the residents identified needs are being met. 17/06/2010 2 8 13 The registered person must ensure that where residents needs require additional specialist advice, that the advice is followed. This will ensure the correct treatment for residents is followed. 01/06/2010 3 9 13 The service must be able to demonstrate that decisions to administer medicines covertly have been made in peoples best interests, and are kept under review In accordance with current legislation and current professional guidance. 31/05/2010 Care Homes for Older People Page 31 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 10 12 The registered person must ensure that the service is conducted in a manner which respects the privacy and dignity of residents. This will ensure that residents dignity and privacy is promoted. 01/06/2010 5 18 13 The registered person must ensure that when concerns are raised that they are dealt with promptly and follow safeguarding procedures. This will ensure that residents are protected. 01/06/2010 6 19 12 The registered person must ensure CCTV is not in place inside the service, where it intrudes on residents privacy. This is to ensure that the service is conducted in a manner which respects the privacy and dignity of the residents. 01/06/2010 7 29 19 The registered person must ensure that all pre employment checks are recorded in staff files, to include start dates, full employment history and a reference from the employees recent employer. 01/06/2010 Care Homes for Older People Page 32 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that residents are protected. 8 30 18 The registered person must 01/08/2010 ensure that all staff have full mandatory training. In particular, where it is stated annually. This is to ensure that all staff are confident, knowledgeable and have the skills needed to provide effective care to the residents. 9 30 18 The registered person must 01/07/2010 ensure that all staff are provided with a full induction programme that is suitable to their individual training needs and is recorded in their staff training records. This is to ensure that new staff have been provided with sufficient initial training so that they can meet the care needs of the residents. 10 33 24 The registered person must ensure that effective quality assurance systems are in place. This will ensure that the service is run in the best interests of the residents. 01/07/2010 Care Homes for Older People Page 33 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The registered person should ensure that all pre admission assessments are signed and dated. This is to evidence they were carried out prior to admission. The registered person should ensure that a more detailed assessment be carried out to ensure a prospective residents needs have all been identified prior to admission. It is recommended that all bruises found on residents should be documented on the accident record, whether it is observed or not. This will highlight any issues that the acting manager can address. It is recommended that the service should seek further advice and clarification with regard to the resident who has Retinopathy. This will ensure the approved course of management is followed. It is strongly recommended that a record should be implemented to evidence the challenging behaviour of any residents over the 24 hour and 7 days a week period. This ongoing record will provide clear information on how the service is managing their needs. It is strongly recommended that when a complaint has been made that it should be recorded, investigated promptly and a full account of the investigation and outcomes for the complainant be documented. It is strongly recommended that when a concern is raised that a record should be kept of all action taken. It is recommended that the bath on the first floor should have the enamel repaired. It is recommended that the fan above the cooker should be repaired or replaced. It is recommended that the walls in the laundry should be repainted. It is recommended that mirrors should be in place in the newly refurbished bedrooms. It is recommended that another room should be made available for residents to dine in therefore making mealtimes more of a social occasion. It is recommended that the service should continue to promote the NVQ level 2 qualification for carers. Page 34 of 36 2 3 3 8 4 8 5 8 6 16 7 8 9 10 11 12 18 19 19 19 19 19 13 28 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 14 15 16 30 30 31 It is strongly recommended that the service should provide equality and diversity training for all staff. It is strongly recommended that the service should provide deprivation of liberty training for all staff. It is strongly recommended that the acting manager should forward her application to be registered manager to the Commission. It is recommended that a development plan should be put in place that is based on a systematic cycle of planninaction-review, reflecting the aims and outcomes of the residents. It is recommended that the manager should continue to provide supervision on a regular basis for the rest of the staff employed. 17 33 18 36 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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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