Care Home: Hillside Nursing Home

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What the care home does well What has improved since the last inspection? We found that requirements that we had made following our last visit had been addressed. This included ensuring that the support given to people to help them manage their money was clear and open. We saw that training has been developed further so that staff have not just received basic training but also specialist training according to their role. In particular staff have received training on the recent changes in the Mental Health Capacity Act, which is good practise. This means that staff have the skills to understand how to support people to make choices. Staff told us that they believed the amount of training offered was " excellent" and " it`s always really good and interesting". Improvements have been made to the environment. In particular two sensory gardens have been built which are different from each other so that they are suitable to the needs of the people who are likely to use them. This shows that staff are aware of the needs and lifestyles of the people who they support. We saw that the dementia nursing unit has been redecorated and furnished in a way, which provokes memories for people who live there. This is good practise and shows an understanding of the type of support that this group of people need. We did not identify any breaches in the Care Home Regulations 2001(law which governs care homes), which shows that the management of the home understand current legislation. What the care home could do better: We found that staff understand the importance of treating people as individuals. We saw some good practise in that information is available for staff to refer to on how to support people with their cultural beliefs. However offering staff training on Equality and Diversity could strengthen this further. This training could give staff a better understanding of people diverse needs and wishes. Staff should consider writing down small day to day concerns that people may raise. This could help to identify whether a concern is occurring which affects the lives of all people who live in the home. For example someone may complain that their cup of tea is cold. Staff may react by providing a fresh cup. However other people may complain of this also at other times, which could suggest that there is a problem, which needs addressing rather than a one off incidentWe found that generally staff manage people`s medications safely however this could be strengthened by ensuring two staff are involved in the task of disposing of any unwanted medicines. This could reduce the risk of medications being mismanaged. CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hillside Nursing Home Hillside Avenue Huyton Knowsley Merseyside L36 8DU Lead Inspector Mrs Joanne Revie Unannounced Inspection 09:30 9 September 2008 th X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillside Nursing Home Address Hillside Avenue Huyton Knowsley Merseyside L36 8DU 0151 4430271 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) wallacma@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd vacant post Care Home 119 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (39), of places Physical disability (20) Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The home is registered for a maximum of 119 service users to include: Up to 30 service users in the category of DE(E) (Dementia over 65 years of age) in Elm Wing. The 2 respite beds on the PD unit have an age range of 18 to 55 years, inclusive. The PD unit provides care and support to a maximum of 3 service users with alcohol problems. Service users out of category by reason of age, 2 service users on Ash unit, 3 service users on Elm unit and 2 service users on Rowan unit. One named service user with MI on Ash Wing Date of last inspection 18th September 2007 Brief Description of the Service: The home is registered to provide care to 119 people. It is divided into five units as follows: Elm unit provides personal care to older people who have dementia. Ash unit provides nursing care to older people who have dementia. Rowan unit provides nursing care to older people Cedar Unit provides nursing care for younger people who have a physical disability. The fifth unit was empty and was not being used on the day that we visited. Each unit has their own lounge, recreation and dining area. The home is surrounded by gardens, which people can access easily. The home is situated close to Huyton village. The home is owned by BUPA and Ms Marian Wallace is the registered manager. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes We had not told the manager of the home that the visit was going to take place. Prior to the visit the manager was asked to complete a document called an AQAA. This document provides information on the services strengths and weaknesses and any future plans to develop the home. We found that the AQAA was completed to a very good standard and that it gave us lots of information about the home, the staff team and the standard of care and support that people could expect. We also sent out surveys to people who live at the home, and the staff team. We received 7 surveys from these groups, which were all complimentary about the ability of the service to meet people’s needs. We spent two days at the home (in total 14 hours) talking to the people who live there, and their visitors and the staff. Time was also spent reviewing a variety of records. We observed a mealtime, activities and how staff interact with people. Comments from the discussions held have been included in the summary section of this report. In total, discussions were held with ten people who live at the home four visitors, and eight members of staff. The records that we looked at related to people’s care, how risk was managed, the service provided by the home and how people’s health and safety was promoted. We looked at the environment and how the service maintains this. We also looked at staff personnel files as well as any training they had had. We found that the home tries to promote people’s equality and diversity needs by treating people as individuals. Examples of this are highlighted within the report. The cost of living at the home ranges from £332.00 to £700.00 per week. What the service does well: Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 6 Each person receives a very thorough assessment before they decide whether they want to move into the home. This means that people get the opportunity to meet with senior staff and ask questions about what the home is like. It also means that staff are able to get a full picture of someone’s needs and how people would like to be supported. This means that staff can plan for their arrival. People told us that the home exceeded their expectations. Their comments included” everyone has been so kind- honestly, nothing is too much trouble”. Each person has an individualised set of up to date care records. This shows that staff understand the importance of treating people as individuals. This also means that staff have accurate instructions to look at, if they need to know how to provide care and support to people. One staff member told us “ I look at the old care plans that we used to use and I cringe- the ones we use now are so much better”. The home employs a team of activities staff. They are very enthusiastic about their role and understand that not every one can take part or wishes to take part in-group activities. These people are offered individual support depending on what they would like to do. People who live in the home are supported to contribute to local charities which is very good practice as it can help people to feel valued and worthwhile. People told us “ I like the party nights – they’re good fun” and “ they know I like doing crosswords and they (activities staff) get them for me”. A range of home cooked food is provided according to what people would like to eat and when. This was beautifully presented and staff supported people to eat in a way, which respected their dignity. People told us “ the food is excellent” and “ its marvellous- I don’t think a hotel could do better”. Staff understand how to support people to complain if they are unhappy and people trust staff to act on any concerns and protect their rights. People told us “ I’d trust them to do anything for me they’re a good bunch”. A competent management team manages the home. Staff find them supportive and approachable. Systems are in place to make sure that people are getting the support and care that they need and want. This includes making sure that any risks, which may affect their health, and safety is identified and acted on. People told us that they thought the home is well managed by saying” it runs like a well oiled machine- no complaints from me”. People and staff are consulted about the service. Staff take pride in the home and people who live there feel involved. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: We found that staff understand the importance of treating people as individuals. We saw some good practise in that information is available for staff to refer to on how to support people with their cultural beliefs. However offering staff training on Equality and Diversity could strengthen this further. This training could give staff a better understanding of people diverse needs and wishes. Staff should consider writing down small day to day concerns that people may raise. This could help to identify whether a concern is occurring which affects the lives of all people who live in the home. For example someone may complain that their cup of tea is cold. Staff may react by providing a fresh cup. However other people may complain of this also at other times, which could suggest that there is a problem, which needs addressing rather than a one off incident. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 8 We found that generally staff manage people’s medications safely however this could be strengthened by ensuring two staff are involved in the task of disposing of any unwanted medicines. This could reduce the risk of medications being mismanaged. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Older People, 2 Adults 18-65 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff carry out very thorough assessments so they can plan for peoples needs. EVIDENCE: We looked at the AQAA; four peoples care records and had discussions with two staff and two people who had recently moved into the home. We also had discussions with the relatives of one person who had recently moved in. We saw that staff complete a very comprehensive assessment before people move in so that a joint decision can be reached about whether Hillside is the Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 11 right place for them and so that staff can plan for their arrival. This includes finding out about people’s future expectations and their likes and dislikes as well as their needs and abilities. This means that care and support can be offered in a way, which pleases them. This is very good practise. We also saw that time is taken to find out how people would like to be supported. Relatives told us that the care and support offered by staff had exceeded their expectations and that they believed that the staff were “ really lovely people”. People who live in the home told us that “ They explained everything- Nothing was too much trouble” and “ Yes they gave me a brochure which told me about the home before I moved in. My daughter came and looked round and chose my bedroom for me”. We saw that the records that staff use to assess someone’s needs have been improved to include details such as whether someone has an advocate or has a representative to help them make decisions. This is very good practise and shows that the organisation has familiarised themselves with recent changes in the law which affect peoples rights Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Older People, 6,9,16,18,19,20 Adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive the care and support that they need in a way that they would wish to receive it. EVIDENCE: Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 13 We looked at the AQAA and the care records of people who live in the home. We had discussions with people about the care that they receive and spoke to staff about the care that they deliver. We also discussed this topic with some relatives who were visiting the home. We saw that individual care plans are in place for all of the people living at Hillside. These contained information about the support and needs people have with regards to their personal and health care. We saw that these records were written using a “person centred” approach. For example one care plan stated that the person preferred a cup of tea before getting dressed but preferred to eat their breakfast after getting dressed, and that someone else preferred morning tea rather than morning coffee. This is good practise. It shows a commitment from the home to try to provide care and support in a way that people would like and also shows that the home tries to support people to continue with their usual daily routines. This also helps to show that the staff at the home treat people as individuals. We saw that plans are written with the involvement of the person and (if appropriate) their relatives. We also saw that the plans are reviewed regularly. People and relatives confirmed this during our discussions. This shows that people are consulted and involved in the planning of their care. This is good practice as its helps to empower people and by encouraging them to feel in charge of their lives. We found that the level of information recorded in peoples care plans along with the regular reviews helped to ensure that staff are aware of how to support people well. Records showed us that people receive support from the staff team to access other health care professionals such as their GP, the Optician and Physio. This was confirmed in discussions with some of the people living there. One person explained that staff liaised with the hospital for them and keep them fully informed about what was happening with regards to their health care. A relative told us that they were very impressed with the speed and support staff had provided to ensure her relative had a hearing aid. The relative explained that this was vital to her as her old one had been lost during a recent stay in hospital. We saw that some people who live at Hillside need a great deal of support with some of their health care needs. For example we met with one person who spends a great deal of time in bed due to their health needs. We saw that this person was cared for correctly and that staff acted quickly by contacting their GP etc when their health care needs changed. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 14 We found that staff understand and have the skills to manage wound care. Senior management closely monitor any wounds that do occur to ensure staff are managing wound care effectively. This is very good practise. We saw that people are provided with equipment, which is appropriate to their needs. For example staff had completed a thorough assessment for one person, which identified that they were at risk of falling out of bed. Bedrails had been provided that had been fitted with padding to reduce the risk of the person becoming trapped and to promote their comfort. We saw that this person had also been provided with a pressure-relieving mattress to reduce the risk of pressure sores occurring. This person told us that they were “ very comfortable “ and that “ the staff look after me well- they do a good job here”. People living at Hillside also told us that they are able to receive support with their personal care when they need it and that staff respond quickly if they use their call buzzer to request help. When we visited the home and met with people living there it was evident that they do receive support on a regular basis to look after their personal care and appearance. Some of the people living at Hillside receive support from the staff team to manage their own medication. This is carried out following a risk assessment of the person’s ability to do this safely. One of the people living there told us that they have a locked drawer to keep their medication safe and explained, “I am pleased to have the chance to look after myself. I am made up with that”. We looked at how staff manage medication for other people who live in the home. We found that generally medications are managed safely with regular checks occurring by senior management to make sure people are receiving their medication, as they should. This is very good practise. We did find that some improvements could be made to how staff manage medication that is no longer required. We saw that staff are keeping a record of any medication, which requires disposal but this task should be completed by two staff rather than one to reduce the risk of medications being mismanaged. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Older People, 12,13,15,17 Adults 18-65 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are provided with activities and a variety of home cooked food, which they enjoy EVIDENCE: Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 16 We looked at the AQAA, which told us that improvements had been made to the activities that are provided for people who live at Hillside and we found this to be true. We found that Hillside employs five activity staff who work Monday to Friday across all the units within the home. They support the people living there by organising outings, providing in house activities and providing individual support for those people who need it. We looked at records, which showed us that people get the opportunity to go on outings to local places. We saw that recent outings have included going on the Ferry and visiting a wildlife centre. We also saw that In house entertainments in the form of singers, 60’s nights etc have also occurred recently. We found that on a day-to-day basis the people living at Hillside have the opportunity to join a number of clubs or activities. These include bingo, film clubs, gardening clubs and knitting clubs. During our visit we observed staff supporting people with fun exercises and also sitting with people having day-to-day conversation. People told us that they enjoyed the activities offered and comments included “ there’s always something going on” and “ I really enjoy the quizzes” In discussions with activity staff we found that they had a clear understanding of peoples individual choices and needs and were able to explain how they meet these. For example records showed that they provide crosswords for one person and sit with another person providing hand massages and sensory experiences. This personal approach to supporting people with their everyday lives helps to ensure that those living at Hillside can retain their interests and also take part in new activities if they wish to do so. We saw that Hillside promotes involvement in the local community in a number of ways. This includes promoting links with local schools and pensioners groups and taking part in fundraising events. This is very good practise as it helps people who live at Hillside to feel valued by contributing towards other people’s needs. These links also help to ensure that the people living at Hillside are not isolated from the world around them. We discussed how people are supported to practice their religious beliefs. We found that Catholic services are held in the home regularly and activity staff explained to us that if anyone wishes to see a minister of any faith they will do their best to arrange this. Everyone we spoke with told us that they liked the meals provided at Hillside and that they are always offered a choice. “ People told us “ the food is greatYes, I can have whatever I want- I had a bacon buttie this morning”. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 17 We observed part of the lunchtime meal on one unit and noted that meals are beautifully presented, tables nicely laid and discrete support provided by staff when needed. This approach to meals helps to ensure that meals are a sociable occasion that people can enjoy. We also observed another meal time on the Dementia care nursing unit and saw that staff provided support and care with dignity and encouragement. People were offered choices and in general the atmosphere was relaxed and pleasant. We had discussions with the Head Chef. It was very clear that he had a good understanding of people’s individual choices as well as their dietary needs. We found that specialist diets are catered for and individual choices are met. In addition the chef has an understanding of different diets that may be requested in the future. These include those based on religious or personal beliefs. We saw that the organisation had provided a guide on how to cater for and prepare different diets, which match different cultural beliefs. This is very good practise. We saw that there were sufficient supplies of food in the home and that people were provided with adapted crockery and cutlery if they needed it. This means that people are provided with equipment to feed themselves independently which can help to promote their self-esteem. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Older People, 22,23 Adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident that their concerns will be listened to EVIDENCE: We looked at the AQAA and the survey that someone had sent us. This told us that people who live in the home knew how to complain if they needed to. We spoke with other people who live at Hillside and they also held this opinion. People also told us that they “ trust the staff to sort it out” if they were unhappy. We looked at the information that we held about the service and we saw that since we last visited no one has made any complaints to us. We also looked at records that the manager keeps of any concerns or complaints that people may have. These showed us that the manager takes peoples complaints seriously and that she investigates and tries to resolve any issues. Staff told us that they pass all complaints to the manager. We discussed this with the manager at the end of our visit and suggested that ways of recording Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 19 people’s small day-to-day concerns should be explored. Recording small concerns would mean that a record would exist which the manager could look at. This would help the manager to resolve any concerns quickly and reduce the risk further of someone who lives in the home becoming unhappy. When we read the AQAA we saw that staff had been reminded regularly of how to protect people’s rights. We looked at the information that we had and saw that three safeguarding situations had happened since we visited. Safeguarding situations are incidents were it is suspected that a person’s rights may have been abused in some way. We saw that in all instances the manager had taken the right action by informing the local social services departments of her concerns. We also saw that were necessary, disciplinary action had been taken against staff. We discussed safeguarding situations with senior staff in the home. They were able to tell us the action they had taken once they suspected someone’s rights had been abused. We looked at staff training records, which showed us that all staff have had training on how to protect people from abuse. These records also showed us that senior staff have had training on how to, and who to inform should they suspect that someone has been abused in some way. All of this information helps to show that staff and management at the home have the skills to protect and support people rights. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Older People, 24,30 Adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean home, which has been adapted to meet their needs. EVIDENCE: We looked at the AQAA and walked around the home. We saw that significant Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 21 improvements have been made since we last visited. These improvements have included building two sensory gardens for people to use. We looked at these and saw that a lot of consideration had been given to the needs of the people who were to use the gardens. For example the younger adults garden has been equipped with decking and bar-b-que which would suit the needs of younger people who use wheelchairs. The other garden has been adapted to provide a relaxing walk with seating along the way. The people who live in the dementia care units of the home use this second garden. This is very good practise and shows an understanding of peoples needs and lifestyles. We saw that one of the dementia care units had been altered to include a Café style room. This means that people who live on the unit have an area were they could entertain visitors and feel as though they have visited a café with them. This unit has also benefited from one corridor being redecorated in a “ memory lane “ style. This means that the corridor has been adapted so that it now gives the impression of walking down a street. Bedroom doors have been painted and furnished with doorknockers so that they resemble front doors. This reflects very good practise and shows a further understanding of people’s needs that live on this unit. The manager explained during feed back that plans are being developed to continue to improve this unit and also to adapt the other dementia care unit so that the environment is more suitable for people with memory problems. During our visit we also saw that Hillside provides a number of aids and adaptations to support people with their personal care and in getting about more easily. For example doorways on Cedar unit are wider than the normal width to enable easier access for people who use wheelchairs. Similarly light switches in a kitchen currently being built on Cedar are lower to enable people to reach them more easily. We also saw that there are a number of adapted baths and showers around the home that enable people to use them independently or with support if needed. We saw that some parts of the home are looking ‘tired’ and are in need of redecoration however staff are aware of this. A recent newsletter sent to the people living at Hillside explained that there are plans to decorate some bathrooms and asked for their opinions on planning the décor. We had a discussion with one member of staff who showed us a record of the choices of schemes that people who live at the home had chosen. This is good practise as it shows that people are encouraged to feel as though the home is “ their own”. We saw that everyone living at Hillside has their own bedroom, which all have ensuite toilets and wash hand basins. We saw that people are able to personalise their rooms and bring some of their furniture with them if they choose to do so. We visited one person who had Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 22 adapted their room so that it contained armchairs and a fridge. This gave the impression that it was more like a bed-sit than a bedroom. We saw that suitable equipment and facilities are provided to enable staff to prevent or quickly deal with any outbreak of infection that may occur. This includes ensuring correct hand washing facilities are available and a laundry room with facilities suited to dealing with everybody’s washing on a daily basis. When we looked as staff training records we saw that staff have had training on how to prevent infection spreading. We also saw that a dedicated team of domestic staff are available on a daily basis to keep the home clean. We saw that all areas that we visited appeared clean and tidy and smelt pleasant. People who live in the home told us that they thought the domestic staff worked” very hard” and that “ you can see that they take a pride in their work”. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Older People, 32,34,35 Adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care and support from staff that they like and who have the skills to support them correctly EVIDENCE: We had discussions with staff, which showed us that they all had a clear understanding of their role in supporting the people who live at the home. Staff were able to explain both the support that people needed and the way in which people prefer to live their lives. The people living at Hillside told us that they like the staff team and that they always get the help and support they want quickly. One person told us that Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 24 they had come to the home on a temporary basis but had decided to stay once they had realised that the staff were “ so kind and genuine”. We watched the staff at work on the various units, which we visited. Whist they appeared busy they did not appear rushed. When we met with staff we found that they were enthusiastic about their roles and motivated to continue to improve the service they offer. We looked at records which showed us which staff were available and when. We found that the units are staffed consistently and staff told us that they try to cover for each other when someone is off sick or on holiday rather than using agency staff. This means that people are more likely to receive care and support from staff that they know. We looked at records, which showed us that before anyone starts work at Hillside a series of checks are carried out to make sure that new staff are suitable to work with people who may be vulnerable. These checks include obtaining written references from past employers and carrying out Police Checks (CRB). We looked at the training that staff receive to enable them to carry out their work. We saw that an extensive training programme is in place, which covers basic essential training such as how to keep people safe but also covers some speciality topics. In particular staff have had training in the recent changes in the Mental Health Capacity Act and guidelines on the “ deprivation of liberties”. This means that staff have an understanding of how to support people to make decisions, which may affect their lives. This is very good practise. As mentioned previously, we saw that staff had a good understanding of how to treat people as individuals by using “ person centre planning” when developing peoples care records. Offering staff training on Equality and Diversity so that they have a good understanding pf people’s religious and cultural beliefs could develop this further. We saw that the qualified nurses are supported to keep their nursing skills up to date by attending refresher training in various topics. Staff told us that they thought the training offered was” excellent” and “ we’ve got training coming out of our ears! - There’s loads of it”. When we read the AQAA we saw that some senior staff have been trained to deliver training on key subjects to other staff in the home. This is very good practise as its means staff can always access training if refreshers or if staff who have just started work need training. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 331,33,35,38 Older People, 37,39,42 Adults 18-65 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well managed, safe home Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 26 EVIDENCE: We looked at the AQQA and the information that we have about the service. We know that the manager is registered with us which means a series of checks have been carried out to make sure that she is suitable to manage the home. Hillside has had several different managers in the past few years. However the current manager and the deputy manager have been there for just over a year and have made very positive changes in that time. Staff we spoke with were positive about their input and described the manager as “fair but firm”. They also said that the manager listens to their opinion but is “all for the residents”. Staff also told us that they believed that polices and procedures which are available in the home are very clear and cover” everything”. One member of staff said” the policies are fantastic and if you’re not sure “managers name” and “ assistant managers name” are always available to help- they’re great”. This clear leadership helps to ensure that staff feel supported and motivated about their role and also helps to ensure the people living at Hillside receive a good service. A member of staff who has worked at the home for a number of years (previous to the present organisation owning it) told us “There’s been loads of managers since I worked here and a lot of change but this manager’s a superstar” People who live at the home told us that they trusted the manager to solve any concerns that they had. One person said “ she’s very busy but you still see her out and about in the home”. We saw throughout our visit that a number of checks are carried out by senior management such as checking medication procedures, checking care plans are updated, checking accidents levels and checking whether wounds are healing. This is good practise and shows that management monitor whether people are receiving the correct care and support. When we looked at the AQAA we saw that the manager had introduced regular residents and staff meetings. We found this to be true. This is good practise as its gives everybody the opportunity to feel involved in the home. We saw that as well as meetings, people who live at the home are asked their opinion through the use of surveys. This happens every year. We viewed the results of the last survey and found that this showed that people believed that 100 of staff treat you as an individual. 100 was also achieved for activities, and 100 achieved for management of the service. This shows that Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 27 people believe that they are living in a well managed home and that they receive individualised support. We saw that improvements have been made to how people are supported to manage their money. We saw that monies are managed safely and that clear records exist for all transactions. We also saw that people were receiving a variety of support according to their individual needs and wishes. We looked at how the manager ensures that people live in a safe home. We saw that a number of checks are carried out by the maintenance officer on a regular basis to ensure that people remain safe. Staff training records showed us that staff have had training in subjects, which support this, such as fire safety, safe moving and handling, preventing infection occurring, and promoting Health and safety. We saw that regular audits are carried by the organisation to ensure that checks are happening regularly which is very good practise. We also saw further evidence of good practise when we looked at how staff manage people’s medications. Staff administer medications from a trolley, which they take to each persons room. Whilst doing this we saw that staff will also check that fire-fighting equipment is working correctly and that fire exits are clear of any obstruction. This shows a serious commitment to keeping people safe. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 4 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 x 33 3 34 x 35 3 36 x 37 x 38 4 Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 YA20 OP30 YA32 Good Practice Recommendations Two staff should carry out the task of disposing unwanted medication. This could reduce the risk of medications being mismanaged. Staff should receive training on people’s equality and diversity needs. This could build on the skills that staff already have in relation to treating people as individuals. 2 Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Hillside Nursing Home DS0000069142.V362772.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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