27 and 28 May 2015
During a routine inspection
Hillbro Nursing Home provides accommodation and nursing care for up to 42 older people at any one time in accommodation spread over 3 floors. On the dates of the inspection, 27 and 28 May 2015, 41 people were living in the service. The inspection was unannounced. At the last inspection in May 2014 the home was compliant with all the standards we looked at.
People and their relatives told us they felt safe in the home and comfortable in the company of staff. Staff we spoke with had a good understanding of safeguarding and how to identify and act on any concerns. They said the manager would take concerns seriously and fully investigate. Safeguarding procedures were in place and we saw evidence these were followed to help keep people safe.
The premises was appropriately managed with a range of communal space available and a sensory garden where people could spend time. Some areas of the building required updating, the provider told us they had a plan in place to refurbish remaining areas.
Medicines were not consistently well managed. Although we found people received their prescribed medicines, some people were not receiving their medicines at the time they needed them. Record keeping in regards to the application of topical medicines was not consistently completed. Appropriate arrangements were in place to record and check stocks of medicines.
People and their relatives and staff told us they thought staffing levels were sufficient. Although we found staffing levels were safe during the morning and early afternoon, staffing was much reduced during the evening and overnight and we concluded it was not sufficient to enable consistently safe care. We saw there was a trend for increased falls in the evening and some overnight care tasks were not always completed as frequently as required which indicated insufficient staff at these times.
Appropriate recruitment procedures were in place and we saw evidence these were followed to ensure staff were suitable for the role.
People and their relatives told us staff displayed a high level of skill and knowledge. Staff were provided with regular training and development. Staff demonstrated a good level of knowledge about the topics we asked them about which indicated training arrangements were effective. Training updates were overdue in some subjects such as fire which the registered manager agreed to address as a matter of priority.
We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and the service was acting within the requirements of the Mental Capacity Act (MCA).
People and their relatives told us the quality of care provided by the home was excellent and staff we spoke with demonstrated a good knowledge of people’s care needs and how to meet them. People’s needs were assessed on admission and covered a range of areas to ensure staff delivered appropriate care. However we found that following changes in people’s needs amendments to plans of care were not consistently taking place.
A varied range of activities was provided by the activities co-ordinator which included trips out into the community. People and their relatives praised the activities co-ordinator and said they were friendly and dedicated to the role.
An effective complaints system was in place. Feedback from people and their relatives showed a high level of satisfaction with the service.
People and their relatives praised the management of the home and said they provided a high quality service.
A range of audits were undertaken. However these were not always sufficiently robust to fully assess and monitor the quality of the service. Checks and audits should have identified and resolved the issues we identified with regards to medication, training and care records.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.