Hillcroft Nursing Home Carnforth

We found the following examples of good practice.

The provider and registered manager had utilised available covid funding to create visiting pods which helped maintain regular visits for people during the COVID-19 pandemic. A visiting co-ordinator helped ensure all visitors adhered to the providers visiting policies. Visiting arrangements included a variety of options determined by the current government guidelines and individual risk assessments. This helped ensure visiting opportunities were maximised.

The provider and registered manager ensured information and guidance was understood and embedded across the different homes in the group. This helped ensure all staff were up to date with guidance and good practice.

The registered manager had worked closely with health providers through Care Home Support to maintain quality health care for people living in the home. This included using technology to maintain regular consultations with the GP practice.

Staff had maintained safe and effective infection prevention and control practices. There were enhanced cleaning routines, which were thorough, and helped minimise the risk of infection.

Rating at last inspection.

At our last inspection we rated the home good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service Good. We found the registered provider continued to provide a good standard of care to people who lived at the home.

Why the service is rated Good

At this inspection we found the registered provider had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service.

Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the Care Quality Commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner. One person commented, “There is more than enough [staff].”

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and training appropriate to their roles.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and saw the home was clean and a safe place for people to live. We found equipment had been serviced and maintained as required. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

Medicine records provided staff with a good understanding about specific support needs of each person who lived at Hillcroft Carnforth. We noted people had access to healthcare professionals and received ongoing healthcare support when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems supported this practice.

People told us they had plenty of food and drink with the option of additional snacks and drinks between meals. One person told us, “If you did not like what was on the menu, they would bring you something else.”

We observed only positive interactions between staff and people who lived at Hillcroft Carnforth. We observed humour used to foster positive relationships. There was a culture of promoting dignity and respect towards people. We saw staff spent time with people as they completed routine tasks. One person told us, “They [staff] are very kind, all of them.” One relative stated, “[Family member’s] quality of life has improved since he came here.”

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service delivered. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the care provided.

People were supported with activities and social interaction but the registered provider also respected people’s right to not participate and engage in activities.

The registered provider offered people dignified end of life support that extended after their passing. People preferences related to end of life care were recorded and respected.

Further information is in the detailed findings below.

Hillcroft Carnforth is one of six nursing homes managed by Hillcroft Nursing Homes Limited. The home provides accommodation for up to 64 people in three separate units, catering respectively for people with general nursing needs, dementia and challenging behaviour. The home is situated in the town of Carnforth and close to community facilities. At the time of our inspection there were 59 people living at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 24 April 2014, we found the provider was meeting the requirements of the regulations that were inspected.

During this inspection, staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had recruitment and selection procedures in place to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

Staff responsible for administering medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Comments we received demonstrated people were satisfied with their care. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

A complaints procedure was available and people we spoke with said they knew how to complain. Staff spoken with felt the registered manager was accessible, supportive, approachable, and had listened and acted on concerns raised.

The registered manager had sought feedback from people who lived at the home and staff. They had formally consulted with people they supported and their relatives for input on how the service could continually improve. The provider had regularly completed a range of audits to maintain people’s safety and welfare.

During our inspection we looked at the way people were cared for and supported, nutrition, staff recruitment, the safety and suitability of equipment and quality monitoring systems. We spoke individually with a number of people living at the home, six relatives, and members of the staff team. Care practices were also observed throughout the inspection.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

We saw that people were treated with respect and dignity by the staff team. People told us they felt the home was safe and secure. People were cared for in an environment that was safe, clean and hygienic. Equipment in the home had been well maintained and serviced.

The senior management team were reviewing policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). This was in response to recent national events and was being reviewed in conjunction with supervisory bodies in Lancashire and Cumbria, who were the home's major commissioners. Reviewing this policy would strengthen the processes in place to protect people living at the home and ensure that practices were up to date.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that unsafe practices were identified and that people were protected.

A monthly medication audit was in place. This helped to ensure medication practices remained safe, by ensuring any shortfall was quickly identified and addressed.

Is the service effective?

People told us they were pleased with the level of care being provided to them and to their relatives. We saw there was a good understanding of each person's assessed needs and personal preferences were accommodated. One person told us, 'My mother's been much better since she moved here. She used to sleep all day'. Another said 'We have seen a massive difference, she is much more alert'.

People's health and care needs had been assessed with professional help and in consultation with relatives. Most people were unable to participate in writing their plans of care because of their conditions. Specialist assessments of nutrition, behaviour, dietary, mobility and equipment needs had been identified in care plans as required.

The relatives we spoke with also said they had good communication with the staff team and were always informed of any changes or concerns. One said 'If I went and asked them for a boiled egg for my Mum right now, I know they would get one. They are always helpful and kind'.

Is the service caring?

We saw people were supported by kind and sensitive staff. Staff were attentive to people's needs and showed patience and encouragement when supporting them. We saw that staff were engaged in a number of activities with residents in addition to offering personal care. These included reading a memory book, looking at a newspaper and taking someone for a short walk outside. A pamper session with hand massage was planned on the challenging behaviour unit on the day we inspected. We knew this because the day's activities and menus were prominently displayed on a large white board.

People's preferences, interests and individual needs had been recorded along with the actions required to ensure these were met. This helped to make sure people were provided with an individualised service that met their specific requirements.

Is the service responsive?

Visitors we met told us they felt listened to and staff were attentive to the needs and wishes of residents. We saw that breakfasts were available at times residents wanted to eat, and they included a wide choice from full English fry ups to toast or porridge. We saw staff were encouraging people to eat, and giving them time to do so.

We saw residents were engaged in a range of activities. Individual preferences were recorded and used by the activities co-ordinator to tailor their likes and dislikes into daily activities.

The home had a complaints procedure in place. Visitors we spoke with knew how to make a complaint if they were unhappy. However they all said that the management was approachable and someone was always there if there were any concerns or questions.

Is the service well-led?

Hillcroft North Road is one of six homes managed by Hillcroft Limited. The provider conducts regular audits of all its homes on a planned basis. These quality assurance systems helped to ensure the quality of the service was continually monitored.

Staff at Hillcroft North Road were clear about their roles and responsibility and said they were well supported by colleagues and the management team.

We saw internal audits had picked up a slippage in supervisions earlier in the year, and that this had been rectified as a result. Staff confirmed good supervision arrangements were in place.

A range of routine audits were in place including medication, accidents, health and safety, risk assessments and fire safety. We saw that any issues identified during these audits were addressed. This helped to ensure a consistent service was maintained that helped to protect people and keep them safe.

Care plans were comprehensive and up to date. Staff were attentive to people's needs and the visitor we spoke with praised the welcome received in the home. Although there were few social activities on the day we visited, the provider had responded to relatives' expressed concerns about this issue. An activities co-ordinator was now employed four days a week, meaning more activities could be planned. We saw that staff were well trained and that supervision was becoming embedded as part of the culture. We saw that the home was clean and that infection prevention and control were managed well.

We saw that the provider had an effective system of auditing to ensure standards were maintained. The provider was open to external advice, and had responded positively to contract visits and inspections. The home had an effective system for managing and responding to complaints.