Archived: Hillscourt Nursing Home

However, we also saw areas of care where improvements had not been made. For example one person had experienced repeated trauma and skin damage and the areas that were at risk of trauma had not being adequately protected or attended to.

Some people had areas on their bodies that showed signs of early pressure damage. Risk assessments and plans of care to address these risks and needs had not been put in place. Nurses identified to us that this damage may be due to staffing arrangements. These arrangements had resulted in people who had been assessed as requiring two members of care staff to attend to their hygiene needs being cared for by one member of staff.

There had been a delay of three days between staff identifying that one person might have an infection and them taking action to obtain treatment for this.

People were not routinely taken to the toilet to have their hygiene needs met unless they asked for this, and we saw one person who became soaked in urine.

People sat on their own for very long periods of time without engagement or activity. People were routinely described as 'the feeds' or 'bed patients'.

Mealtimes were very busy with the majority of people requiring support from staff to eat. We saw two care staff trying to support all these people, some of whom we were told can take up to 40 minutes to finish a meal. People had been weighed but where weight loss was noted actions were not always taken to identify the reasons for this and plans of care had not always been changed to address the risks identified.

Records kept show that people have enough to drink and visitors to the home say that this area of care has improved. Where people had been identified as being at risk of choking, referrals had been made to the speech and language therapist and we saw that the actions they had recommended have been followed.

People's medicines were poorly managed. For example, one person had not received a prescribed medicine for eight days. Staff we spoke with were not sure why this was. Records relating to medicines kept in the home could not be reconciled with the medicines actually kept. This meant that medicines were open to misuse. Prescribed creams were not dated when opened and this meant that they could be used beyond their use by date.

Record keeping relating to care planning, nutrition and medicines were sometimes confused, contradictory or difficult to access and understand.

The internal quality monitoring systems in this home have not been sufficient to identify the above issues or to address the risks to people's health and welfare.

Some visitors told us that although they think the staff are 'lovely' and 'very good' that they are less than confident that their relative's needs are met when they are not there. They say staff are busy due to the high turnover of people living here.

Records which are intended to give directions to staff about how to meet needs and which should be used to evaluate the effectiveness of care are sometimes incomplete and disorganised making them difficult to understand. Records in general are not robust. The registered provider has recognised this and has purchased a new record keeping system and is providing training on how to use this.

Two people living here have developed pressure sores, one of these people has more than one pressure sore. Staff are not aware that the tool they are using to assess risk has associated recommendations to manage the risk and are therefore not using these. Records show that measures to prevent sores developing were not put in place as promptly as they should have been. Staff are not always following the plan of care about how to prevent pressure sores.

Staff are sometimes using inappropriate lifting techniques which means that people's risk of developing pressure sores may be increased, and may cause discomfort for those people.

Some people who are at risk of dehydration or malnutrition or choking are not always having those risks adequately managed. For example, the records of one person show that on some days they had less than 500mls to drink in a day. Some relatives are concerned that some people are not being adequately supported to eat and drink. We saw one person being supported to eat in a way that increased their risk of choking.

People told us that they get their medicines on time and that they believe these are the right medicines. A relative told us that regular pain killers are given and that these are given in a form that suits this person. Medicines are stored securely and those medicines that need refrigeration are stored at the correct temperature.

Some staff are hand transcribing some records and that these are not being checked for accuracy by a second person. There is no medicines audit system in place and we found some discrepancies between what records say should be in stock and what is in stock. Creams which should be prescribed are being used without a prescription.