Hilton Lodge Nursing Home Care Home Service Adults Court Street Haddington EH41 3AF Telephone:

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1 Hilton Lodge Nursing Home Care Home Service Adults Court Street Haddington EH41 3AF Telephone: Inspected by: Carol Moss Type of inspection: Unannounced Inspection completed on: 1 February 2013

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 11 4 Other information 25 5 Summary of grades 26 6 Inspection and grading history 26 Service provided by: The Stewart Partnership, Trading as Hilton Lodge Private Nursing Home Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Carol Moss Telephone enquiries@careinspectorate.com Hilton Lodge Nursing Home, page 2 of 28

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 6 Excellent Quality of Environment 5 Very Good Quality of Staffing 6 Excellent Quality of Management and Leadership 6 Excellent What the service does well Hilton Lodge Nursing Home continues to provide an excellent standard of care in a comfortable and well maintained home. Staff are well trained, knowledgeable and focused on ensuring that each resident receives a high quality service that meets their individual needs. The service is committed to continuous improvement and achieves this through the robust use of an effective quality management system. What the service could do better The service recognises the importance of listening and responding to the views of people who use the service. They also recognise that this is an ongoing process that they intend to continue. This, combined with regular reviews and updating of their quality management system, will enable further developments and maintenance of a high quality service. What the service has done since the last inspection The management team and staff have worked very hard to ensure that the service continues to comply with current legislation and good practice guidance. Hilton Lodge Nursing Home, page 3 of 28

4 They have used effective monitoring of all aspects of the service to identify and respond promptly to areas that need to improve. This has included ongoing refurbishment of the home. Conclusion Hilton Lodge Nursing Home continues to meet it's stated aim of providing a safe, healthy, comfortable home environment in which to enhance the quality of life of their residents. Management and staff are approachable, knowledgeable and responsive. The service constantly looks for ways to build upon and improve their provision. Who did this inspection Carol Moss Hilton Lodge Nursing Home, page 4 of 28

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it needs to do more to improve, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. - A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Hilton Lodge Nursing Home is a care home for older people situated in a residential area of Haddington. It is close to local transport, shops and local amenities. It is registered to provide care and accommodation for 20 older people. At this inspection there were 19 residents in the home. It is owned and managed by The Stewart Partnership. Accommodation is provided on a ground and first floor. Stairs and lifts provide access to the upper floor. There are 20 single bedrooms with the majority of these having ensuite facilities. There are additional bathing facilities that can cater for residents with limited mobility. There is a communal sitting room and dining room/sunroom, as well as additional seating in the reception/entrance area. There is a well maintained garden which includes an enclosed dementia friendly garden for people using the service to enjoy. The service states that it's aim is to "provide a safe, healthy, comfortable home environment in which to enhance the quality of life of our residents". Based on the findings of this inspection this service has been awarded the following grades: Hilton Lodge Nursing Home, page 5 of 28

6 Quality of Care and Support - Grade 6 - Excellent Quality of Environment - Grade 5 - Very Good Quality of Staffing - Grade 6 - Excellent Quality of Management and Leadership - Grade 6 - Excellent Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Hilton Lodge Nursing Home, page 6 of 28

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report after we made two inspection visits to the service. We made an unannounced inspection visit on Wednesday 30 January 2013, between 10am and 4.50pm. An announced visit was made on Friday 1 February 2013, between 8.30am and 2.15pm, to obtain further evidence and to feedback to the service's registered manager. The inspection was carried out by Inspector Carol Moss. As part of the inspection, we took account of the completed annual return and self assessment that we had asked the provider to complete and submit to us. During the inspection we gathered evidence from a number of sources. We looked at a range of documentation, including the following: Certificate of Registration Public Liability Insurance Certificate Minutes of residents' committee meetings Minutes of management review meetings The home's newsletter Accident and incident records Activities programme Residents' personal plans Residents' medication administration records Repairs log and maintenance records Staff records Training plan Staff handbook Duty rotas Residents' dependency assessments Minutes of staff meetings. We spoke with residents, relatives and carers. We had discussions with a range of staff which included the manager, care staff and housekeeping staff. We looked round the accommodation and observed how staff worked. Hilton Lodge Nursing Home, page 7 of 28

8 Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection report continued Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Hilton Lodge Nursing Home, page 8 of 28

9 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the service. We were satisfied with the way this had been completed and with the relevant information they had given us for each of headings that we grade them under. Taking the views of people using the care service into account During our visits we spoke with residents in the communal areas of the home. Five residents were spoken with individually. All said that they were very satisfied with the quality of the service provided. They described the staff as being extremely helpful and kind. They thought the home was kept very clean and the food was of a high standard. Some of the residents were unable or only able to give limited verbal comments on the service due to their frailty and/or dementia. We spent time observing how staff interacted with these individuals. We saw that staff were gentle in their approach and respectful in their manner to residents. Residents appeared to be at ease around staff and we saw many smiles in response to the presence and/or assistance of a member of staff. Hilton Lodge Nursing Home, page 9 of 28

10 Taking carers' views into account At the start of our inspection year, April 2012, we had sent out twenty relatives and carers questionnaires. We received seven completed Care Standard questionnaires from relatives and carers of people who were using the service at that time. The returned questionnaires indicated high levels of satisfaction with the service. In response to the statement; "Overall, I am happy with the quality of care my relative/ friend receives at this home" all strongly agreed. Comments included: "I have nothing but praise for the care my mother receives" "The staff are kind and attentive" "The home is run for the benefit of the residents and their needs are given priority" "There are always many staff members on duty, smiling and cheery with residents and relatives/friends and all working well together as a team" "During frequent chats with my friends re. elderly parents and nursing homes I have always told them I would rate mum's ie. Hilton Lodge, at 110%" "I am delighted with the care mum has received" "Mum has not looked so healthy in years" "I would describe Hilton Lodge as the residents' home rather than a home" "Mum could not be better looked after, nothing is too much trouble for the staff" "Mother is beautifully cared for in the Hilton Lodge Nursing Home. This establishment offers an excellent prototype for good practice in every way". During the course of our inspection visits we spoke with three relatives/carers. All told us that they were very satisfied with the care and level of service that the staff in the home provided to their relative/friend. All were regular visitors to the home and confirmed that high standards of service were consistently maintained and that the level of communication with the staff on each visit was very good. Comments included: "An excellent home" "They're very good at keeping us up to date" "The home is always spotless" "No smells" "The quality of staff is very good" "Very accommodating and helpful." Two of the relatives/carers told us that they had looked round a number of care homes before choosing this one and remained very satisfied with the decision they had made in choosing Hilton Lodge. Hilton Lodge Nursing Home, page 10 of 28

11 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths There was robust and comprehensive evidence of regular residents, relatives and carers involvement using a range of methods. There was evidence that the service responded positively to the feedback it receives. The service continues to perform to an excellent level in the areas covered by this statement. Prospective service users were provided with clear information about the facilities and level of service that Hilton Lodge Nursing Home provides. A more detailed residents' handbook is provided to new residents which includes details about how the home is managed, who the staff are and their roles, as well as the level of service that they should expect to receive. Emphasis is placed on the service's flexibility with regard to personal routines and preferences. This makes people aware of the standards that residents should expect to receive and how the home meets these. Written information and pre-admission visits give residents and relatives/carers the opportunity to make a well informed decision about moving in. The entrance and reception area of the home was welcoming with information about the service and how to give feedback and share ideas. This information includes details of activities and entertainment, details of the service's complaints procedure, the service's newsletter and details of the management structure of the service. This supports people using the service to make suggestions or raise concerns. Hilton Lodge Nursing Home, page 11 of 28

12 Residents' personal plans evidenced that residents, relatives and carers were involved in developing the support plans and in the reviews of care which take place six monthly. We received very positive comments from relatives about how the staff kept them up to date with what was happening with their relative's care and with things that were going on in the home. Many of the residents had family or friends who could speak for them if they needed support. Staff were able to help residents to contact an advocacy service as and when needed. The development of life stories of residents provides a valuable resource for staff in enabling them to more fully understand the individual residents and help develop the care and support provided. As a small care home with a stable staff group, staff knew residents and many of their relatives/carers well. This helps to support good communication. We saw that staff spent time listening to residents and encouraging them to express their preferences. Staff know the residents well and were able to pick up on non verbal communication. The service continues to send out an annual quality questionnaire to professional visitors, residents and relatives/carers. This asks people to tell them what they thought about the home. The results were collated and are brought forward to the service's management and review meetings. We saw documented evidence of actions taken in response to a request. All of the people who commented in the last survey completed in July 2012 said that the home was excellent or very good. Minutes of the residents' committee meetings indicated that the group met regularly. The service also held social events throughout the year which helped staff get together informally with residents, their relatives and friends. They had found that this was effective in providing people with a relaxed and informal opportunity to talk about the home and the care. We found that the home listened to comments or suggestions made by residents and relatives/carers and made changes whenever it was possible. This has included activities and menu ideas. The service uses ISO 9001:(2008) which is a system of quality management. This system means that the service checks all its systems and policies regularly and is customer focused. An action plan was written on areas of improvement and these were time-scaled. An independent auditor checks that they are using this system correctly. A successful re-certification inspection was completed in September Hilton Lodge Nursing Home, page 12 of 28

13 Areas for improvement The service recognised that meeting this statement was an ongoing process. The service plans to continue to look at ways of involving residents and their relatives/ carers in improving the quality of care and support. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Hilton Lodge Nursing Home, page 13 of 28

14 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We graded this quality statement as 6 - excellent at the previous inspection. The service has maintained these high standards in this area and we awarded a grade of 6 -excellent at this inspection. We evidenced this through discussion with residents, relatives and staff as well as reviewing care records and observing staff practice. The residents, relatives and carers that we spoke with told us that they were very satisfied with the care being provided. The seven questionnaires returned to us indicated that they were all happy with the quality of care being provided. When we looked at residents' personal plans we found the files organised and the information in them easy to find. The plans of care gave details of the individual's needs and how staff should provide the care and support to meet these needs. These had been developed through the use of a comprehensive range of appropriate assessment tools. We saw that the care plans were regularly evaluated to see if the planned care was meeting the residents' needs. Where residents' care needs changed we found that the care plans had been updated to reflect these changes. The language used in the personal plans indicated a person centred approach to the planning of care. There was a team approach to providing care. An example of this was in the organised way the cook and kitchen staff worked together with the care staff to ensure residents' dietary needs and preferences were met. The personal plans evidenced that where appropriate residents, relatives and/or carers had been involved in reviews of care. The recent reviews indicated that people were very satisfied with how the service was meeting their or their relatives/friends health and wellbeing needs. The activities programme gave details of the week's activities. This included outings and gentle exercise groups. We were told by people using the service that there was regular musical entertainment and that they also enjoyed the various social events that took place. From observation and discussion with staff we also found that many of the residents were supported to take part in activities on a one to one basis. The very good staffing levels and the way care was organised allowed time for staff to do this. One to one activities seen at the time of inspection included going for a short walk into town, spending time in the garden, reading articles out from a newspaper and chatting with a resident in their room. Hilton Lodge Nursing Home, page 14 of 28

15 During the inspection we saw that residents looked well cared for and were dressed in appropriate clean and tidy clothing. We also saw that, where necessary, residents were wearing personal aids such as hearing aids and glasses. From speaking with and observing staff practice we concluded that staff were very knowledgeable about residents' personal likes and dislikes and how their care and support should be delivered. We learned through discussions with care staff and listening to the afternoon handover that positive links were in place with an appropriate range of healthcare professionals. Care staff use these effectively to support their work in meeting the needs of the residents. A GP visiting the service told us that they found the home to be a welcoming environment where staff were very responsive to advice about residents' care and quick to note changes in health. Staff were described as being organised and they had no concerns about the standards of care and support provided. We saw that accident and incident records were maintained in the home. We noted that the outcomes of accidents and incidents were fully recorded including any actions taken as a result of the accident or incident. The management team carry out regular checks to make sure that that staff followed expected practice. This includes use of audits and observation of staff practice. We saw records to show that these checks are done regularly and any identified areas for improvement are followed up. We saw that the service regularly reviews their policies and procedures so that they continue to follow current legislation and best practice guidance. Areas for improvement We discussed the Care Inspectorate's good practice document "Guidance about medication, personal plans, review, monitoring and record keeping in residential care services". The service are to use this to consider how to improve the way they record how topical creams are applied and to consider whether any other improvements are needed. The provider should continue to monitor and maintain the excellent quality of care. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Hilton Lodge Nursing Home, page 15 of 28

16 Quality Theme 2: Quality of Environment Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths The strengths identified in Quality Theme 1, Statement 1, Quality of Care and Support, also support residents, relatives/carers to participate in assessing and improving the quality of the environment within the service. This includes written information about the service, as well as how they can make suggestions or raise concerns. The service continues to perform to an excellent level in the areas covered by this statement. We saw that residents' bedrooms were personalised. The minutes of meetings indicate that improvements to the environment were discussed at meetings which residents attend. Residents were also included in discussions about colours for rooms when they were to be decorated. Discussion with relatives, residents and carers indicated that they were very happy with the environment and many had chosen the home for the building, garden and location. Residents had the opportunity to view the home with their relatives/carers prior to moving in and meet the staff. Everyone was encouraged to personalise their bedrooms which could include bringing their own furniture and possessions. Areas for improvement The service recognised that meeting this statement was an ongoing process. They would continue to encourage people using the service to give comments and offer suggestions. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Hilton Lodge Nursing Home, page 16 of 28

17 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths Inspection report continued In reviewing this statement we looked round the home to see if there were any safety issues and spoke to staff about cleaning practices. We examined some of the equipment used in the home to see if it was maintained. We concluded from the examination of the evidence sampled that the service performed to a very good level in the areas covered by this statement. During our visit, we walked round the home to see all the communal rooms and some of the bedrooms. The home was in a good state of repair, the décor and furnishings were of a high standard and the home was very clean and tidy. Cleaning rotas and environmental audits were seen to support this. Staff were knowledgeable about safe infection control procedures. Gloves and aprons were available for staff to use in order to follow good practice with regard to infection control procedures. We saw these being used appropriately. Hot water temperatures were kept at a safe temperature in resident areas and were seen to be regularly checked. We examined one of the bath hoists, a standard and another free standing hoist. This equipment was seen to be clean. Service stickers attached indicated the equipment had been serviced. These and the servicing records indicated that the hoists were being appropriately maintained as in keeping with Lifting Operations and Lifting Equipment Regulations (LOLER). The service had a list of all the moving and handling slings in the home. This ensured that they were included in six monthly LOLER checks. The service receives notifications from Medicines and Healthcare products Regulatory Agency (MHRA) and demonstrated that they acted on their advice. MHRA alerts services to the risks, benefits and good practice guidance in using medicines and healthcare products. We examined two of the wheelchairs and looked at the records detailing the cleaning that was carried out on all the wheelchairs in the home. Both wheelchairs were clean and functioning correctly. The wheelchair cleaning records indicated that staff routinely clean the wheelchairs. We looked at the repair reporting book. We saw that entries were made against all reported repairs indicating that the repairs had been been completed. Hilton Lodge Nursing Home, page 17 of 28

18 We received very positive feedback from residents and relatives/carers we spoke with at the visit about the standard of cleaning. All questionnaires returned to us confirmed that people thought the home was clean, hygienic and free from smells. Minutes of meetings and progress of the service's action plans indicated that there was on going refurbishment of both the outside and inside of the home ensuring the home maintains a good appearance and is a pleasant place to be. Areas for improvement We were told that checks on wheelchairs were carried out. In evidencing the appropriate checking of these we recommend that the service records the checks and maintenance carried out as in the manufacturers instructions. See recommendation 1. We saw some of the waste bins unlined. The bins were seen to be clean however all waste bins should be lined unless a specific resident's risk assessment states otherwise in which case alternative measures should be introduced for that resident. See recommendation 2. We were informed of further improvements that the service intends to make to the environment. This included replacing some of the taps. The service plan to continue to use environmental audits and checks to ensure consistent high standards of tidiness and cleanliness are maintained. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 2 Recommendations Inspection report continued 1. It is recommended that records of the appropriate checks and maintenance of wheelchairs are kept to confirm the on going safety of such equipment. This takes account of National Care standards, Care homes for older people, Standard 4 Your environment. 2. It is recommended that all internal waste bins should have a liner to prevent contamination of the bin and reduce the need for cleaning after each episode of emptying of contents. Risk assessment should be used if this practice is inappropriate for specific resident's room bins. This takes account of National Care Standards, Care homes for older people, Standard 4 Your environment. Hilton Lodge Nursing Home, page 18 of 28

19 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths In reviewing this statement we looked at the service's recruitment procedures and how new staff were inducted. We concluded from the evidence found that the service was performing to an excellent level in the areas covered by this statement. We looked at the recruitment records of three members of care staff. All the three files evidenced that the service had followed very thorough safe recruitment practices prior to these staff commencing employment in the home. The use of a checklist supported management in following the provider's comprehensive recruitment and induction procedures. The service had completed checks to ensure that applicants for jobs were the right people to work in the home. This included asking them to fill in an application form with details of their experience and qualifications. The manager interviewed potential staff to make sure they understood what the job involved and to find out if they had the skills they needed to do the work. We saw that there were notes made at interview that indicated careful consideration was made as to the suitability of potential staff. We found that the files contained evidence that at least two appropriate references had been obtained. Additional information that supported the individual's fitness was also noted where appropriate. Other appropriate safe recruitment practices, including completing Disclosure Scotland checks/protection of Vulnerable Groups (PVG) Scheme Membership checks, were seen followed. The service also checked with the Nursing and Midwifery Council to make sure that nurses were correctly registered with them. Hilton Lodge Nursing Home, page 19 of 28

20 We saw that new members of staff complete inductions appropriate to their role. This helped them to get to know the home and the work they were to do. The induction process was seen to be comprehensive and included an Employee Handbook. All new staff had a trial period working in the home before a final decision was made about whether or not they were suitable. Staff turnover in the service was low and there was very good staffing levels and skill mix of staff. This meant that new staff were well supported. Areas for improvement The service should continue its current level of practice in relation to future staff recruitment and induction. They plan to continue to routinely review all their procedures to ensure that they continue to follow current legislation and best practice guidance. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Hilton Lodge Nursing Home, page 20 of 28

21 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The service has excellent systems in place to ensure a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. We concluded this after we observed staff in the course of their work, looked at how staff were kept up to date with current best practice and spoke to people who use the service. We saw staff encourage residents to make choices and provide care in a way that was respectful and dignified. It was clear from the way they worked that the staff knew the residents well and understood how to communicate with each of them in different ways. The staffing levels and organisation of care in the home allowed staff to provide care in an unrushed manner. We saw that staff were confident when using moving and handling equipment to transfer residents. Staff turnover was low and staff members were provided with appropriate training to help them to update and develop their skills and knowledge to enable them to do their jobs well. The stable staff group ensures very good continuity of care for all residents. There was clear leadership in the home with staff fully aware of the high standards that the management team expected of them. This was reflected in their professional conduct and positive attitude to changes. Listening to staff handover and how staff communicated with each other evidenced a strong team approach to providing care. There was good day to day supervision of staff and formal recorded staff supervision was seen completed regularly. This helps to make sure that staff have the support they need and the chance to discuss any problems or guidance they might need. Regular staff meetings were held. These meetings gave staff the chance to express their views about the service and to make sure they had relevant information about expected practice. Staff told us that they were very satisfied with the support that they received and felt that this meant they could work to a high standard. There was a training plan for the year that included mandatory training as well as areas that had been identified through discussion at staff supervision. Good practice guidance was seen available in staff areas. A copy of the service's policies and procedures and Employee Handbook were kept in the staff office. All care staff could access care records and were seen to use these. Hilton Lodge Nursing Home, page 21 of 28

22 The service use a dependency monitoring tool, along with monitoring of accidents and incidents, observing practice and listening to feedback to assist with planning staff numbers, allocation and skill mix. This helps to ensure that there are sufficient staff on duty to fully meet the needs of the residents. The management team had taken steps to ensure that all staff who will require to be registered by the Scottish Social Services Council (SSSC) in the near future have made an application to do so. This will ensure they are registered by the date of required registration. The SSSC is responsible for registering people who work in social services and regulating their education and training. This helps to make sure that people receive effective services from a safe and skilled workforce. Residents we spoke with told us that they felt the staff were kind and caring. Visitors told us that they felt that staff were very professional and that they were made very welcome in the home when visiting. The seven questionnaires returned to us, all indicated that they strongly agreed with the statement "I am confident that staff have the knowledge and skills to care for my relative/friend." Areas for improvement We would support the service to continue to monitor staffing levels through use of a dependency tool, reviews of accidents and incidents and regular observation of practice. The provider should continue to monitor and maintain the excellent quality of staffing. The provider should ensure it is rigorous in identifying any areas for improvement and implementing action plans to address these. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Inspection report continued Hilton Lodge Nursing Home, page 22 of 28

23 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths When we reviewed this statement we found that the strengths identified in the previous participation statements also supported residents, relatives and carers to participate in assessing and improving the quality of the management and leadership of the service. This included written information about the service as well as how they could make suggestions or raise concerns. The service continues to perform to an excellent level in the areas covered by this statement. When we spoke to people who used the service, they all told us that they felt they could speak to any of the staff, the deputy manager or the manager if they had any concerns. They told us that they felt very confident that any issue or questions would be appropriately addressed or responded to. Areas for improvement The service recognised that meeting this statement was an ongoing process. They would continue to encourage people using the service to give comments and offer suggestions. They plan to continue to use their customer focused management systems to monitor and develop how they meet this statement. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Hilton Lodge Nursing Home, page 23 of 28

24 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths Hilton Lodge Nursing Home use effective quality assurance systems and processes which involve staff, residents, relatives, carers and other stakeholders to assess the quality of service they provide. The service continues to perform to an excellent level in the areas covered by this statement. The management team carry out regular checks to make sure that things are running well in the home. These checks cover all aspects of the service provided and include health and safety checks, medication audits, audits of accidents and incidents, monitoring of staff performance and listening to feedback from staff, residents, relatives, carers and other stakeholders. Any areas for improvement were seen to be responded to through development of an action plan with a timescale and then checking that this had been completed. The service's quality management systems were seen to be regularly checked by an independent auditor to confirm that they continue to use them correctly. The strengths identified in the previous participation statements also supported residents, relatives and carers to participate in assessing and improving the quality of the service. Our inspection findings indicate that excellent standards of care are given and the management are aware of and take action on areas needing to improve. The management and staff have worked very hard to ensure that the service continues to comply with current legislation and good practice guidance. Areas for improvement The service has developed excellent standards of care and support with management and staff continuing to look at different ways to keep improving the service. We would support the continued use of the provider's quality assurance systems to enable areas for improvement to be identified and acted on. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Hilton Lodge Nursing Home, page 24 of 28

25 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information The service's current Certificate of Registration and Public Liability Insurance Certificate were seen displayed within the home. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Hilton Lodge Nursing Home, page 25 of 28

26 5 Summary of grades Quality of Care and Support Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Environment Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Staffing Excellent Statement 2 Statement Excellent 6 - Excellent Quality of Management and Leadership Excellent Statement 1 Statement Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 2 Dec 2010 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 19 Aug 2010 Announced Care and support 6 - Excellent Environment 6 - Excellent Staffing Not Assessed Management and Leadership Not Assessed 25 Feb 2010 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 6 - Excellent Management and Leadership Not Assessed Hilton Lodge Nursing Home, page 26 of 28

27 30 Jun 2009 Announced Care and support 6 - Excellent Environment 6 - Excellent Staffing 6 - Excellent Management and Leadership 6 - Excellent 21 Jan 2009 Unannounced Care and support 6 - Excellent Environment Not Assessed Staffing 6 - Excellent Management and Leadership Not Assessed 24 Jul 2008 Announced Care and support 6 - Excellent Environment 6 - Excellent Staffing 6 - Excellent Management and Leadership 6 - Excellent All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Hilton Lodge Nursing Home, page 27 of 28

28 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Hilton Lodge Nursing Home, page 28 of 28