Inspection on 15/04/10 for Harefield Hall

This is the latest available inspection report for this service, carried out on 15th April 2010.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harefield Hall 14/12/06

Harefield Hall 07/12/05

Harefield Hall 12/05/05

Harefield Hall 31/01/05

Harefield Hall 17/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Harefield Hall 171 Bath Road Willsbridge South Glos BS30 9DD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Clarke     Date: 1 5 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Harefield Hall 171 Bath Road Willsbridge South Glos BS30 9DD 01179323245 01179328884 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Banff Securities Limited Name of registered manager (if applicable) Ms Susan Anne Evans Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 21 persons aged 65 years and over requiring personal care only Date of last inspection Brief description of the care home Harefield Hall is a well-established care home situated in its own large grounds, between the villages of Longwell Green and Willsbridge. The centre of Bristol is six miles away and can be accessed by the buses that stop at the bottom of the driveway. The home is easily accessible to the local shops and the post office, plus there are two areas of interest nearby, namely the Willsbridge Mill and the Bitton Railway Station. Both have tearooms and provide a pleasant area where visitors can take their relative. The house has been extensively adapted to provide accommodation for 21 people, both male and female. The private rooms are spread over three floors and there is a passenger lift ensuring that all areas are accessible. The home has a pleasant lounge Care Homes for Older People Page 4 of 26 Over 65 21 0 Brief description of the care home and dining room and the large hallway is also able to accommodate seating for individuals. The kitchen is on the ground floor; the laundry and the storerooms are in the basement The home provides care for older people and aims to do this in a personalised way, ensuring that as much independence is retained and that a fulfilling and meaningful lifestyle is offered. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection. We visited the home over two days. On the first day we looked at records about the care provided in the home including care plans, medication, staff recruitment and training. We also spoke with a number of individuals who live in the home about their experience of the care provided at Harefield Hall asking them about the life of the home, daily routines, activities, staffing, meals and other issues relating to the quality of the care provided. We also spoke with a group of staff about working in the home and their views about the quality of the care they provide. On the second day we spoke with the member of staff who takes the lead in health and safety practice in the home and looked at records. The manager was also present on the second day so we were able to discuss with her the care provided in the home and give our views and the results of our inspection. As part of this inspection we sent Have Your Say questionnaires to the home and we Care Homes for Older People Page 6 of 26 received 8 replies from individuals who live in the home. We have used their responses to help us make a judgement about the quality of care provided in the home. Fee at the time of our inspection £525-575 excluding laundry. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: We have made one requirement from this inspection which relates to the need to undertake nutritional assessments where there is identified concerns about an individuals health related to their diet and nutrition. This would further help in identifying and evidencing the support made available where there are risks of poor Care Homes for Older People Page 8 of 26 nutrition. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes a comprehensive pre-admission assessment so that they are able to make an informed decision about their ability to meet the individuals health and social care needs. The home provides good information when individuals are admitted to the home so that they are fully informed about the quality of the service they can expect to receive. Evidence: We looked at the homes pre-admission assessment for two individuals. They were comprehensive and included information about the individuals medical history and physical care needs. Where an individual is known to the social services a copy of their assessment is obtained by the home and this was seen for one individual. As part of the admission the home completes a check list which includes information about medication, diet and night checks. A Welcome Pack is given to each individual who comes to live at Harefield Hall. This Care Homes for Older People Page 11 of 26 Evidence: includes Day to Day Information (routines such as mealtimes), Activities available, Staffing arrangements, Medication Arrangements and Visitors. Also included is the homes complaint procedure. Individuals sign to say they have received all of this information. Wherever possible individuals visit the home before making a decision. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning arrangements are thorough and provide comprehensive information so that the health and social care needs of individuals are identified and can be met. The health needs of individuals are protected and the medication arrangements are good so that individuals receive their medication as prescribed. Evidence: We looked at a number of care plans. They provided comprehensive and detailed information about the care needs of the individual. Included were Medical Care Plan, Diet Care Plan, Social Care Plan, Hygiene Care Plan and recently introduced Chronic/Acute Medical care Plan. The later provides a summary of the health conditions and significant health events and needs of the individual. Alongside the specific elements of the care plans were records of events associated with that element of the care plan. In one instance a record relating to diet care plan stated diet remained minimal monthly weight had been recorded for this individual. There was no Nutritional Assessment. For another individual weight loss had been identified by the home and referral made to GP. Records showed this individual was receiving food supplement though no nutritional assessment had been completed. For another Care Homes for Older People Page 13 of 26 Evidence: individual there was a record about the individuals skin integrity. This individual had been referred to a community nurse and the home was responding to the concern and records evidenced the treatment the individual was receiving. Information about the individuals likes and dislikes, daily routines and interests were recorded as part of the care plan. Moving and handling assessments had been completed with risk assessments where these were required around behaviour or other identified risks such as falls. Records evidenced that care plans are reviewed frequently generally monthly. Reviews are also held where the individual if able attends and others such as relatives. Notes of these reviews showed that they provided an opportunity for the individual to comment on the care they received and any changes they felt needed to be made in how they received their care. Records showed that individuals have access to community health services such as chiropody, dentist and optician. An individual confirmed that an optician regularly visits the home. A record in the care plans regarding chiropodist visits had not been completed showing last visits for some individuals as 13/10/08 however there was a separate record of visits confirming visits since this date. We asked individuals about the homes response to requests to see a doctor one told us it happens straight a way its never a problem and another I can see my doctor whenever I wish I only have to ask. All of the individuals who responded to our questionnaire said that the home Always make sure you get the medical care you need and receive the care and support they need. We looked at the arrangements for the storage, administration and management of medication. Administering records had been completed accurately with no gaps in recording. Changes and entries had been made to the administering records but had not been signed however the senior care support worker told us that wherever possible they get the GP to sign changes in medication and this was seen. There are a number of individuals who receive controlled drugs (CD), stocks were checked against the records in the Controlled Drug Register and all were found to be correct. The controlled drugs though not kept in a CD cupboard are in a secure cupboard attached to the wall within a cupboard and also the room where medication is kept is also locked at all times. In response to a Department of Health report the home has asked all of the individuals living in the home about the time of medication particularly in the evening they would prefer and changes had been made for some individuals to meet their choice. Homely remedies are available and records are kept of when they are requested and given to individuals. A pharmacist inspection took place in September 2009 (requested by the home) and they found all the procedures and practices of the home good. Care Homes for Older People Page 14 of 26 Evidence: We spoke with a number of individuals about the approach of staff and they told us: staff all very good, treat us with respect always speak to me the way I would expect. Care Homes for Older People Page 15 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for meeting the social and recreational needs of individuals living in the home are good with a wide variety of activities being provided with individuals having the opportunity to maintain positive relationships with family and friends. The homes practices and routines are flexible and individuals are able to have choice and make their own decisions about their daily routines. The meals provided in the home are balanced and varied meeting the nutritional needs of individuals living in the home. Evidence: We spoke with individuals who live in the home about the activities available. They told us that there are a number of activities provided including: music and exercise, quizzes, care games, table skittles and trips out. One individual told us that they thought that the entertainers are excellent (this is outside entertainers). There is generally some form of activity daily and records seen confirmed this. On the day of our visit there was pottery painting where the home had applied to the local authority for funding of an activity. In the homes questionnaire a number of comments had been made by individuals about the activities: I like what I join in and like the Care Homes for Older People Page 16 of 26 Evidence: entertainers I enjoy activities we can all do together and I enjoy the mini bus trips. Individuals who responded to our questionnaire said that The home arranges activities that I can take part in? six Always two usually. The home has an open visiting policy and individuals who live in the home are encouraged and able to have visitors at any reasonable time. We asked individuals about how their visitors are received by the home and staff and they told us: my visitors are always made to feel welcome I can have visitors any time its very welcoming here. One visitor in their response to the homes questionnaire said there is a welcome feeling as you walk through the front door and another said I have always been made to feel very welcome . Individuals told us that they are able to make choices about their daily routines such as getting up and going to bed its up to me its my choice choice is mine its like home from home you can do as you like. We also asked staff about flexibility of routines such as getting up. and they were very clear it was the individuals choice. We looked at the menu and it showed a variety of meals being provided with an emphasis on home cooked meals. Individuals told us that the meals were excellent theres variety and always a choice if theres something I dont like I only have to say and theres something else provided. Individuals told us in their questionnaire response that they Always four, Usually four like the meals at the home. On the day of our visit the meal was well presented and a number of individuals had an alternative choice. There was a relaxed and unhurried atmosphere and staff were available to offer assistance if this was needed. Care Homes for Older People Page 17 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure and individuals were confident their concerns, dissatisfaction or complaints would be listened too and action taken. There is Safeguarding policy and procedure in place and staff have the necessary skills and understanding to respond professionally to any concerns so that individuals are protected from possible abuse. Evidence: We spoke with individuals who live in the home about what they would do if they were unhappy about the service they receive. One individual said if you have a problem you can go to Sue (the manager and owner) she is very helpful staff always listen to you. One individual she had been unhappy about something and it was dealt with and was not a problem. Individuals were aware that they could make a complaint if they wished and all of those we spoke with knew that the home had a complaints procedure and had received a copy. The procedure is included in the homes Welcome Pack. In response to the homes questionnaire an individual had said I feel I can always talk to someone if I had any concern and another commented I always feel I can talk to anyone. All of the individuals who responded to our questionnaire said they knew how to make a formal complaint. There is an Safeguarding Adult policy and staff have completed Safeguarding training. We asked staff to give us some examples of what they would consider as abuse and they were able to illustrate a good understanding and knowledge of the subject. Care Homes for Older People Page 18 of 26 Evidence: Examples included not giving choice, ignoring people, not having respect for individual dignity. Staff were confident that if they had any concerns about possible abuse the manager and seniors would act professionally and something would definitely be done it would be investigated. Care Homes for Older People Page 19 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an attractive and well maintained environment with practices and procedures to manage the risk of infection and maintain as far possible an hygienic environment. Evidence: Since our last inspection a number of rooms and areas of the home have been refurbished including two bathrooms. New security lighting has been installed outside of the home. A new boiler has been installed and currently all of the homes fire doors are being improved and bringing up to current standards with new seals. The home retains its original features with the communal areas and entrance hall being attractive areas of the home. There is a homely and welcoming environment and individuals we spoke with all said how the home is always clean and well kept. All of the individuals who responded to our questionnaire said that the home is Always fresh and clean. There are procedures in place to maintain an hygienic environment and staff have received training in infection control. There is an awareness of the need to reduce the risk of infection particularly when individuals are discharged home from hospital. Staff have access to protective clothing when this is required. Care Homes for Older People Page 20 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has robust selection and recruitment practice so that individuals who live in the home are safeguarded by through checks being undertaken on all those who work in the home. Staff receive the necessary training so that they have the knowledge and skills to meet the requirements of their roles and responsibilities. Evidence: We looked at the recruitment records for four members of staff and found that full and detailed application forms had been completed. Two references had been received for each applicant as well as POVA1st and Criminal Record Bureau checks. We discussed with the deputy the arrangements for individuals who start working in the home before a CRB has been received and also recommended the completion of a CRB (now known as ISA) log to record when applied for received. Training records for staff members showed they had all completed the mandatory areas of training: moving and handling, Safeguarding, Fire and Food Hygiene. Other training complete by staff included Dementia, Mental Capacity Act, Medication. Staff complete Health and Safety Induction. Staff told us that there are good opportunities for training in the home and the majority of staff have completed NVQ professional qualification at Level 2 or 3. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place quality assurance system which provides an opportunity for individuals and others to comment on the quality of the care they are receiviing so that they can influence the care arrangments of the home. The health and safety practice of the home helps to protect the welfare of those that live and work in the home. Evidence: The manager of Harefield Hall, who is also the owner, has worked in the home for 26 years having been the manager since 1983. She has NVQ 4 Registered manager Award and has undertaken the full range of training required including Safeguarding. We spoke with individuals who live in the home and staff about her approach and they told us Sue is someone we can always go to shes there for us. Staff described her as approachable there if we have a problem. It is noted that the majority of staff have worked in the home for a number of years and there is very good retention of staff. Care Homes for Older People Page 22 of 26 Evidence: The home undertakes Quality Assurance questionnaires for individuals living in the home and visitors. We looked at the results and they were very positive and overwhelmingly Good and Excellent views of the care provided in the home. Comments from individuals included: I wouldnt want to be anywhere esle very happy to be here Visitors comments included: We are extremely happy with the care you have given and would highly recommend Harefield Hall Welcome feeling as you walk through the front door we would recommend the home to any one, excellent care taken at all times to each and everyone. appreciate the kindness and patience staff always friendly and helpful There are regular residents meetings issues raised have been activities, dining room arrangements, food provided in the home. We spoke with the health and safety responsilble member of staff who has undertaken Risk Assessment and COSSH training. They outlined the practice around risk assessments with monthly, quarterly and yearly reviews of all risks assessemnts. These range from those relating to individuals to environment of the home. In addition the home has systems in place to review water temperatures, tests for Legionaires, boiler and other equipment servicing. Records showed bath hoists and lift had been serviced twice yearly with additional insureers assessment of the new boiler. Records showed that the necessary fire safety checks take place: weekly alarm and emergency lighting check, fire system has been updated with all rooms now having smoke and fire alarm. Staff undertake regular fire drills and practice evacuations and records confirmed day and night staff undertaking these. Incident and Accident records are reviewed monthly and where necessary moving and handling and risk assessments are changed to reflect increase in risk such as for falls and use of equipment. Monthly security check of the building and environment is untaken. We discussed with the manager the planned installation of additional security. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered manager to make sure that unnecessary risks to the health or safety are identified and so far as possible eliminated. This relates to the completion of nutritional risk assessments where it is identified that individuals diet and health is a matter of concern. 07/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 As part of quality assurance undertake questionaires around specific areas of care such as meals and nuitrition, activities, health and safety. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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