Inspection on 16/05/07 for Harbledown Lodge Nursing Home

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harbledown Lodge Nursing Home 15/05/08

Harbledown Lodge Nursing Home 31/08/06

Harbledown Lodge Nursing Home 13/12/05

Harbledown Lodge Nursing Home 22/06/05

Harbledown Lodge Nursing Home 14/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Harbledown Lodge Nursing Home Upper Harbledown Canterbury Kent CT2 9AP Lead Inspector Mrs Susan Hall Key Unannounced Inspection 16th May 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harbledown Lodge Nursing Home Address Upper Harbledown Canterbury Kent CT2 9AP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 458116 01227 784816 carolina.simmons@njch.co.uk Unique Help Group Post Vacant Care Home 56 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (56) of places Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. OP is 56 of which 30 beds can be DE(E) Date of last inspection 31st August 2006 Brief Description of the Service: Harbledown Lodge is an elegant Georgian country house, which is set within 50 acres of grounds and is accessed via a private drive. There is a separate Day Centre within the grounds, which is not included in this inspection report. There are adequate parking facilities at the front of the house. Harbledown Lodge is part of a group of care homes called the Nicholas James Care Homes Ltd. There are four other nursing homes owned by this company within the vicinity, and some activities for residents include more than one home at a time. The home can be easily accessed via the M2 motorway, and is close to the historic city of Canterbury, with all its accompanying facilities. Most bedrooms are for single use, and most have their own en-suite toilet facilities. Each room is fitted with a call bell, telephone point, and TV. The company added an additional category to the Home’s registration during 2006, so that older service users with dementia (and nursing needs) can be admitted to the home, as well as older people with nursing needs. There is no segregation between these categories, but the Provider has stipulated that service users who may be disruptive to others will not be considered suitable for admission. There is an enclosed garden area for the safety of residents with dementia, and outside doors are fitted with key pad locks for security. The fees range from £400 - £1000 per week, depending on the type of room, and the care needs required. This information was provided by the Manager during May 2007. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which included assessing all of the Key Standards, and many of the other National Minimum Standards. The inspection includes information gathered since the time of the last inspection visit, and this was provided by relatives, visitors, and health professionals, as well as residents. The Inspector spent eight and a half hours in the home, arriving in time to briefly meet some of the night staff, and so being able to converse with a wider staff range. During the course of the visit, the inspector talked with six residents, two relatives, and three other visitors; and also with eleven staff, including nurses, care staff, cook, laundry assistant, cleaner, and activities organiser. This was in addition to the Manager and the Group Manager, who were available throughout the day. The visit included reading documentation, viewing all areas of the home, and observing care being given (where applicable). Information gathered since the last inspection came in from seven different sources. These included relatives, health professionals and care managers, who telephoned or wrote in to the CSCI office with different concerns. Some of these were directed to the home for investigation; and other comments were used by the Inspector as a basis for looking at different aspects of the home during the visit. One referral was made to the Social Services Adult Protection team. This related to allegations in respect of meeting care needs. An investigation has been completed, and the team took no further action. As a relatively high number of concerns have been made directly to CSCI, the Providers would be advised to consider how they could improve liaison with relatives and other stakeholders, and check their levels of approachability. The home had received twelve complaints since the last inspection, in addition to those outlined above. On the day of the visit, the Inspector found the staff to be helpful and supportive to residents and to each other, and to be knowledgeable about the care needs of individual residents. This was difficult to assess, as some concerns had been voiced about staff competency and management. Residents said the care staff were “good to them”, and they were well cared for. The Inspector concluded that there are inconsistencies with staffing, whereby some are suitably caring and experienced, but others may not have had sufficient oversight or training. Good progress was noted in a number of areas, including better care planning, increased opportunities for activities, and refurbishment of many areas in the building. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Individual risk assessments need to be checked to ensure they cover all relevant areas of potential risk. Some further improvements to the building are indicated. These include the tiling for the kitchen – which is old and difficult to clean effectively; refurbishment of a bathroom on the first floor; continued improvements to some bedrooms and en-suite areas; and cleaning and weeding the paved area at the side of the building (the enclosed garden). Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 7 More training has been implemented for staff, but the inspector could not verify that all staff have completed at least mandatory training. The manager needs to ensure that all staff are supported with regular one to one supervision; and take a stronger lead in ensuring that health and care needs are fully met. There is a good response to concerns and situations which are pointed out, but the home would benefit from a greater degree of proactive management. The management need to ensure that there is an effective system of quality assurance; – for example, more relatives/resident meetings; and questionnaires on a regular basis which are audited and publicised. Stakeholders need to be confident that their views will be listened to and acted on. Health and safety checks in the home need to be applied more rigorously. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 People who use the service experience good quality outcomes in this area. The company provides suitable information to enable residents to make an informed choice about coming into the home. Detailed pre-admission assessments are carried out. EVIDENCE: The manager stated that no changes had been needed or made to the Statement of Purpose and Residents’ Guide. These are readily available to view, and are in the same format. The Statement of Purpose is set out clearly and contains all the required information from Standard 1 and Schedule 1 of the Regulations. The complaints procedure is included and is up to date. The Service Users’ (Residents’) Guide is produced in large, bold print, and includes the terms and conditions of residency, as well as the complaints procedure, a précis of the Statement of Purpose, a sample contract and a service user survey form. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 10 Pre-admission assessments are usually carried out by the manager. She has two deputy managers, and has been training them in assessing prospective residents as well. The Inspector viewed three pre-admission assessments, and these had been well completed, with lots of details recorded about all aspects of residents’ health needs, emotional needs, and social needs. Residents are admitted for a trial period of 4 weeks, and all have a contract in place. Fees are charged according to the type of room, and the fee is specified in each contract. Joint assessments are also obtained – from hospitals/care management. Part of the pre-admission assessment is to determine if the resident needs any specialist equipment prior to moving in to the home – e.g. pressure-relieving mattress, nursing bed, hoisting facilities. Residents with dementia care as well as nursing needs, have additional assessments, to ensure that they do not have disruptive or challenging behaviour which could upset other residents. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience adequate quality outcomes in this area. Care plans show that person centred care is promoted, and that health needs are being met. EVIDENCE: Care plans are reviewed monthly, and show discussion with other family members as appropriate. They contain detailed assessments and care plans; good charts for food and fluid intake, monthly observation records, and weights. Personal hygiene records are kept for each day. Some of these had not been completed every day for March/April records, but the manager had noticed this, and a different format of charting has been commenced. These records are stored in residents’ rooms, but kept in a drawer (with their agreement) to preserve confidentiality when visitors are present. Residents were seen to be clean and mostly well groomed. The hairdresser was visiting on this day. Residents were appropriately dressed for the time of year. Relatives are requested to check clothing items are clearly labelled, to avoid Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 12 confusion over clothes. Care staff and the laundry lady assist with this process. Male residents had been shaved. Care staff stated that foot care is checked daily at each wash/bath/shower or bed bath, and this is included on the tick charts; and that oral hygiene is attended to twice daily. There are good records for multi-disciplinary involvement, showing appropriate referrals to other health professionals. These include GPs, Speech and Language therapist, Physiotherapist, dentist, optician, and specialist support nurses. Comments received from relatives included concerns that while care plans may be well written, they cannot be sure that the care is actually given in accordance with the plan (e.g. they have found times when oral hygiene or pressure relief has not been given, or referrals to other health professionals have been slower than necessary). A new directive from the management was for night staff to aim to assist some residents with washing and dressing prior to breakfast. Staff will have to be very clear that they do not get residents up and dressed unless they wish to do so. The management will need to monitor this carefully, and ensure staffing needs are met at the busiest times of day. The Inspector viewed four care plans, and these showed good attention to detail in regards to wound care. Wounds are recorded separately, and records include graphs for the size of the wound, body mapping, and details of the wound at each dressing change. Photographs are included, but the Inspector did not always identify that consent had been obtained for these. Risk assessments are in place, but were not seen in regards to residents going out of the building for activities. The manager stated that residents from the home and the Day Centre sometimes go out in the home’s vehicle together; the manager of the Day Care centre has drawn up a form for completing risk assessments that will also be adopted by the home. Medication is stored in a small, locked, clinical room on the ground floor. Storage is neat and tidy, but there were some difficulties with locking some cupboards. This was attended to on the next day. The room was well organised, and there is no overstocking of medication. No items were found to be out of date, and there was evidence of good stock rotation. Homely remedies are not used. Two systems are used for administration, with different Medication Administration Records (MAR charts). One system is supplied by Boots, and the other by a local GP surgery. The home has good input from this GP, who visits 2-3 times per week as a routine, and will always visit promptly if the call is urgent. There are two medication trolleys, which are stored locked to the wall. One is for the ground and second floor, and the other for the middle floor. One of these was inspected. MAR charts had been well completed. Handwritten entries are signed by two nurses. There were correct procedures in place for the management of controlled drugs, and for the disposal of Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 13 unused medication. Nursing staff were all in the process of carrying out a training programme (ASET course) to update their knowledge and skills with management of medication. The trainer was working in the home on the day of the inspection visit. The clinical room temperature was seen to have been high over several days (26-27 degrees centigrade), and had been reported to the manager. This had been resolved at the time, but needs to be kept under review to ensure there is no damage to medication. There is a recommendation to review the size of the clinical room, and to keep temperature checks under review. The Inspector observed care staff interacting well with residents, and caring for them with kindness. However, there were times when residents were seen in the lounge for some time, without anyone checking them. Not all of these were able to use a call bell. Care plans show some records in regards to any special wishes if residents are dying. Care staff will stay with residents who are dying, if relatives are not available. The home tries to ensure that residents are not inappropriately admitted to hospital if they wish to stay in the home, and their needs can be met. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good quality outcomes in this area. The home offers a variety of activities on a group or one to one basis. Food is generally satisfactory, but could be improved at times. EVIDENCE: The home has an activities organiser, who oversees day to day activities for groups, one to one activities, and outings. Each resident has a life history taken, and the organiser finds out their preferred hobbies, likes and dislikes. The main lounge on the ground floor has a table at one end where many shared activities are carried out. This enables the organiser to spend time with five to six residents at a time, carrying out activities such as art and craft, cooking or reminiscing. Some residents like to actively take part, while others are happy to sit and observe. The lounge is also used for larger activities such as singing entertainment, and dance/theatre groups. The activities organiser keeps a record for each individual person, so that she can see the things which they most enjoy taking part in. She has recently extended these folders to include additional information for residents who have dementia needs as well as nursing. These now include copies of photographs of friends, family, events and places, which mean something to that person. This Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 15 is very helpful for reminiscing on a one to one basis. She has recently increased the amount of one to one sessions, as there are many residents who do not particularly wish to join in with others. The Inspector noted that there are limited opportunities for one activities organiser to interact with such a large and diverse group of residents, - especially at times when there is an increased number of residents with dementia. The company need to consider if more staff are needed to assist with activities. Residents have the opportunity to go over to the Day Centre in the grounds if they wish to do so, and mix with other people there. This enables them to broaden their circle of friends. Outings are arranged with the Day Centre driver, usually 2- 3 times per week, enabling residents to go out for a drive, or to a local town. As stated in standard 8, the manager needs to ensure that appropriate risk assessments are in place for this. Although the Day Centre is not included in the inspection, the Inspector visited it briefly, in order to see this additional venue where residents can go if they wish to. It is separately staffed, and visitors were enjoying being there. Visitors are welcome at any time, and are invited to join in with activities with residents. There are also occasional residents/relatives meetings, when there is the opportunity to share ideas and suggest any changes. Residents said that the food is usually good, and that there is always a choice. The Inspector viewed the menus, and these showed a varied and nutritious diet. Main meals prepared for lunch looked well cooked and presented. The choice on the day was for roast beef etc. or for prawn and egg salad. The cook said that she makes homemade soup most days, and often makes homemade cakes. Fresh fruit and vegetables are supplied on a regular basis. The cook is helped by a kitchen assistant during the day, and prepares food ahead of time for evening meals as far as possible. Some comments from CSCI survey forms showed that residents and relatives were less happy with teatimes, and said there was less choice, and the food quality was not as high as it used to be. The Inspector has been informed since the inspection visit that the management have been addressing this. Cooked breakfasts are available if wanted, and snacks are available throughout the night. Different menu choices are tried out every 2-3 months, and if residents like these dishes, they are added to the next set of menu choices. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience adequate quality outcomes in this area. There have been a number of complaints made to the home since the last inspection. Staff training could be evidenced for safeguarding adults from abuse, but could not be verified for all staff. EVIDENCE: The complaints procedure was on display in the entrance hall of the home, and is clearly set out with all the relevant details. The Inspector viewed the complaints log, and this showed that complaints are acted on. There had been twelve complaints to the home since the last inspection, and the recorded details showed that they had been dealt with appropriately. One complaint in regards to different aspects of care was still in the process of being dealt with. The Inspector had received concerns which were raised from seven different sources since the last inspection, and this information was used to form some of the items to look at, and people to talk to, during the inspection visit. The sources included health professionals, visitors and relatives. Some sources indicated that people are sometimes hesitant to raise concerns, as they feel they (or residents) may be victimised. People expressed a lack of confidence in being sure that all possible action is taken to resolve issues. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 17 One referral had been made to the Kent Social Services Adult Protection team. These concerns were in respect of meeting care needs. The details have been investigated, and the alert is now closed. The investigating team did not pursue any further action at the home with regards to this. The home has a training programme in place for all aspects of staff training, including the recognition and prevention of adult abuse. (Safeguarding Adults programme). The Inspector was informed that the basics of this training are included in the induction programme. Adult protection training is delivered by the manager and by another staff member, who have completed “training the trainer” courses for this subject. As there is no staff training matrix in place, the Inspector was unable to verify training for all staff in this subject. This could lead to inconsistent knowledge and practice within the service, and the management must ensure that all staff (not just care staff) are properly trained in this subject. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 People who use the service experience good quality outcomes in this area. The premises have been much improved by a continuing programme of refurbishment and redecoration. EVIDENCE: The Inspector viewed all three floors, all bathroom facilities, and many of the bedrooms. Communal areas, the entrance hall and corridors have all been redecorated and carpeted since the last inspection, and look much improved. Many of the bedrooms have been redecorated and refurbished, and new bedroom furniture, nursing beds and soft furnishings are evident. There are still a few bedrooms which need attention (e.g. to walls/carpets), and the manager is already aware of these. Most bathrooms have been completely refitted. There is a “Parker” bath on the ground floor, an electric shower room on the ground floor, and a bathroom Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 19 with a hoist facility on the first floor. A bathroom on the top floor has been refurbished, but still needs a hoist fitting. This is in the process of being arranged. Some of the bedrooms have usable en-suite shower facilities. There is one other shared bathroom on the first floor, which cannot currently be used, and which needs to be re-fitted. It is important that the home has another useable bath facility on this floor. A requirement was given at the last inspection to provide an action plan for tiling the kitchen and replacing the floor. Although this work appeared on an action plan, it has not been done. The Inspector was informed that the Provider intends to refurbish the whole kitchen. There is a recommendation to replace the wall tiling as soon as possible, as this is old and cracked in places, and is difficult to clean. The laundry is in the basement, and has been fitted with two commercial washing machines and a commercial sized dryer. A red alginate bag system is used for soiled items. The laundry room is quite a small area, but the laundry assistant was able to explain the procedures for keeping clean linen separate from dirty items. The home has a passenger lift to all floors. Radiators are fitted with guards, and window restrictors are fitted throughout the building. One of these failed on the day of the inspection, and caused an injury to a carer. The maintenance man was called to rectify this immediately. There is a keypad system at the front door, for the safety of service users with dementia. There is a call bell in each room, and a system for checking residents at regular intervals if they are unable to use a call bell. The premises have extensive grounds, and these would enhance the property if the immediate flowerbeds were kept in better condition. Lawns are kept at a reasonable level, but flowerbeds had lots of weeds. The large pond at the front entrance needed cleaning, and the fountain was not working. The surrounding flowerbed was being weeded as the Inspector left the home. Paving at the side of the building (the area for dementia residents) had weeds growing between the slabs, and the paving would benefit from jet washing. Lack of maintenance was not doing justice to this area, and paving could become slippery for residents if not cleaned regularly. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience adequate quality outcomes in this area. Staffing levels are generally satisfactorily maintained, using agency staff to make up any shortfalls. There is a good programme of staff training in place, although it cannot be verified that all staff have received mandatory training. EVIDENCE: The home currently had 39 residents, and one of these was in hospital. Staffing levels include two nurses throughout the 24 hour period. These are allocated as one for the middle floor (the largest area), and one for the ground and top floor. One of the nurses said that they rotate their allocation, so that the nursing staff remain familiar with all residents’ needs in the home. There are 7-8 care staff on duty in the mornings, 5 in the afternoons and 2 at night. These numbers will need to be increased in line with increased numbers of residents in the future, and their dependency levels. Nursing and care staff are assisted by other senior staff, including two deputy managers. One of these had just been recruited. The aim is to ensure that either the manager, or one of the two deputies, is on duty at all times. Residents said that they are usually attended to fairly quickly, but there are times when they have to wait for the necessary attention. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 21 Nursing and care staff are supported by ancillary staff which include a cook, kitchen assistants, laundry assistants, maintenance men and cleaning staff. There were two cleaning staff on duty. Bedrooms are cleaned each day, and rooms are highlighted by care staff where there is the need for more in-depth cleaning in any areas. The home currently has 50 care staff who have completed NVQ 2 or 3. Recruitment practices are generally satisfactory. Staff files have been reorganised and are now easier to access information. The Inspector picked three files at random, including one nurse and one newly recruited carer. Appropriate checks had been carried out for all three, and there were two written, satisfactory references obtained for these staff. However, the application form for the latest staff member was incorrect, as it asked for details of the last ten years of employment, when it should ask for a full employment history. This was pointed out to the manager, and application forms have been amended. Nurses’ PIN numbers are checked, and POVA first and CRB checks are completed prior to commencement of employment. The Inspector pointed out that staff files did not contain adequate supervision records, and copies of training certificates were not fully evidenced. The manager showed the Inspector a separate training file, whereby each staff member has training certificates stored. This file showed more recent levels of training (i.e. during the last year, and for different subjects). Training could be evidenced for Adult Protection, basic food hygiene, fire training, infection control, pressure area care, communication, first aid, moving and handling, and medication administration (for nurses). However the home does not have a training matrix in place, and so it is not possible to tell who has had what training without viewing every file. It is important to be able to clarify that all staff have received all mandatory training, and there is therefore a requirement to put a training matrix in place. Nursing staff have the opportunity to carry out training courses to update their skills and competencies. The manager stated that new staff have an induction using the “Skills for Care” induction programme. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, 35-38 People who use the service experience adequate quality outcomes in this area. The manager has gained in experience and ability during the past year, and now needs to be more proactive in different aspects of management. This includes ensuring that the service is user focussed, and that staff have adequate leadership and support. EVIDENCE: The manager has been in post for nearly a year, but has not applied for registration as yet, and this is identified as a requirement. She is a level 1 nurse, and Nurse Assessor, and has completed the Registered Managers’ Award. The Inspector talked with a number of different staff, who said that if they have any concerns about residents or their care, they go to the manager. They were confident that she would address their concerns. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 23 However, other comments received on surveys from relatives and health professionals expressed a lack of confidence in the management, although they said that the manager listens to concerns, and does take action. Sometimes the action seems to be short-lived, and there is a need to ensure that improvements are maintained. A more proactive approach would be of benefit to the home, rather than reacting to situations which are highlighted. The introduction of another deputy manager may assist in this process. The manager works well in partnership with senior management in the organisation. Staff on duty on the day of the visit were aware of their differing roles, and the importance of working together. Some nurses have been designated with specific tasks – e.g. oversight of medication. Residents are assigned named nurses and key workers, to enable them to know who is most familiar with the details of their care. The Inspector stayed in to listen to the morning handover, and night staff gave clear information regarding any changes. The nursing staff have the responsibility of ensuring that care staff on their floor are familiar with any changes, and checking these are implemented. This works well when knowledgeable and well-trained staff are on duty. However, comments from some sources suggested that not all staff have the understanding, ability and training to promote care, and some of the nursing staff work by being reactive to situations rather than being proactive in delivering care. Staff said that staff meetings are held on a regular basis, and they are able to voice their opinions. Residents and relatives meetings are held, and these are advertised on a notice board in the entrance hall. The manager said that she has identified that more residents/relatives meetings, and more staff meetings, would be of benefit for the running of the home. The manager has an open door policy to be available to staff and relatives. However, comments from relatives and visitors since the last inspection indicate that people are not confident that their concerns will be acted on, and are frustrated that they have to bring things to the attention of the manager, without them already being identified and addressed. The home has an annual quality assurance survey, but this is not effective if appropriate action is not taken. Senior management carry out monthly audit checks in the home. Residents are encouraged to manage their own finances if possible, or relatives/advocates are appointed. The home does not manage any residents’ money except for “pocket money”. This is stored in individual wallets in a safe place, and all transactions are recorded and signed for by two people including the resident if possible. All receipts are retained. These records were not viewed at this visit, but the Inspector was informed that the process is the same as for the last inspection. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 24 Staff supervision records showed that there is some formal one to one supervision, but again, there was no way of clarifying if this was up to date. A system needs to be put in place whereby it is easy to see that all staff are having the opportunity for one to one supervision on a regular basis. The Inspector has seen evidence of better recording of supervision since the inspection. Other records viewed were up to date and stored with regards to confidentiality. Care staff said that they can access the care plans at any time, and do so as needed. Policies and procedures are all in place and were reviewed at the end of 2006. Pre-inspection documentation indicates that equipment maintenance is managed satisfactorily. This includes lift and hoist servicing, fire equipment, emergency call bells, PAT testing, and gas and electrical checks. COSHH assessments are in place. Water testing for temperatures and chlorination is satisfactory. The manager needs to ensure that other health and safety checks are all in place. The occurrence of a window restrictor failing on the day of the inspection indicates that health and safety checks need to be applied more rigorously. Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 3 2 Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13 (6) Requirement All staff should be trained in the prevention of abuse; and the home must be able to verify this. To provide another useable bath or shower facility on the first floor. To complete a staff training matrix, so that mandatory training can be verified for all staff. The registered provider has the responsibility to appoint a registered manager. The manager therefore needs to apply to CSCI for registration. Timescale for action 31/07/07 2 OP21 23 (2) (j) 31/08/07 3 OP30 18 (1) (c) 31/07/07 4 OP31 8 (1) (a) 30/06/07 5 OP33 24 (1) 6 OP36 18 (2) The registered provider and 30/06/07 manager must ensure that the quality assurance programme is effective, and that residents’ and stakeholders’ views are listened to and acted on. To ensure that all staff have 31/07/07 appropriate supervision, and that this is recorded using a clear and transparent system. DS0000026096.V337040.R01.S.doc Version 5.2 Page 27 Harbledown Lodge Nursing Home RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP8 Good Practice Recommendations To ensure that consent is obtained for taking photographs of wounds. To ensure that risk assessments are completed for residents’ activities, including going out of the home in the home’s transport. To ensure that residents are not left unattended in the lounge for too long. To review the size of the clinical room, ensuring it is adequate in keeping with the medication needs of the home; and to ensure that the clinical room temperature stays within the required boundaries. To ensure there are sufficient staff to carry out activities, especially for residents with dementia. To ensure that teatime meals are suitably varied and nutritious. To replace the wall tiling in the kitchen as soon as possible, where it is old and difficult to keep clean. To ensure that the grounds are kept well maintained. To ensure that staff application forms request a full employment history. The manager needs to communicate a clear sense of direction and leadership in the home, taking a proactive approach to improving the service. To ensure that routine health and safety checks are kept up to date. 3 4 OP8 OP9 5 6 7 8 9 10 OP12 OP15 OP19 OP19 OP29 OP32 11 OP38 Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harbledown Lodge Nursing Home DS0000026096.V337040.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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