Inspection on 31/08/06 for Harbledown Lodge Nursing Home

This inspection was carried out on 31st August 2006.

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 16/05/07

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 Unannounced Inspection 09:30 31st August & 1 September 2006 st 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.V300068.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.V300068.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 kan.rajakanthan@njch.co.uk Unique Help Group 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.V300068.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 13th December 2005 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 nursing homes called the “Unique Help Group”, and this group was purchased by Nicholas James Care Homes in May 2005. There are 4 other nursing homes owned by this company within the vicinity, and some activities involve 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 it’s 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 have added an additional category to the Home’s registration this year, so that older service users with dementia (and nursing needs) can now 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. The fees range from £389.98 to £900.00 per week, depending on the type of room, and the care needs required. This information was provided by the Manager on pre-inspection documentation in June 2006. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first visit by this Inspector to the home, and she spent 11 hours over 2 days assessing most of the National Minimum Standards. During this time, she toured all areas of the home, and talked with 11 service users (6 of these were long chats), 5 relatives/friends, and 11 staff (as well as the Manager). The Manager and Group Manager were available during both days, and the Provider visited the home on the second day of the inspection. The inspection process includes information obtained by CSCI since the last inspection. This was gained from 4 care managers, 2 friends and 2 relatives, and 1 GP – who considered the overall care given in the home as “satisfactory”. CSCI had been informed of 2 areas of concern which had been referred to the Kent County Council Social Services Adult Protection department. These were being investigated at the same time, under one alert, and the process was ongoing at the time of the report. The management of the home were working to assist external agencies with their investigations. Service users told the Inspector that “the staff are always friendly and kind”, and enjoyed the activities provided. Most service users appeared well groomed. The home was clean throughout, and had recently had some rooms redecorated, and some new furniture and soft furnishings. There is an ongoing plan of refurbishment, which was evident during the 2 days of the inspection. Maintenance men were continuing with redecoration and gardening, and told the Inspector that the home was due to be re-carpeted in all areas, the following week. There were 2 small areas where the home had unpleasant odours, and it was expected that the new carpeting would overcome this problem. What the service does well: The home had recently employed a new Activities Organiser, and the programmes are designed to meet individual needs, as well as providing group activities. The programme is excellent, and service users were enthusiastic about the changes this had made in the home. One said “ we have lots of things to do now”, and “ I like being able to go out.” Service users said that the food is good, and that they can ask for additional dishes as well as the choices supplied for each meal. The cook ensures that there are usually 2-3 fresh vegetables at every lunch, and a variety of fresh Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 6 fruit is offered daily. Food is home-cooked, and the cook is suitably qualified for catering for these service users. What has improved since the last inspection? What they could do better: 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. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 7 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.V300068.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The company provides clear information to enable service users to make an informed decision about staying in the home. Detailed pre-admission assessments are carried out. EVIDENCE: 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’ 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.V300068.R01.S.doc Version 5.2 Page 9 Fees are charged according to the type of room, and the fee is specified in each contract. The Inspector viewed 3 contracts, and these had been completed with the service user or their next of kin as appropriate. There is a 4-week trial period, and service users are reviewed at the end of this time to check the suitability of the placement. The Inspector viewed 3 pre-admission assessments, which are carried out by the manager to assess the needs of the prospective service user. Two of these were for recent admissions, and the pre-admission assessments contained detailed information covering all aspects of care. Joint assessments are also obtained – from hospitals/care management. Part of the pre-admission assessment is to determine if the service user needs any specialist equipment prior to moving in to the home – e.g. pressurerelieving mattress, nursing bed, hoisting facilities. The manager ensures that any extra equipment is provided before admission. Nursing and communication needs are assessed to ensure the home can meet the care needs. The home is now registered to take up to 30 service users with dementia care as well as nursing needs. There were currently only 4 service users in this category. All staff have been trained in dementia care. The manager will not arrange admission for any service users who may cause disruption to other service users, and this is written into the Statement of Purpose. The Inspector spoke with a service user who had been recently admitted, and who said they were “very happy with their transition into the home”, and had been given adequate information to help with the settling in process. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Health and personal care needs are generally met satisfactorily. Nursing staff must ensure that relatives and health professionals are contacted as soon as possible when any changes occur. EVIDENCE: The Inspector examined 5 care plans – 2 in all areas, and another 3 for nursing and wound care intervention. The care plans are stored in individual folders, and showed evidence of discussions with service users (and relatives) where applicable. They are reviewed monthly. The manager was in the process of putting all care plans into a revised format, which is much easier to follow and more comprehensive than the previous format. This work was not yet completed. Different areas of assessment are used to determine which care plans are needed. For example, a personal safety risk assessment or a general risk Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 11 assessment may show the need for taking care with use of bed rails, unsupervised mobility, risk of choking, or managing hot drinks unaided. Assessments and care plans were included for all aspects of care such as: personal hygiene needs; nutritional needs (with nutritional risk assessment, monthly weight and BMI index); incontinence (with detailed continence assessment); skin integrity (with wound care assessments); mobility (with moving and handling assessment);confusion and agitation; cognitive assessment; and sleep and rest. Observations of temperature, pulse and blood pressure are recorded where indicated, and blood sugar charts for service users with diabetes. Care staff complete daily records for personal hygiene – indicating if bath/shower/shave/nail care etc. are given; and bowel charts and fluid balance/food charts, where needed. These were satisfactorily completed. Care staff give daily feedback to the nurses on duty. The nurses complete separate nursing records, and these were properly timed and dated. Some wound care had not been clearly documented during the year, but the format for this had been altered in the last 2 months, and was much clearer. Wound care is now documented on a separate form for each wound, and records the state of the wound at each dressing change. There was evidence of service users having been admitted with wounds, and these had been healed since admission. The Inspector discussed the importance for nurses to record any wounds clearly on written documentation when any service user is transferred to or from hospital or the community. This will enable a clear pathway to be seen for the service user’s condition at any given time. Separate records are maintained for visits/phone calls with other health professionals. These included visits/intervention from GPs, optician, dentist, physiotherapist, chiropodist, specialist support nurses, and care management reviews. A concern had been raised regarding a delay with this process, and there is a recommendation concerning this. Medication is stored in a small clinical room, which is just sufficient. The cupboards were neat and tidy, and there was no overstocking of medication. The Inspector was informed that this is sometimes a difficulty with one GP surgery, and the Inspector suggested further communication with the GP concerned, or the PCT Pharmacy Advisor. Controlled drugs (CDs) were properly stored, and entered into a CD register. The room and drugs fridge temperatures are recorded daily. There are 2 medication trolleys, and these were in good order. One item in a cupboard was found to be out of date, and this was brought to the attention of the Acting Deputy Manager who assisted with this part of the inspection. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 12 Medication Administration Records (MAR charts) are supplied by Boots pharmacy, and some different ones by a GP prescribing pharmacy. The nursing staff manage these 2 different systems competently. MAR charts had been properly completed. Records are retained for medication which is sent for disposal, and satisfactory contracts are in place. There is a detailed assessment form for any service user who wishes to self-medicate, and a lockable facility is provided for each service user. The Inspector observed service users being treated with respect by care staff. Personal care needs and professional visits are carried out in service users’ own rooms. Several concerns had been raised with the Inspector over the past 3 months about details of care, and the Inspector mentioned the importance for staff to concentrate on these details. The Inspector noticed that some service users did not have their hands and faces cleaned straight after meals, but otherwise care was seen to be good. Call bells were answered promptly and bells were within reach. Service users were mostly well groomed. Care plans included some records regarding service users’ wishes for death/dying. Some just stated that “the service user did not wish to discuss this”. The Inspector read a letter of thanks from one relative regarding the care given to a service user and their relatives when the service user was dying. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has implemented a new programme of activities which service users really enjoy. Food is home-cooked, and menus have a good variety. EVIDENCE: A new Activities Organiser has implemented a different range of activities and outings. There is an individual plan in place for each service user, and their likes and dislikes are taken into account. The documentation for each person is excellent. The Activities Organiser plans in individual times for service users who prefer to stay in their rooms, or who do not like to join in with group activities. These times may include helping choose books, one to one chats or carrying out nail care. Group activities are arranged on a daily basis, and service users are provided with individual information, as well as posters being displayed on the notice boards. Activities on the first morning of the inspection included card making, colouring and cake making at a table in the ground floor lounge. Eight service Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 14 users were taking part, and they enjoyed icing the cakes in the afternoon. On the previous day a number of service users had taken part in flower arranging in the first floor lounge. This lounge is used every 2 weeks for a communion service, and 12 service users had attended the last one. Entertainment afternoons are sometimes arranged with singers or theatre groups. One service user told the inspector about a show held in the lounge on the previous week, and said he/she “loved all the dancing, it was brilliant.” Group trips are arranged 2 –3 times per week, using a number of mini-buses (there are 6 owned by the group). These include service users from other company homes in the vicinity, so that service users can make friends with people from other homes. Risk assessments are carried out for each trip to assess the numbers of staff/relatives for the service users who are going, and the numbers of wheelchair users being included (usually up to 2). Recent trips had been to Margate beach, Tankerton shops, Herne Bay, and a farm shop at Faversham. Each venue is checked out to ensure its suitability before service users are taken out. Several service users also go out frequently with their families. Some relatives are happy to take part in trips and activities, or to go out into the garden with service users. There had been some recent interest in gardening, and service users had been able to take part in re-arranging a large flower bed and a herb bed. Service users can walk in the grounds unaided if risk assessed as able, and the rear garden has fencing for the safety of service users with dementia. It was noted that this prevents other service users from walking all around the premises, and other systems for securing the gates/padlocks are being assessed for service users who are safe to walk unaided. Service users are encouraged to retain their independence and individuality where possible, and many bedrooms were personalised with their own belongings. The home has a current programme of redecoration, and one service user said that their bedroom was not according to their style. This was discussed with the Provider, and a recommendation was given to ensure that service users have opportunity for individual choice of décor and furnishings. Advocacy is arranged for service users if needed. The cook had been recently employed, but already knew the service users well, and their likes and dislikes. She has appropriate qualifications for this style of catering. Service users can have a cooked breakfast if they wish, and can choose to eat in their own rooms or 2 dining rooms. There is always a starter of melon or soup (home-made) for lunch, and a choice of main dishes and desserts. The cook will also prepare other dishes if a service user requests something different, and there is always a vegetarian and a soft option. A record is kept of what each service user eats. When there is a roast dinner, there is usually a lighter choice at teatimes, as service users do not want so much. Teatime choices usually include a hot dish, but not always, as there may Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 15 be a buffet style menu, especially if it is a birthday tea or entertainment afternoon. There are 2-3 fresh vegetables every day, and fresh fruit is actively offered each day. Most items are home-cooked, including cakes, pastry, soups, cheesecakes. A kitchen assistant is employed every day to assist with preparation, cleaning and serving drinks. The kitchen was clean, but needs some attention to tiling and flooring. This is addressed in standard 19. Harbledown Lodge Nursing Home DS0000026096.V300068.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to the service. The home has a satisfactory complaints procedure in place, and complaints are dealt with appropriately. Staff are trained in the protection of vulnerable adults. EVIDENCE: The complaints procedure is on display in the entrance hall, and contains details for contacting the Group Manager and the Provider, as well as Social Services and CSCI. The Inspector had been contacted by relatives with concerns for 2 service users, and had passed the information on to their care managers to assess. The Inspector was contacted by 3 other care managers; one of these was for information to check at the Inspector’s next visit, and the other 2 concerns had already been passed on to the Adult Protection Department at Social Services, and were being investigated. The home has been co-operating with external agencies where investigations are needed. The home had received 12 complaints made directly to the home since December 2005, and these had been properly documented, and appropriate action was taken. Most had been made prior to the commencement of the new Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 17 manager in June 2006. The Inspector discussed a process for auditing complaints with the manager, who said that she proposed to initiate this. Staff recruitment procedures include POVA First checks (Protection of Vulnerable Adults) prior to commencement of employment, and a CRB (Criminal Record Bureau) check before employment is confirmed. Staff do not start to work in the home until 2 satisfactory written references are obtained, and only work under close supervision until a satisfactory CRB check is received. The induction programme includes training in the recognition and prevention of different types of abuse. There was good evidence for all staff being trained in the prevention of adult abuse. Harbledown Lodge Nursing Home DS0000026096.V300068.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There is a detailed programme of redecoration and refurbishment for the home, and many areas have already been improved. There is still outstanding work to do in regards to the kitchen, laundry, en-suite areas, bathrooms and gardens, and this is under way. EVIDENCE: The ongoing redecoration and refurbishment of the premises was evident on the day of the inspection. Maintenance men were carrying out redecorating of some bedrooms, and a gardener was working in the grounds. All communal areas and most bedrooms had been redecorated, and new soft furnishings had been fitted in lounges, dining rooms and bedrooms. New bedroom furniture and armchairs were in evidence, and some of the chairs are recliners. This will enable service users to have their feet elevated for nursing purposes or for Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 19 comfort. New carpeting was due to be laid throughout the home the next week. The home has a large lounge on the ground floor and the first floor, and 2 dining rooms on the ground floor. The Inspector viewed all communal areas and most bedrooms. Some toilets and sinks had been changed in priority areas, but some bathrooms require refurbishment. The bathroom opposite room 35 had been taken out of use because some tiles had come off the walls. The Parker bathroom on the ground floor would benefit from refurbishment, and the ground floor sluice room. Most rooms have en-suite areas – some with toilets and washbasins, and some with a bath or shower as well. The majority of en-suite areas are in poor condition, and the Provider said that he plans to refurbish these. Some are too cramped for wheelchair users, and refurbishment may mean taking out baths or shower units, widening doorways, and replacing some toilets and washbasins. Service users who cannot access en-suite areas are mostly supplied with wheeled commodes which fit over the toilets. This helps to preserve some dignity. The home is fitted with an Intercall bell system, with call bells in each room. The Provider is considering alternative systems which do not include training leads which can be a safety hazard. There is a keypad system at the front door, for the safety of service users with dementia. The home has a passenger lift to all floors. Radiators are fitted with guards, and window restrictors are fitted throughout the building. There are 3 mobile hoists, which was sufficient at the time of the report, as many service users did not require hoisting facilities for all moves. These had been recently serviced and were in working order. The Inspector was informed that the Provider would purchase additional hoists if more were needed for new admissions in the future. Water temperatures are recorded for every bath taken, and sink and bath temperatures are recorded randomly each week. Water chlorination tests have been carried out via the Head Office. The home is set in extensive grounds with lovely views. The gardens had suffered from a lack of maintenance for some time, but this was being addressed. A gardener was cutting back bushes by the front entrance on the first day of the visit. The kitchen needs attention to the flooring, and some tiled areas. The Inspector was informed that the Provider proposes to have the kitchen refitted. The laundry room is in the basement, and the stairs to it are protected by a keypad system. The laundry room had one commercial sized washing machine, and one which does not work. The Provider is aware of this, and is waiting for a new gas main to be put through to the road before he can have new machines fitted. For this reason, bed linen and towels are currently sent to another home for laundering. There had been a shortage of bed linen at one time, but the Provider has purchased a large quantity of new bed linen to be Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 20 sure there are sufficient stocks. Only personal clothing is currently washed in this laundry, and the manager and laundry assistant were in the process of trying out a new system to turn the process round more quickly. The laundry assistant irons all dresses, shirts, blouses etc. Soiled items are put into red alginate sacks and dealt with separately. The home was generally clean, although there was only one cleaner on duty on the first day due to sickness and annual leave. The Inspector was informed that more domestic staff were being recruited. The staff room is in the basement, and the Inspector noticed that the window was broken, and recommends this is repaired for security purposes. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing levels are adequate in accordance with assessed dependency levels. The company are working to increase the numbers of care staff with NVQ level 2 training, and to improve staff training in all areas. Recruitment procedures are satisfactory. EVIDENCE: The home currently had 40 service users in residence, and care staffing levels had been increased according to their dependency levels. There are 2 nurses on duty throughout the day and night, in addition to the manager’s hours. There were 8 care staff on duty in the mornings, 5 for afternoons and evenings, and 2 at night. These are assisted by ancillary staff including a cook, a kitchen assistant, and usually 2 cleaners. Care staffing numbers will be increased in line with dependency levels as more service users are admitted. NVQ level 2 or 3 had been attained by 6 out of 19 care staff, and another 4 were due to complete training during September 2006. This will bring the percentage up to 50 . The home also had 2 adaptation nurses in training. There has been a recognition that the home needs to employ staff who understand the culture of the predominantly white, British, service users, and the manager is recruiting staff to accommodate this. There have been Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 22 language and communication difficulties with some staff, and the company are working to improve this. The manager carries out the induction programme, which is the “Learn to Care” (Skills for Care) programme. She is also an NVQ Assessor. The Inspector viewed some of the induction booklets and saw that these are being thoroughly completed. Four staff files were examined for recruitment procedures, and these were satisfactory. The application form has been recently altered to request that applicants complete a full employment history – not just a few years. Interview records showed that any gaps in employment history are discussed. Applicants complete a health questionnaire, and provide 2 proofs of identity. POVA First and CRB checks are carried out in accordance with legal requirements. Staff from abroad had details of work permits and immunisation records where applicable. Nurses’ files include confirmation of their NMC (Nursing and Midwifery Council) PIN number. Staff files included confirmation of training, and a training matrix was available. This showed good records of staff training for mandatory subjects (fire safety, basic food hygiene, first aid, moving and handling etc.). Other subjects included dementia care and prevention of adult abuse. Nursing staff had been asked to update their portfolios to show their skills and competencies. Training courses were being booked for venepuncture (currently carried out by the Acting Deputy), flu vaccination, and wound care. Other courses were being accessed for trained staff to develop their skills and knowledge. Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33 and 35 -38 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager has begun to settle into her recent appointment, and shows developing leadership of the staff. EVIDENCE: The manager is a level 1 nurse who has completed the Registered Managers’ Award training. She has previously been a registered manager in a smaller home. She is in the process of applying to CSCI for registration. Since commencing as manager in June 2006, she has been developing an understanding of the increased responsibilities for managing a larger home. She does not currently have any administrative help, but has an Acting Deputy Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 24 who is assisting with some management audits. She is carrying out inductions, NVQ assessments and most staff supervisions, but is also trying to keep a presence on the “floor”. She is gradually gaining in confidence in leading the other staff. One general staff meeting had been held since her commencement, and one trained staff meeting. More frequent meetings could be of benefit. She is carrying out clinical supervision with new trained staff, and most formal supervision for day staff. Night trained staff carry out supervision for other night staff. This was all in the process of being brought up to date. The Inspector viewed supervision notes for 4 staff, and these had been well completed. Service users are encouraged to manage their own finances if possible, or relatives/advocates are appointed. The home does not manage any service users’ money except for “pocket money”. This is stored in individual wallets in a safe place, and all transactions are recorded and signed for by 2 people including the service user if possible. All receipts are retained. Policies and procedures had been written or reviewed in 2005 or 2006. It is good practice to review these each year, and make any necessary amendments. Other records were appropriately stored and maintained. Care plans were being put into a new format, and this will take time to implement, but is easier to follow the content. Staff training showed good evidence of mandatory training in health and safety subjects. The last fire training session had been attended by 80 of staff, which was good attendance, but yearly training could not be evidenced for all staff. Two training sessions for fire safety are held on the same day to facilitate staff with attendance. The home had good fire risk assessments in place, confirmed as satisfactory by the fire service. Other maintenance records were viewed for gas, electricity, hoist and lift servicing, COSHH data, and the last Environmental Health Officer’s report. The insurance certificate was on display and was up to date. Regulation 26 visits are carried out every month by the Group Manager, to check the running of the home. The company have their own survey system, and this was ready to be used for service users, relatives and visiting health professionals. Accident and incident records were properly completed, and stored in accordance with the Data Protection Act. The manager carries out a monthly audit for these. Harbledown Lodge Nursing Home DS0000026096.V300068.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 1 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 2 3 Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 23 (1) (a) Requirement To provide the Inspector with a proposed plan of action for improving the flooring and tiling in the kitchen. To provide an action plan – with proposed timescales – for the improvement and refurbishment of en-suite facilities and bath/shower facilities. To review the laundry equipment, and ensure there is sufficient equipment for the effective management of clothing. To provide timescales for when new machinery can be fitted. Timescale for action 01/12/06 2 OP21 23 (2) (b,d,f,j) 01/12/06 3 OP26 23 (1) (a) and (2) (c) 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000026096.V300068.R01.S.doc Version 5.2 Page 27 Harbledown Lodge Nursing Home 1 Standard OP8 To clearly document any wounds or pressure sores when service users are admitted into the home; and before and after any transfers to hospital or the community. To ensure all nursing staff are informed about how to contact relatives and/or health professionals; and carry this out as soon as possible if changes occur. To promote more choice for service users in regards to the décor and furnishings of their individual bedrooms. To ensure that the gardens are suitable for the use of service users. To refurbish the ground floor sluice room. To ensure that all staff attend yearly fire training. 2 OP8 3 4 5 6 OP14 OP19 OP26 OP38 Harbledown Lodge Nursing Home DS0000026096.V300068.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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.V300068.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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