CARE HOME ADULTS 18-65
Harbour House 6 Margaret Street Folkestone Kent CT20 1LT Lead Inspector
Wendy Mills Unannounced Inspection 27th January 2006 11:30a Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 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 Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 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 Adults 18-65. 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. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Harbour House Address 6 Margaret Street Folkestone Kent CT20 1LT 01303 211180 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) Mrs Tina Dennison Mrs Tina Dennison Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Owner does not engage in any other paid employment. Date of last inspection 6th July 2005 Brief Description of the Service: Harbour House is a small Home for four adults with a learning disability. It is situated in a residential area of Folkestone, with easy access to local facilities and amenities. The premises is a mid-terrace Victorian house offering single accommodation for each of the Residents. Communal areas include a lounge and separate dining room and kitchen. There are two bathrooms, one of which also serves as a laundry room. There is a small enclosed garden to the rear of the property. The Home was registered in March 2004 and is owned and managed by Mrs Tina Dennison. There are currently four Residents living in the Home. Harbour House has a sister home, Anchorage House, which is very close by. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and a quarter hours. The inspection consisted of discussion with three of the four residents, a senior carer and the registered provider/manager, Mrs Tina Dennison. A tour of the home was undertaken in the company of one of the residents and the senior carer. Documentation was examined and both direct and indirect observation was used throughout the inspection. The residents and staff were all in good health and spirits on the day of inspection. Harbour House has a sister home, Anchorage House, near by and there is a lot of social interaction between the residents of both homes. The inspector wishes to thank the residents, manager and staff for their welcome and assistance during the inspection. What the service does well: What has improved since the last inspection?
The home has reviewed the way it manages and administers medicines. Medication records have improved and the medicine cupboard is well maintained. However, there are some central heating pipes that run at the back of this cupboard. It is possible that the temperature may rise above the recommended temperature for the storage of medicines when the heating is on. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 6 The home has made significant improvement in the way it supports the residents to manage their personal hygiene and appearance. The home has developed more activities within the home to encourage residents who are reluctant to participate in outside activities. The residents now have two rabbits that they look after, with support of staff. More detail has been added to the care plans and risk assessments and behavioural agreements are in place where indicated. 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. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards was inspected at this visit. EVIDENCE: No new service users have been admitted since the last inspection. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 There is a clear care planning system in place. Some require more detail to be fully effective. Residents are supported to make decisions and participate in the life of the home. They know that the home will respect their dignity and handle confidential information about them appropriately. EVIDENCE: Care plans and risk assessments have been reviewed since the last inspection. Decision-making is documented in the care plans and risk assessments are in place. Since the last inspection the home has made significant progress in encouraging the residents to take an interest and pride in their appearance. In one case, where this has been difficult in the past, new written agreements have been set up. It was good to note how well the residents looked. All had lovely clear skin, shining hair and were well dressed. The residents spoke enthusiastically about their interests and said that they could make choices about the activities they want to do. Indirect observation showed that there is very good interaction between the staff and residents. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 &17 Residents are supported in being more independent and in taking part in a range of social, leisure and work activities. The home encourages and supports the residents to maintain appropriate friendships and contact with their families. Nutrition at the home is very good. This means that the residents are able to maintain a healthy diet and eat appetising meals. EVIDENCE: Staff support the residents to maximise their independence, prompting is given appropriately and recently thought has been given to involve residents who are reluctant to participate in creative activities. For example, if a resident’s only interest is television, the home has looked into their favourite programmes and then encouraged them to use the Internet to find out more about the characters. In the same way, the home is trying to overcome reluctance to go out of the home by tying information about the favourite TV programmes to a trip to the library. Some significant progress has already been made. It would be helpful if the home recorded not only the activities in which residents have participated but also those in which they have partially participated. For
Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 11 example, if a trip to the gym is planned and a resident gets ready for the gym, but then does not attend, this could be regarded as a partial success. If he or she got ready and went to the gym, but then did not do anything, this could be considered as further step to achieving the total success of making the trip to the gym and taking part in exercise. The home is very good at helping the residents to maintain links with friends and families. Relatives and friends can visit and share meals, transport is provided for visits home and telephone contact is maintained. It was very good to hear that there has been great progress for one resident whose behaviour has improved so much that they are now able to make regular visits home without difficulty. Very good use is made of local facilities and amenities. There are excellent neighbourly relationships. One neighbour has recently given the residents two new rabbit hutches and often calls by to say hello. Residents said that they are free to spend time in their rooms when they wish. All the residents are made very welcome at the local pub and some take part in pub games. During the inspection the residents were in and out of their rooms to find things of interest to show us and talk about their recent creative work. Recently they had made Christmas decorations and advent calendars. Residents are consulted each week regarding the menus, they said that they enjoy the food and get plenty to eat. On the day of inspection a delicious smelling casserole had been prepared for supper and the residents said that they were looking forward to their evening meal. There was plenty of good quality produce in the home and residents said that they can choose something different if they really don’t like what everybody else is having. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Residents receive sensitive personal support and all aspects of their healthcare are promoted. EVIDENCE: Support for personal care support is given in a sensitive and discreet way that respects privacy and dignity. Since the last inspection the home has made significant progress in the way it encourages and supports the residents to take a pride in their appearance and checks that they are able to maintain their personal hygiene. The residents were well groomed and dressed. Conversation with them showed that they are now more aware of the importance self care. The self-esteem of the residents has improved. Storage and documentation in respect of the control and administration of medication were inspected. The home has worked to address the concerns raised at the last inspection. Storage of medication is now better organised, however, some central heating pipes run through one end of the cupboards and it is possible that this may lead to medicines being stored above the recommended temperatures. The home should monitor the temperature of this storage and take action if temperatures prove to be too high. MAR sheets were in order. Handwritten entries had been countersigned and there are better records of medicines received into the home. It was good to note that the work on reducing medication levels is still progressing well.
Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected at this visit. EVIDENCE: Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30 The standard of the environment within the home is good. It provides the residents with a homely and welcoming place that meets their needs. EVIDENCE: Two residents showed the inspector around the home. They said they are very happy with their rooms and like living in the home. Their rooms have been personalised to reflect their interests, family and friends. The environment was clean, comfortable and homely on the day of inspection. No health and safety hazards were noted during this tour and there was a relaxed and friendly atmosphere throughout. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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 & 36 Residents benefit from a settled staff team who are well trained and supported. There are enough staff to meet the needs of the residents. Formal staff supervision has improved but should be more frequent. EVIDENCE: The home has sufficient staff and a low staff turnover. On the day of inspection two residents were at home all afternoon, one returned later and the other was still out by the time the inspection was complete. Activity and staff rosters showed that there are enough staff to ensure that scheduled activities are supported and that activities within the home are encouraged. All healthcare appointments are kept and medication and personal needs are supported. The registered manager said that formal staff supervision now takes place every three months but agreed that it should be at least six times per year in order to comply with the standards. However, there is ongoing informal supervision and very good communication between the staff and the home’s manager on a daily basis. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 & 42 There is an open management culture that promotes the independence, health, safety and welfare of the residents. The registered provider/manager provides strong leadership and promotes good care practice within the home. EVIDENCE: Mrs Dennison, the registered provider/manager is an enthusiastic and friendly person who is clearly committed to creating a positive environment for the residents and staff. She deals appropriately and promptly with any concerns that arise and has the respect of her staff. Mrs Dennison ensures she maintains updated care practice, often attending training with her staff. The residents were noted to interact well with her and were able to express their views to her with confidence. No health and safety hazards were noted on the day of inspection. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 X X X 3 x Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES 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 YA20 Regulation 13 Requirement Temperature of medicines storage to be monitored to ensure they do not rise above recommended temperatures Staff to receive formal supervision at least six times each year. This requirement is carried forward from the last inspection with an extended timescale. Timescale for action 28/02/06 2. YA36 18 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA12 Good Practice Recommendations Home should improve the recording of activities in which the residents participate by noting those activities in which they have partially participated. Harbour House DS0000058814.V280693.R01.S.doc Version 5.1 Page 19 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
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